1020 — Gender Differences in Patterns of Comorbidity with PTSD among OEF/OIF Veterans
Desai RA (VA CT Healthcare System and Yale University), Goulet JL
(VA CT Healthcare System and Yale University), Haskell S
(VA CT Healthcare System and Yale University), Brandt C
(VA CT Healthcare System and Yale University)
Women represent 15% of the 1.5 million US military personnel in active duty, and this may double in the next 5 years. Women Veterans are increasingly using VHA healthcare services. While it is well known that there is substantial comorbidity associated with a diagnosis of PTSD among both men and women, it is unknown whether there are gender differences in comorbidity patterns across gender.
Using data on OEF/OIF Veterans from the HSR&D-funded Women Veterans Cohort Study (WVCS), we determined gender differences in rates of PTSD diagnosis, timing of diagnosis from separation from military service, patterns of comorbidity, and timing of the comorbid diagnoses. Multivariable logistic regression models were used to predict types of comorbidity, and proportional hazards regression was used to determine timing of comorbid disorders in relation to PTSD.
Women were less likely than men to receive a PTSD diagnosis (OR = 0.85), but when they did it occurred significantly earlier than in men (P < 0.001). Seven comorbidity patterns accounted for over 80% of those with any other disorder, but PTSD was almost always diagnosed first. The most common comorbidities were back pain, migraines, substance abuse, and other psychiatric disorders. There were significant gender differences in both prevalence and timing of comorbidities, with women more likely to be diagnosed with depression (OR = 1.2) and migraines (OR = 1.6), and men more likely to be diagnosed with drug (OR = 1.2) and alcohol (OR = 1.3) use disorders.
PTSD treatment is likely to be complicated by the presence of comorbid conditions. These results suggest that PTSD symptoms may be the most likely motivation for Veterans to seek VA care regardless of gender. The results also imply that there will be differing patterns of comorbidity, and thus different treatment needs within VA, of men and women returning from deployments to Iraq and Afghanistan and entering VA care.
Clinicians treating PTSD should be aware of other comorbidities and integrate treatment plans for PTSD with treatment plans for other disorders. They should also be aware that comorbidity patterns, and their accompanying complication of PTSD care, may differ in women and men, and that gender-specific approaches to treatment planning may be required.