title: Psychosocial Functioning and Health-Related Quality of Life Associated with Posttraumatic Stress Disorder in Male and Female Iraq and Afghanistan War Veterans: The VALOR Registry.
abstract: OBJECTIVE
  Iraq and Afghanistan war veterans suffer from high rates of posttraumatic stress disorder (PTSD). Given the growing number of women in the military, there is a critical need to understand the nature and extent of potential gender differences in PTSD-associated psychosocial functioning and health-related quality of life (HRQOL) in Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans, which has not been studied to date.
  
  
  METHODS
  We used data from a gender-balanced national patient registry of warzone-deployed OEF/OIF veterans (Project VALOR: Veterans After-Discharge Longitudinal Registry) to determine the impact of gender on PTSD-related psychosocial functioning and HRQOL in 1,530 United States Iraq and Afghanistan war veterans (50% female) with and without PTSD. Overall psychosocial functioning was assessed with the Inventory of Psychosocial Functioning (IPF) and mental and physical HRQOL with the Veterans RAND 12-item Health Survey (VR-12) Mental and Physical Component Summary scores, respectively. Stratified linear regression models estimated gender-specific associations, controlling for demographic, deployment, and postdeployment factors. Interaction models tested for significant effect moderation by gender.
  
  
  RESULTS
  In gender-stratified models, PTSD was strongly associated with higher IPF scores (greater functional impairment), with similar associations by gender. PTSD was also associated with lower Mental Component Summary scores (lower mental HRQOL) in both men and women, with no evidence of effect moderation by gender. PTSD was associated with lower Physical Component Summery scores in women but not men in adjusted models; however, interactions were not significant.
  
  
  CONCLUSIONS
  PTSD among warzone-deployed OEF/OIF veterans is associated with significant impairments in both overall psychosocial functioning and HRQOL, with associations that are largely similar by gender. Findings support the need for thorough and continuous assessment of functional impairment and HRQOL during treatment of PTSD for both male and female OEF/OIF veterans.
authors.affiliation: 1 Division of Epidemiology, New England Research Institutes , Inc., Watertown, Massachusetts.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.affiliation: 2 Executive Division, National Center for PTSD, VA Medical Center , White River Junction, Vermont.|3 Department of Psychiatry, Geisel School of Medicine of Dartmouth , Hanover, New Hampshire.
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
authors.affiliation: 4 Behavioral Science Division, National Center for PTSD at VA Boston , Boston, Massachusetts.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Kulish
authors.affiliation: 4 Behavioral Science Division, National Center for PTSD at VA Boston , Boston, Massachusetts.|5 Department of Psychiatry, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Darren W
authors.initials: DW
authors.lastname: Holowka
authors.affiliation: 4 Behavioral Science Division, National Center for PTSD at VA Boston , Boston, Massachusetts.|5 Department of Psychiatry, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Marx
authors.affiliation: 4 Behavioral Science Division, National Center for PTSD at VA Boston , Boston, Massachusetts.|5 Department of Psychiatry, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Keane
authors.affiliation: 1 Division of Epidemiology, New England Research Institutes , Inc., Watertown, Massachusetts.
authors.forename: Raymond
authors.initials: R
authors.lastname: Rosen
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D005260:Female; D006306:Health Surveys; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology; D010555:Personality Inventory; D011788:Quality of Life / Q000523:psychology*; D012042:Registries; D012044:Regression Analysis; D012727:Sex Characteristics; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data