Journal of Psychiatric Research xxx (2011) 1e9
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Journal of Psychiatric Research
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Stress and mental disorders in female military personnel: Comparisons between
the sexes in a male dominated profession
Natalie P. Mota a, b, Maria Medved b, JianLi Wang c, Gordon J.G. Asmundson d, Debbie Whitney e,
Jitender Sareen a, b, f, *
a
Department of Psychiatry, University of Manitoba, Winnipeg, Canada
Department of Psychology, University of Manitoba, Winnipeg, Canada
Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Canada
d
Department of Psychology, University of Regina, Regina, Canada
e
Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
f
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
b
c
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 24 May 2011
Received in revised form
9 September 2011
Accepted 29 September 2011
The proportion of women in militaries is growing; however, many studies in the area of military mental
health have been conducted with majority male samples. The present study examined sex differences in
trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey e
Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286
reservists ages 16e54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder,
panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events,
and work stress were assessed. Regular and reserve female personnel were less likely than males to
experience deployment-related traumas, accidents, and several events involving violence (adjusted odds
ratio [AOR] range 0.10e0.62). Women were more likely to endorse sexual trauma, partner abuse, and
being stalked (AOR range 3.60e13.63). For work stress, regular force women reported higher levels of job
demand and stress around social support than men, whereas regular and reserve force women reported
less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely
than males to have PTSD (AOR 1.88, 99% CI 1.01e3.50), while reservist women were more likely than men
to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87e6.98). Both
regular and reservist women had lower rates of alcohol dependence (AOR range 0.30e0.34). Clinicians
working with female personnel should screen for trauma/stressors and mental disorders that are
particularly common in this population.
Ó 2011 Published by Elsevier Ltd.
Keywords:
Female military personnel
Traumatic events
Occupational stress
Mental disorders
1. Introduction
1.1. Sex differences in trauma exposure
Women comprise a growing sector of many militaries. Until
recently, the research examining stressor/trauma exposure and
mental distress in personnel and veteran samples has often been
conducted in either exclusively or predominately male samples
(Dohrenwend et al., 2006; Fikretoglu et al., 2006). However,
examining stressors and mental health profiles in military women,
including how they differ from those in men, is becoming
increasingly important.
Traumatic event exposure can precipitate the development of
mental disorders, and a growing number of studies have examined
military men and women separately with regard to exposure to
trauma/stressors. Women have been found to experience significantly higher rates of sexual harassment and assault (within and
outside the military) than men (Belik et al., 2009; Carter-Visscher
et al., 2010; Haskell et al., 2010; King et al., 2006; Murdoch et al.,
2007; Street et al., 2007, 2009; Vogt et al., 2005). Women have also
reported a higher prevalence of a history of several traumatic
events, including childhood sexual abuse and intimate partner
violence (e.g., Belik et al., 2009; Carter-Visscher et al., 2010; Rosen
and Martin, 1996; Street et al., 2009). With regard to militaryspecific stressors, women have endorsed more general
* Corresponding author. Department of Psychiatry, University of Manitoba,
PZ-430 PsycHealth Centre, 771 Bannatyne Avenue, Winnipeg, Manitoba, Canada,
R3E 3N4. Tel.: þ1 204 787 7078; fax: þ1 204 787 4879.
E-mail address: [email protected] (J. Sareen).
0022-3956/$ e see front matter Ó 2011 Published by Elsevier Ltd.
doi:10.1016/j.jpsychires.2011.09.014
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
2
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
harassment (King et al., 2006), and lower levels of pre-deployment
preparedness and deployment-related social support (King et al.,
2006; Vogt et al., 2005; Vogt et al., 2008a).
Military men typically report more combat exposure, violencerelated events (e.g., being badly beaten), natural and manmade
disasters, and accidents (Belik et al., 2009; Hourani et al., 2003;
King et al., 2006; Vogt et al., 2005; Vogt et al., 2008a). No sex
differences have been found for several stressors/traumatic events,
including worries related to life/family disruption, physical abuse
by a parent/caregiver, and a sudden death of someone close (Belik
et al., 2009; Carter-Visscher et al., 2010; King et al., 2006; Vogt et al.,
2005; Vogt et al., 2008a).
