Women's experience of traumatic stress in cancer treatment

In this study we investigated gender differences in the prevalence and predictors of posttraumatic stress disorder (PTSD) in a sample of cancer patients. Eighty-seven patients (59 women and 28 men) recruited from a local cancer clinic completed measures of individual coping style, social support resources, symptoms of PTSD, and the nature of the trauma associated with these symptoms. PTSD symptoms were more frequently reported by women (27% versus 10%). Predictors of PTSD for women were (1) perceived intensity of cancer treatment; (2) problems with health care professionals; (3) and cognitive avoidant coping style. For men, the sole predictor of elevated PTSD scores was behavioral avoidance. Women reported significantly higher levels of treatment intensity (TI), greater numbers and types of treatment, and more problems with health care professionals. Interpersonal and relational aspects of their illness were reported as most stressful, compared with men who were more concerned with work and finances. These differences may, in part, reflect an androcentric model of cancer treatment, which women experience as particularly stressful.     

Coping with infertility in couples: Gender differences

Despite the fact that the incidence of infertility is increasing, health care professionals know very little about gender differences in responses to infertility. This study was designed to (1) explore gender difference in the problems of infertile women and men, (2) compare and contrast how women and men cope with the problems, and (3) explore gender differences in personal and social resources available for coping with infertility. Sixty‐six individuals, 39 females and 27 males, responded to a self‐administered questionnaire. Results of this study confirmed that women and men experience infertility differently. Women had significantly more problems in the areas of self‐esteem, personal life, health care systems, and occupation. There were no gender differences in social support ratings or in access to a confidant. Both women and men used a similar number of problem‐focused coping strategies. Women, however, also employed significantly more emotion‐focused coping strategies than did men. Results of this study suggest directions for nurses and others providing support and counseling for infertile couples.     

Prior assault and posttraumatic stress disorder after combat deployment

BACKGROUND: Factors that make people vulnerable to or resilient against posttraumatic stress disorder (PTSD) following overwhelming stress are not well understood. The objective of this study was to prospectively examine the relation between prior assault and new-onset PTSD symptoms in a large US military cohort deployed in the wars in Iraq and Afghanistan. METHODS: Data on exposures and health outcomes were collected in the Millennium Cohort study at enrollment (July 2001 to June 2003) and follow-up (June 2004 to February 2006) from over 55,000 participants. Of these, 5324 were deployed in Iraq and Afghanistan, reported combat exposures, and were free of PTSD at baseline (881 women and 4443 men). We used multivariable logistic regression analysis to model the odds of new-onset PTSD in relation to prior assault. RESULTS: New-onset PTSD symptoms or diagnosis among deployers reporting combat exposures occurred in 22% of women who reported prior assault and 10% not reporting prior assault. Among men reporting prior assault, rates were 12% and 6%, respectively. Adjusting for baseline factors, the odds of new-onset PTSD symptoms was more than 2-fold higher in both women and men who reported assault prior to deployment. CONCLUSIONS: Prior assault appears to confer increased vulnerability for, rather than resilience against, PTSD symptoms among military professionals deployed to recent combat operations.     

Coping Styles as Mediator of Sexual Orientation-Related Health Differences

The higher prevalence of health problems in homosexual compared to heterosexual populations is usually understood as a consequence of minority stress. We hypothesized that differential rates of health problems also could result from sexual orientation-related differences in coping styles. We explored this using data collected in a general population-based study (N = 9684) via face-to-face interviews. A higher prevalence of both mental and physical health problems, as assessed with individual questions, the GHQ-12, and checklists, was observed in homosexual compared to heterosexual men and women. Coping style was related to sexual orientation in men, but not in women. Compared to heterosexual men, homosexual men more strongly applied emotion-oriented and avoidance coping strategies. Emotion-oriented coping mediated the differences in mental and physical health between heterosexual and homosexual men. Findings suggest the importance of further exploration of the development and use of emotion-oriented and avoidance coping by homosexual men.     

Communication and Cultural Issues in Providing Reproductive Health Care to Immigrant Women: Health Care Providers’ Experiences in Meeting Somali Women Living in Finland

Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives’ communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics.     

Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse.

This study examined the relative contributions of Posttraumatic Stress Disorder (PTSD) symptoms and the extent of trauma exposure as factors contributing to the current health status of childhood abuse survivors. Sixty-seven women with a history of familial childhood abuse (sexual and/or physical) and twenty-nine women with no abuse history were assessed on two distinct aspects of health status: reported number of medical problems and perceptions of overall health. Women with abuse were found to have a greater number of medical problems and poorer perceived physical well-being than the no abuse comparison group. Regression analyses of the women with abuse histories revealed that trauma exposure was a stronger predictor than PTSD symptoms of medical problems. PTSD symptoms, however, were better predictors of the experience of physical well-being than trauma exposure. These results suggest that the nature of a traumatic exposure, especially when there is repeated, cumulative trauma may be more significant to medical problems than the psychological symptoms of PTSD. Perceived health, however, appears to be predominantly influenced by psychological factors, suggesting the importance of these variables in the quality of life of multiply traumatized women.     

