Assessing the Association of the Intersection of Gender, Race, and Trauma Type with the Diagnosis of PTSD in U.S. Veterans Restricted; Files Only

Abstract

Veterans identifying as women and of color have been understudied in research due to the primary demographic previously consisting of men and White veterans. A predicted shift in demographics is expected to occur within the next decade, predicting an increase veterans identifying as women and people of color and a decrease in non-Hispanic White veterans. It is necessary for research to investigate whether PTSD measurement tools work for previously understudied veterans to ensure all veterans are being accurately diagnosed. This secondary data analysis utilized data from the Emory Healthcare Veterans Program to investigate the association of the intersection of gender, race, and trauma type with a positive PTSD diagnosis using the PCL-5 and CAPS-5. Looking at race, gender, and trauma type, a chi-square analysis found trauma type to be significantly associated with a positive PTSD score on the PCL-5 and a logistic regression found the odds of receiving a PTSD diagnosis to be 0.27 lower if veterans experienced MST compared to MCT (p=0.05). Gender was found to be nearly significant (p=0.08). No association was found between intersecting identities and trauma types. This study adds to the growing field of intersectionality in veteran research, emphasizing identities are not mutually exclusive. 

Table of Contents

Chapter 1. Introduction.......................................................................................................... 1

Chapter 2. Literature Review................................................................................................... 3

PTSD ................................................................................................................................ 5

History of Military/Demographics of Veterans ..................................................................... 6

Race ............................................................................................................................. 7

Gender .......................................................................................................................... 7

Intersectionality................................................................................................................ 8

Trauma Type ................................................................................................................... 10

Diagnostic Criteria (DMS-5) and Biases.............................................................................. 10

PCL-5 and CAP-5.............................................................................................................. 11

Chapter 3. Methods .............................................................................................................. 13

Study Design.................................................................................................................... 13

Population and Sample ..................................................................................................... 14

Eligibility......................................................................................................................... 14

Measures......................................................................................................................... 15

Exposures................................................................................................................... 15

Outcome Measures........................................................................................................... 15

Data Analysis Methodology .............................................................................................. 16

Chapter 4. Results ................................................................................................................ 17

Baseline values ................................................................................................................ 17

Intersectionality............................................................................................................... 18

CAPS and PCL and Positive PTSD Score ............................................................................. 18

CAPS........................................................................................................................... 18

PCL ............................................................................................................................. 19

Intersectionality Analysis ................................................................................................. 19

Matched Diagnoses........................................................................................................... 20

Chapter 5. Discussion, Implications, Recommendations, and Conclusion .................................. 20

Introduction and Summary of Study .................................................................................. 20

Discussion of Key Results .................................................................................................. 21

Baseline Values and Intersectionality Frequencies........................................................... 21

Positive PTSD Score ...................................................................................................... 22

Matched Diagnosis........................................................................................................ 24

Strengths and Limitations .................................................................................................. 26

Public Health Implications.................................................................................................. 27

Recommendations ............................................................................................................. 30

Conclusion ........................................................................................................................ 31

Citations ............................................................................................................................... 33

Tables ................................................................................................................................... 41

Table 1. .............................................................................................................................. 41

Table 2 ............................................................................................................................... 42

Table 3 ............................................................................................................................... 43

Table 4 ............................................................................................................................... 44

Table 5 ............................................................................................................................... 45 Figures.................................................................................................................................. 46

Figure 1.............................................................................................................................. 46 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Mental Health Health Sciences, Public Health
Keyword	Mental Health Veteran Research Intersectionality
Committee Chair / Thesis Advisor	Robin McGee, Emory University
Committee Members	Kathryn Black, Emory Health Veterans Program Mark Burton, Emory Health Veterans Program

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