1.2. Sex differences across mental disorders
Exposure to traumatic events and military-related stressors
have been found to be associated with negative mental health
outcomes (Belik et al., 2009; Carter-Visscher et al., 2010; King et al.,
2006; King et al., 2008; Murdoch et al., 2007; Sareen et al., 2007,
2008; Vogt et al., 2005; ; Vogt et al., 2008b). With regard to sex
differences across mental disorders, several studies in personnel
and veteran samples have shown women to have a higher prevalence of symptomatology, including depression, PTSD, and suicidal
ideation (Haskell et al., 2010; Rona et al., 2007; Sareen et al., 2008;
Vogt et al., 2005). Military men typically endorse more alcohol use
and related disorders than women (Ames et al., 2007; Bray et al.,
1999; Rona et al., 2007; Sareen et al., 2008). However, some
studies have failed to find such differences or have shown higher
rates of some psychological disorders in males (Bray et al., 1999;
Haskell et al., 2010; Jones et al., 2006; Rona et al., 2007; Street
et al., 2009).
1.3. Sex differences in work stress
Research in civilian samples has shown that higher perceived
levels of work stress can be detrimental to employees’ mental
health (Virtanen et al., 2007; Wang, 2004, 2005; Wang et al., 2008).
Work stress in the military can be substantial and has demonstrated associations with negative outcomes (Bray et al., 1999, 2001,
2010; Hourani et al., 2006; Pflanz and Ogle, 2006). Only a handful of
studies using military samples have examined sex differences in
occupational stress. Women have shown more strain (Bridger et al.,
2008; Hourani et al., 2006), although similar proportions of men
and women experienced high stress levels in another sample (Bray
et al., 1999, 2001). However, a relatively high proportion of female
personnel reported experiencing stress around being a woman in
the military (Bray et al., 2001), and another study found that
a greater proportion of women than men reported past-year work
problems (Ames et al., 2007).
1.4. Sex differences across sociodemographic variables
Military males and females have been found to differ on
a number of sociodemographic variables. Some studies have found
that women are less likely to be married and more likely to be nonCaucasian, of younger age, and of lower military rank (Haskell
et al., 2010; Murdoch et al., 2007; Rosen and Martin, 1996). Such
factors might be important confounding variables to consider
when investigating sex differences across stress and mental
disorders.
1.5. Regular versus reserve force personnel
In several studies, regular and reserve/National Guard
personnel have differed with respect to trauma/stressor exposure
and mental disorder symptomatology (Browne et al., 2007; King
et al., 2006; Milliken et al., 2007; Vogt et al., 2008b). Such traumatic events have included combat exposure, other aspects of war
(e.g., handling/seeing dying or dead bodies), and deployment
social support/unit cohesion (Browne et al., 2007; King et al.,
2006; Milliken et al., 2007; Vogt et al., 2008b). However, findings have been mixed for several of these variables and inconsistent with regard to differences in psychopathology (Browne et al.,
2007; Iowa Persian Gulf Study Group, 1997; Hotopf et al., 2006;
Iversen et al., 2009; King et al., 2006; Kinley et al., 2011; Mather
et al., 2010; Milliken et al., 2007; Pietrzak et al., 2010; Vogt
et al., 2008b). Further, a recent study in a small sample of
veterans examined threeeway interactions (sex by stressor by
regular versus reserve status) in relation to symptoms of PTSD
(Vogt et al., 2008b). The authors found that the associations
between a number of stressors and increased symptomatology
were particularly strong in active duty women and National
Guard/reserve status men (Vogt et al., 2008b). Such findings
highlight the importance of examining sex differences within
regular and reserve personnel separately.
1.6. Rationale and current study
Previous research examining sex differences with regard to the
above constructs in the military has been limited by several factors.