Mental health service use: comparing people who served in the military or received Veterans' Affairs benefits and the general population

Objectives: To compare the lifetime prevalence of affective, anxiety and substance use disorders and the use of mental health services between people who had served in the Australian Defence Force (ADF) or received Department of Veterans' Affairs (DVA) benefits and the general population. Method: The 2007 National Survey of Mental Health and Wellbeing obtained data from a nationally representative household survey of 8,841 respondents. Results: Fewer than 20% of men who had served in the ADF reported receiving benefits from DVA. ADF men were older and more likely to report poorer health than other men. They were 50% more likely to be diagnosed with any lifetime mental disorder, any affective disorder, depression, PTSD, any substance use and alcohol disorder. Almost 90% of women who received DVA benefits had not served in the ADF. DVA women were older, and more likely to report moderate/severe psychological distress and less life satisfaction than other women. There was no evidence of greater lifetime use of mental health services by ADF men or DVA women compared to the general population. Conclusions: Health care providers should ask their patients if they have connections with the military in order to better detect and treat potential mental health problems.     

Gender and Illness Behavior Among Colorectal Cancer Patients

This study of 154 men and 152 women with cancer of the colon or rectum addresses the lag between the first recognition of symptoms and the securing of definitive diagnosis and treatment. Total treatment delay is divided into two categories: patient delay, or the lag between the patient's fust recognition of symptoms and first physician contact; diagnostic delay, or the lag between the patient's first physician contact and treatment. The results do not support the contention that women are more prone than men to respond to cancer symptoms; women in this sample are not more likely than men to recognize and respond to symptoms and seek care. The results suggest that, among patients with cancer of the rectum, women are more likely than men to delay in seeking care. Among patients with cancer of the colon, women are more likely than men to experience diagnostic delay.     

Screening for Post-traumatic Stress Disorder in Prenatal Care: Prevalence and Characteristics in a Low-Income Population

Objectives Investigate the feasibility of using a brief, 4-item PTSD screening tool (PTSD-PC) as part of routine prenatal care in two community health care settings serving ethnically and linguistically diverse low-income populations. Report prevalence and differences by sub-threshold and clinical levels, in demographic, health, mental health, risk behaviors, and service use. Methods Women were screened as part of their prenatal intake visit over a 2-year period. Those screening positive at clinical or sub-threshold levels were recruited if they spoke English, Spanish, Portuguese, Vietnamese or Arabic. Enrolled women were interviewed about psychosocial risk factors, prior traumas, PTSD symptoms, depression, anxiety, substance use, health and services, using validated survey instruments. Results Of 1362 women seen for prenatal intakes, 1259 (92 %) were screened, 208 (17 %) screened positive for PTSD at clinical (11 %) or sub-threshold levels (6 %), and 149 (72 % of all eligible women) enrolled in the study. Those screening positive were significantly younger, had more prior pregnancies, were less likely to be Asian or black, and were more likely to be non-English speakers. Enrolled women at clinical as compared to sub-threshold levels showed few differences in psychosocial risk, but had significantly more types of trauma, more trauma before age 18, more interpersonal trauma, and had greater depression, anxiety, and PTSD symptoms. Only about 25 % had received mental health treatment. Conclusions The PTSD-PC was a feasible screening tool for use in prenatal care. While those screening in at clinical levels were more symptomatic, those at subthreshold levels still showed substantial symptomology and psychosocial risk.     

Relationship of Sleep Quality with Coping and Life Styles in Female Moroccan Immigrants in Germany

BACKGROUND: Epidemiologic studies conducted in Western societies show poorer sleep quality in women compared with men. Socioeconomic and stress-related psychological variables have been shown to influence sleep, but not much is known about sociological and psychological influences on the sleep of women in general and non-Western women in particular. The present study reports on sociodemographic and coping variables in relation to sleep quality in female Moroccan immigrants living in Germany. METHOD: Participants took part in a structured personal interview on Pittsburg Sleep Quality Inventory (PSQI) sleep quality, coping style preferences, and information related to the degree of identification with Western life style. RESULTS: Sleep quality was poor (PSQI > 6) in 39% of women. Surprisingly, women who had identified with a more Western lifestyle had poorer sleep quality than women who had retained their traditional Moroccan life style. An unusually large proportion of women preferred monitoring (i.e., information-seeking coping style) and adaptive coping (48% and 19%, respectively), regardless of sleep quality. Monitoring was more frequent in women who were less integrated into German culture. CONCLUSIONS: Results on sleep quality suggest that for Moroccan immigrant women in Germany, adopting a Western life style may be more stressful than retaining their native life style. The high preference for an information seeking approach in coping may reflect the desire for information rather than actual coping behavior.     

Gender and coping: the parents of children with high functioning autism

Gender is a concept that is frequently discussed in the literature on stress, coping and illness. Research has reported that women are more vulnerable than men are to stressful events and use different strategies to cope with them. Furthermore, it is often asserted that these gender-based differences in coping may partially explain the differential impact of stressful events on men and women. Unfortunately, much of this research has equated gender with sex and failed to contextualise the experience of illness and coping. This paper presents a qualitative analysis of the role of gender and coping among parents of children with high functioning autism or Asperger's syndrome in an Australian sample. It attempts to analyse the different meanings of the disability for mothers and fathers and describes the various strategies that parents use to cope with their child's disability.     

