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The Impact of Most Traumatic Life Event on Post-traumatic Stress Disorder (PTSD) Symptoms in Women Veterans

McGee B, Mengeling M, Sadler AG, Booth B, Torner J. The Impact of Most Traumatic Life Event on Post-traumatic Stress Disorder (PTSD) Symptoms in Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.

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Research Objective: To examine post-traumatic stress disorder (PTSD) in relation to type of traumatic life event Study Design: Retrospective cohort study design using a computer-assisted telephone interview to collect data on socio-demographic and military characteristics, lifetime trauma exposure, physical and mental health. Population Studied: Participants were US service women ( < 52 years of age) enrolled in two Midwestern Veterans Affairs (VA) Health Care Systems or outlying clinics within the five years preceding study interview (63% response rate). At the time of VA enrollment, all women had either been discharged from active duty military service or were Reserve or National Guard servicewomen eligible for services and classified as military veterans. The retrospective study (1004 women; mean = 38 years) found 29% had served in military combat, 75% experienced the sudden death of a close friend or relative, and 51% reported one or more lifetime rapes (32% experienced Military Sexual Trauma (MST)), not mutually exclusive. Participants were asked to identify their most traumatic life event and respectively, to rate the presence and severity of PTSD symptoms (Posttraumatic Symptom Scale). Lifetime trauma exposure was measured by traumatic events associated with PTSD (i.e., combat, sexual assault), and was further classified into self-oriented (i.e., events directed toward self: sexual assault, personal illness) and other-oriented (i.e., events directed at another person: witnessing injury/death). Principal Findings: Among the 1004 participants, 772 (77%) endorsed at least one of the queried traumas as their most traumatic event. 23% (n = 178) met criteria for current diagnosis of PTSD. Most frequently endorsed traumatic events were grouped into three categories: Combat (8% n = 66; e.g. incoming artillery during combat), sexual assault (SA) (33%, n = 253; attempted or completed rape), and other life (59% n = 453; e.g. the sudden death of a close friend or relative). Participants whose most traumatic event was a combat trauma or SA were more likely to have current PTSD (OR 3.04, CI (1.7, 5.4) and OR 3.5, CI (2.4, 5.0), respectively). When trauma events were classified into self-oriented (50% n = 388) vs. other-oriented (50% n = 384), participants who endorsed a self-oriented trauma as the most distressing were more likely to have PTSD than those endorsing other-oriented trauma ((50% n = 384), OR 2.4 CI(1.7, 3.4)). Conclusions: Although experiencing a traumatic event was prevalent in this cross-sectional cohort of women veterans, the type of trauma was a more specific predictor of PTSD than trauma exposure alone. Specifically, women veterans who reported combat trauma or sexual assault as their most traumatic event were three times more likely to report PTSD symptoms than those who reported other trauma events. Likewise, compared to other-oriented traumas, those traumatic events of a self-oriented nature posed greater risk for PTSD symptoms. Implications for Policy, Delivery, or Practice: Further understanding is needed regarding the heterogeneity of trauma events and their impact on the development and severity of PTSD, particularly in clinical populations recognized as being at greater risk for exposure to traumatic events over the life course. These findings highlight the importance of trauma-informed clinical practice, delivery of care, and policymaking.

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