Women Veterans, a Population at Risk for Fibromyalgia: The Associations Between Fibromyalgia, Symptoms, and Quality of Life
Women Veterans, a Population at Risk for Fibromyalgia: The Associations Between Fibromyalgia, Symptoms, and Quality of Life
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DOI：
10.7205/milmed-d-15-00557
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发表时间：
2017-07-01
影响因子：
1.2
通讯作者：
Groer, Maureen
中科院分区：
文献类型：
--
作者：
D'Aoust, Rita F.;Rossiter, Alicia Gill;Groer, Maureen
背景：联邦卫生保健研究所最近发布了一份圆桌讨论的执行摘要，指出现役和退役女军人面临着服兵役特有的不良健康后果的高风险，包括与创伤后应激障碍(PTSD)相关的并发症、未报告的性创伤和肌肉骨骼问题。2008年，医学研究所开始审查、评估和总结海湾战争中健康后果的文献，发现了与创伤后应激障碍存在因果关系的充分证据，以及与纤维肌痛(FM)有关的提示性证据。这项研究考察了女性退伍军人中FM的患病率和影响，并探索了其他共病之间的联系，以改善治疗的风险差异和改善结果。方法：这项研究是由美国陆军在南佛罗里达大学护理学院资助的一个更大的项目中的一个嵌套的横断面研究，名为“为女退伍军人赋权的护理健康倡议”。76名参与者完成了一系列与生理和心理压力源相关的研究工具。结果：超过一半的样本调频筛查得分为阳性(56.68%)，尽管只有14.42%被部署到中东。超过70%的参与者报告了在军队中的生活骚扰，32.9%的人报告了在军队中的性侵。单因素方差分析结果发现，FM与压力、抑郁和创伤后应激障碍的心理症状显著相关。FM与生活质量和睡眠困难显著相关。讨论、影响和建议：这项初步研究的结果表明，FM与抑郁症和创伤后应激障碍的心理症状有显著关系。这些女性中近三分之二的人筛查出抑郁症状呈阳性，略高于四分之一的参与者有创伤后应激障碍的症状。在这项研究中，只有一小部分女性退伍军人被部署(14.42%)，这表明除了部署或战斗之外的触发或危险因素可能有助于FM和心理健康症状的发展。为了关注疼痛、疲劳、睡眠和抑郁之间的复杂相互关系，有必要对更复杂的统计分析进行更大样本的后续研究。这项研究中的其他分析显示，超过一半的女性退伍军人报告在军队中遭受过军中性创伤(MST)，FM筛查呈阳性。虽然我们的分析没有发现FM和MST之间存在显著的影响，但它应该被认为是FM的一个潜在危险因素，因为MST可以是PTSD的先兆。患有FM的女性退伍军人应该进行MST筛查，因为性创伤可能不会被披露。了解有多少女性退伍军人受到FM的影响，以及与创伤后应激障碍、MST、压力、抑郁和睡眠的关系，可以改善筛查和治疗，以提高生活质量。这也将为决策提供关于如何最好地设计和实施干预措施、方案和政策的信息。
Background: The Institute of Federal Health Care recently published an executive summary from a round table discussion indicating that active duty and retired female military personnel are at high risk for adverse health outcomes unique to military service including complications related to post-traumatic stress disorder (PTSD), unreported sexual trauma, and musculoskeletal problems. In 2008, the Institute of Medicine began to review, evaluate, and summarize the literature on health outcomes in Gulf War-deployed and found sufficient evidence of a causal relationship with PTSD and suggestive evidence of an association with fibromyalgia (FM). This study examines the prevalence and impact of FM in women veterans and to explore the association between other comorbidities to improve risk differentiation for treatment and improve outcomes. Methods: This study is designed as a nested, cross-sectional study within a larger project funded by the U.S. Army at the University of South Florida, College of Nursing entitled "Nursing Health Initiative for Empowering Women Veterans." A sample of 76 participants completed a battery of study instruments related to physical and psychological stressors. Findings: Over half of the sample had a positive FM screening score (56.68%) although only 14.42% were deployed to the Middle East. More than 70% of participants reported harassment in life in the military and 32.9% reported sexual assault while in the military. Results of the 1-way analysis of variances find that there was a significant association of FM with the psychological symptoms of stress, depression, and PTSD. There was a significant association of FM with quality of life and sleep difficulty. Discussion, Impact, and Recommendations: The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of women veterans in this study were deployed (14.42%) and this suggests that a trigger or risk factor other than deployment or combat may contribute to the development of FM and mental health symptomology. To focus on the complex interrelationships between pain, fatigue, sleep, and depression, a follow-up study with a larger sample powered for more complex statistical analyses is warranted. Additional analyses in this study reveal that over half of women veterans who reported military sexual trauma (MST) while in the military, screened positive for FM. Although our analyses did not reveal there to be a significant effect between FM and MST, it should be considered as a potential risk factor for FM as MST can be a precursor for PTSD. Women veterans who present with FM should be screened for MST as sexual trauma may not be disclosed. Understanding how many women veterans are affected with FM and the relationship with PTSD, MST, stress, depression, and sleep can improve screening and treatment to improve quality of life. This will also inform decision-making about how best to design and implement interventions, programs, and policies.