Posttraumatic stress disorder and health status: the veterans health study

This article examines the association between self-reported prevalence of posttraumatic stress disorder (PTSD) and health status in a sample of 2425 male Department of Veterans Affairs (VA) ambulatory care patients who participated in the Veterans Health Study. Participants were recruited at 1 of 4 VA outpatient clinics in the Boston area. They completed self-report measures of PTSD (using the PTSD Checklist and measures of exposure to traumatic events), depression (using the Center for Epidemiologic Studies--Depression scale), and health status (using the Short-Form-36) and a medical history interview assessing 22 conditions and a history of psychiatric treatment. The screening prevalence of PTSD was 20.2% among all patients (24.3% among those exposed to traumatic events); another 15.5% met the criteria for depression but not PTSD. The health status of patients with either PTSD or depression was significantly worse than that of patients with neither disorder, even after controlling for age, education, and number of comorbid medical conditions. Patients with PTSD reported more medical conditions than did other patients. Patients with PTSD currently in mental health treatment had worse health status than did those who reported no treatment; the health status of patients who reported past mental health treatment was generally comparable to that of those with no treatment. The prevalence and comorbidity of PTSD among this sample of VA ambulatory care patients were higher than previously reported among samples of community-residing adults. The association of PTSD with health status was substantial, suggesting that the burden of PTSD is at least comparable to, and may be worse than, that of depression. Mental health treatment alleviated some of this burden. The potential impact of PTSD on health status should be more widely recognized.     

Coping styles and personality domains related to menopausal stress.

PURPOSE: Examine the role of coping styles and personality domains in relationship to stress associated with menopause. DATA/INFORMATION: Data are from 170 women ages 45 to 54 who completed a mailed questionnaire and a telephone interview that assessed women's stress associated with menopause, coping style, personality, menopausal symptoms, depressive symptoms, and use of hormone replacement therapy. RESULTS: Rating menopause as stressful was associated with higher levels of neuroticism, seeking social support, and avoidance, and lower levels of agreeableness in unadjusted analyses. In a multivariate model, menopausal symptoms, seeking social support, and neuroticism accounted for 21% of the variance in rating menopause as stressful. CONCLUSIONS: Health care providers treating women going through menopause should be aware that the stress response to the menopause transition is multifactorial and is associated with women's individual personalities and coping styles.     

Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans

BackgroundThe Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans.MethodsWomen veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use.ResultsROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income.ConclusionsFindings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities.     

Sexual Health in Patients with Gynecological Cancer: A Qualitative Study

The sexual problems of patients with gynecological cancer were investigated. This qualitative study was conducted among eleven Turkish women who were treated in the gynecologic oncology clinic and aged between 30 and 55 years old. Data was collected using a semi-structured questionnaire. Of the cases, 55 % had been diagnosed with ovarian cancer, 27 % with cervical cancer and 18 % with endometrial cancer. The participants had been affected in terms of body image, sexual functioning, wifehood and motherhood and reproductive ability. Most of the participants reported severe decreases in such features as sexual desire, arousal, the frequency of intercourse and orgasm. In addition, all participants reported that they wanted information from health care professionals (preferably female) and to be able to share problems with them. Sexuality remains a problem that is ignored by healthcare professionals in Turkey. As a vital component in terms of quality of life, healthcare professionals should utilize a more sensitive and personalized approach to sexuality with patients.     

Managed Care and Gender Disparities in Problematic Health Care Experiences

Objective. To determine whether gender differences in reports of problematic health care experiences are associated with characteristics of managed care.
Data Sources. The 2002 Yale Consumer Experiences Survey ( N =5,000), a nationally representative sample of persons over 18 years of age with private health insurance, Interstudy Competitive Edge HMO Industry Report 2001, Area Resource File 2002, and the American Hospital Association Annual Survey of Hospitals 2002.
Study Design. Independent and interactive effects of gender and managed care on reports of problematic health care experiences were modeled using weighted multivariate logistic regression.
Principal Findings. Women were significantly more likely to report problems with their health care compared with men, even after controlling for gendered differences in expectations about medical care. Gender disparities in problem reporting were larger in plans that used certain managed care techniques, but smaller in plans using other methods. Some health plan managed care practices, including closed networks of providers and gatekeepers to specialty care, were associated with greater problem reporting among women, while others, such as requirements for primary care providers, were associated with greater problem reporting among men. Markets with higher HMO competition and penetration were associated with greater problem reporting among women, but reduced problem reporting among men. Women reported more problems in states that had enacted regulations governing access to OB/GYNs, while men reported more problems in states with regulations allowing specialists to act as primary care providers in health plans.
Conclusions. There are nontrivial gender disparities in reports of problematic health care experiences. The differential consequences of managed care at both the plan and market levels explain a portion of these gender disparities in problem reporting.