Reversals in initially denied Department of Veterans Affairs' PTSD disability claims after 17 years: a cohort study of gender differences.
Reversals in initially denied Department of Veterans Affairs' PTSD disability claims after 17 years: a cohort study of gender differences.
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DOI：
10.1186/s12905-021-01214-7
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发表时间：
2021-02-16
期刊：
影响因子：
--
通讯作者：
Noorbaloochi S
中科院分区：
文献类型：
--
作者：
Murdoch M;Spoont MR;Sayer NA;Kehle-Forbes SM;Noorbaloochi S
2011年，退伍军人事务部（VA）加强了针对军事性创伤的伤残索赔程序，希望减少最初的创伤后应激障碍（PTSD）伤残赔偿中的性别差异。这些流程的改进还应该帮助女性扭转之前被拒绝的索赔，并有可能减少上诉索赔结果中的性别差异。我们的目标是检查 2011 年之后被拒绝的 PTSD 索赔结果逆转中的性别差异，确定其他疾病的残疾奖励（也称为“服务联系”）是否抵消了任何 PTSD 性别差异，并确定可以解释任何持续差异的调解混杂因素。我们从 1998 年创建的具有全国代表性的队列中，检查了 253 名男性和 663 名女性的服务联系结果，这些人最初的 PTSD 声明被拒绝。主要结局是截至 2016 年 8 月 24 日的 PTSD 服务联系。次要结局是任何疾病的服务联系和总体残疾评级。总伤残等级决定了退伍军人福利的慷慨程度。截至研究结束，51.4% 的男性和 31.3% 的女性因 PTSD 而接受服务 (p<0.001)。开始时，54.2% 的男性和 63.2% 的女性有任何服务联系，即除 PTSD 以外的疾病的服务联系 (p = 0.01) 和类似的总残疾评级 (p = 0.50)。然而，到研究结束时，拥有任何服务联系的男性多于女性（88.5% 对比 83.5%，p = 0.05），并且男性的平均总伤残等级明显高于女性（77.1± 26.2 对比 66.8± 30.7，p < 0.001）。军队性侵犯的历史对男性和女性的 PTSD 服务连接几率影响最大。即使在 2011 年之后，男性比女性更有可能扭转最初被否认的 PTSD 说法，而军队性侵犯史是造成这种差异的主要原因。其他疾病的服务连接最初抵消了女性较低的 PTSD 服务连接率，但最终，男性的总残疾评级超过了女性。应在初始索赔期之后对服务连接中的性别差异进行监测。在线版本包含可在 10.1186/s12905-021-01214-7 获取的补充材料。
In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims’ outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims’ outcomes after 2011, determine whether disability awards (also known as “service connection”) for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans’ benefits. 51.4% of men and 31.3% of women were service connected for PTSD by study’s end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study’s end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men’s mean total disability rating was substantially greater than women’s (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men’s versus women’s odds of PTSD service connection. Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women’s lower rate of PTSD service connection, but, ultimately, men’s total disability ratings exceeded women’s. Gender discrepancies in service connection should be monitored beyond the initial claims period. The online version contains supplementary material available at 10.1186/s12905-021-01214-7.
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影响因子：
3
作者：
Murdoch, M;Hodges, J;Sayer, N
通讯作者：
Sayer, N
影响因子：
1.2
作者：
Spoont, Michele R.;Sayer, Nina A.;Nugent, Sean
通讯作者：
Nugent, Sean
影响因子：
3.4
作者：
Sripada, Rebecca K.;Hannemann, Claire M.;McCarthy, John F.
通讯作者：
McCarthy, John F.
影响因子：
3
作者：
Murdoch, M;Hodges, J;van Ryn, M
通讯作者：
van Ryn, M
影响因子：
1.2
作者：
Noorbaloochi, Siamak;Nelson, David;Asgharian, Masoud
通讯作者：
Asgharian, Masoud