Dissertation
Traumatic brain injury, stress, and mental health of American servicewomen and women veterans
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2023
DOI: 10.25820/etd.006934
Abstract
Traumatic brain injury (TBI) is a common injury among military personnel and can lead to long-term symptoms of mental health problems. Women in the military are a growing population who are at increased risk of mental health problems after a TBI compared to both non-military women and men in the military. With a recent policy change allowing women to assume combat roles that had been previously restricted to men, the risk of TBI in military servicewomen has increased.
With their evolving roles, women in the military are likely to encounter deployment-related stress from combat-related events and military sexual trauma (MST). Examining stress and its relationship with mental health is crucial among those who have sustained a TBI, as those with TBI often have abnormal responses to stress that could predispose them to mental health problems. Further, examining factors that may modify or mediate these relationships will help to provide a clearer idea of the complex relationship between TBI, stress, and mental health.
This research sought to elucidate how TBI and stress in conjunction affect mental health among military servicewomen. In Aim 1, I assessed how the association between deployment- related stress and symptoms of depression and posttraumatic stress disorder (PTSD) could be modified by social determinants of health and military characteristics among a population of military servicewomen with TBI. In Aim 2, I examined how TBI might affect posttraumatic growth (PTG), and how this association might be modified by a positive screen for PTSD, among a population of rural women Veterans of the Reserve Armed Forces and National Guard (RNG). Finally, in Aim 3, I explored how stress from the COVID-19 pandemic mediated the associations between TBI and mental health problems among rural women RNG Veterans.
Among women in the military with TBI, nine different deployment-related stressors were independently associated with both depression and PTSD. Education level modified these associations, where those with a high school education or less had more severe symptoms of both depression and PTSD compared to those with some college or more education who were exposed to the same stressor. Military rank specifically modified the relationships between two deployment-related stressors and depression, where enlisted servicewomen had more severe symptoms than officers exposed to the same stressor. Household income did not significantly modify any association.
Among rural women RNG Veterans, TBI was not associated with PTG and PTSD did not modify the association. It is possible that other factors not included in this analysis, such as social support, have a greater effect on PTG. Additionally, TBI-related factors that could not be assessed, such as severity and time since most recent TBI, might affect PTG more than TBI would in this population. Future research exploring these factors will help to elucidate any effect TBI might have on these positive psychological outcomes.
COVID-19-related stress significantly mediated the association between TBI and depression among rural women RNG Veterans. Stress about accessing daily necessities also mediated this association. Associations between past TBI and current PTSD were not statistically significant but were still mediated by COVID-19-related stress. Because the total effects for the TBI-PTSD models were not statistically significant, confounding factors, such as sexual violence victimization and other traumas, may have had a stronger effect on PTSD than TBI does.
Stress and TBI in conjunction are associated with mental health problems in military servicewomen. Future research might examine TBI-related factors, including temporality in relation to stress, number, and severity, to further elucidate this complex association.
Details
- Title: Subtitle
- Traumatic brain injury, stress, and mental health of American servicewomen and women veterans
- Creators
- Daniel T Corry
- Contributors
- James C Torner (Advisor)Carri Casteel (Committee Member)Michelle A Mengeling (Committee Member)Jonathan Platt (Committee Member)Anne G Sadler (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Summer 2023
- DOI
- 10.25820/etd.006934
- Publisher
- University of Iowa
- Number of pages
- xiii, 161 pages
- Copyright
- Copyright 2023 Daniel T. Corry
- Language
- English
- Date submitted
- 07/25/2023
- Description illustrations
- illustrations, tables, graphs
- Description bibliographic
- Includes bibliographical references (pages 140-159).
- Public Abstract (ETD)
- Women in the military are a growing population and can now assume combat-related roles within the military that were once restricted to men. This evolution in role, however, comes with an increased risk of traumatic brain injury (TBI), which can lead to mental health problems long after their military service is completed. The connection between TBI and mental health problems may be due to heightened or suppressed responses to stressful situations, which can increase the risk of mental health problems among those with TBI. Because women are at higher risk of developing these mental health problems after TBI than men are, it is crucial to assess how TBI and stress work in conjunction to affect mental health in a population of military servicewomen. For this dissertation research, I utilized two different populations of military servicewomen to assess three aims. First, I assessed how deployment-related stressors might be associated with symptoms of depression and posttraumatic stress disorder (PTSD), and whether these associations are modified by education level, household income, and military rank. Second, I explored how TBI might be associated with posttraumatic growth (PTG) among rural women Veterans of the Reserve Armed Forces/National Guard (RNG) and whether this association is modified by a positive test for PTSD. Finally, I examined how much stress introduced from the COVID-19 pandemic accounted for the association between TBI and mental health problems among rural women RNG Veterans. Through this research, I demonstrate the importance of TBI and stress on mental health, finding that stressful situations introduced to servicewomen and female Veterans with TBI can have profound detrimental effects on mental health.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984454318502771
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