title: Duty-related and sexual stress in the etiology of PTSD among women veterans who seek treatment.
abstract: OBJECTIVE
  The stressful experiences of women serving in the military have been a focus of increasing concern. A model of the impact of stress related to military duty and stress related to sexual abuse and harassment on the development of posttraumatic stress disorder (PTSD) among female veterans was evaluated.
  
  
  METHODS
  Structural equation modeling was applied to data from 327 women treated in a VA clinical program for women with stress disorders. The model was a chronological one and included variables related to the women's premilitary experience, their military service, and their postmilitary experience.
  
  
  RESULTS
  Altogether 48 percent of the sample served overseas, and 12 percent were exposed to enemy fire. A total of 63 percent reported experiences of physical sexual harassment during military service, and 43 percent reported rape or attempted rape. Both duty-related and sexual stress were found to contribute separately and significantly to the development of PTSD. Sexual stress was found to be almost four times as influential in the development of PTSD as duty-related stress. Postmilitary social support played a highly significant mediational role between sexual stress during military service and development of PTSD.
  
  
  CONCLUSIONS
  Women's exposure to sexual stress in the military is much more prevalent than previously believed. It is particularly toxic for the development of PTSD. Correct assessment is essential to effective treatment.
authors.affiliation: Northeast Program Evaluation Center, Veterans Affairs Connecticut Healthcare System, West Haven 06516, USA.
authors.forename: A
authors.initials: A
authors.lastname: Fontana
authors.forename: R
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D008890:Military Psychiatry; D008960:Models, Psychological; D012189:Retrospective Studies; D012742:Sex Offenses / Q000523:psychology*; D017406:Sexual Harassment / Q000523:psychology*; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology; D014481:United States; D014728:Veterans / Q000523:psychology*; D014857:Warfare; D014931:Women, Working / Q000523:psychology