First, most studies have investigated mental disorders using selfreport questionnaires instead of standardized diagnostic interviews. Second, the few studies that have examined work stress
have used one or two self-reported yes/no questions rather than
a multi-faceted assessment. Third, many previous studies have not
adjusted for potential confounding factors. Fourth, most previous
studies have not distinguished between regular and reserve status
personnel.
In the present study, we have addressed the limitations of past
research by using a standardized assessment of mental disorders
and a validated measure of work stress to examine sex differences
1) in the exposure to 28 lifetime traumatic events, 2) across
several dimensions of past-year work stress, and 3) in the prevalence of several past-year DSM-IV mental disorders in a representative sample of forces personnel. We also accounted for
several potentially confounding factors in our analyses and stratified by regular versus reserve status. To our knowledge, no
previous study has been able to address all of these issues under
one investigation.
Our primary hypotheses were the following:
1a: Female personnel would endorse less combat exposure and
accident-type traumas than male personnel.
1b: Female personnel would endorse more sexual trauma and
intimate partner violence than male personnel.
2: Female personnel would show more stress than male personnel
on several dimensions of work stress examined.
3a: Female personnel would report a higher prevalence of
depression and anxiety disorders than male personnel.
3b: Female personnel would report less alcohol dependence than
men.
2. Method
2.1. Participants
Data from the Canadian Community Health Survey on Mental
Health and Wellbeing: Canadian Forces Supplement (CCHS-CFS)
were used. The CCHS-CFS was a representative survey of active
military personnel in the Canadian Forces conducted by Statistics
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
Canada and the Department of National Defence. The survey, conducted in 2002, included 5155 regular and 3286 reserve force
personnel aged 16e54, which consisted of 5849 men and 2592
women. Other sociodemographic characteristics of respondents
can be found in Table 1.
2.2. Procedure
Details on the design and methodology of the CCHS-CFS can be
found elsewhere (Statistics Canada, 2003). A multistage sampling
strategy was employed to obtain representation of the Canadian
military population, with stratifications being made by regular
versus reserve personnel, rank, and sex. The response rates were
79.5% and 83.5% for regular and reserve force members, respectively. Interviews were mostly conducted face-to-face in on-base
rooms and were administered by trained lay interviewers from
Statistics Canada using computer-assisted interviewing. The
CCHS-CFS is safely held at the Research Data Centre at the
University of Manitoba in Winnipeg, Canada, and all analyses
were conducted there. Due to the anonymized and secondary
nature of the data, approval from an institutional ethics board
was not needed.
2.3. Measures
2.3.1. Traumatic events
The lifetime exposure of 28 traumatic events was assessed in the
CCHS-CFS and asked in the form of yes/no questions to all
respondents. Events were grouped conceptually into five categories
in line with a previous study with this sample (Belik et al., 2009):
sexual trauma, other interpersonal, accident and/or unexpected,
deployment-related, and civilian in war or refugee.
3
2.3.2. Work stress
Work stress in the past-year was assessed using a 12-item,
abbreviated version of the Job Content Questionnaire (JCQ)
(Karasek et al., 1998), which has been previously used (Wang,
2004; Wang et al., 2008). Six dimensions of work stress were
queried,
including
skill
discretion/demand
(3
items,
range ¼ 0e12), decision authority/control (2 items, range ¼ 0e8),
psychological demand (2 items, range ¼ 0e8), job insecurity (1
item, range ¼ 0e4), physical exertion (1 item, range ¼ 0e4), and
social support from colleagues and supervisors (3 items,
range ¼ 0e12). Each question was measured on a 5-point Likert
scale (0e4) from ‘strongly agree’ to ‘strongly disagree’. The Cronbach’s alpha coefficient for the JCQ scale was a ¼ 0.52 (0.33 for skill
discretion, 0.66 for decision authority, 0.42 for psychological
demand, and 0.48 for social support). As noted in a previous paper
that used the JCQ (Wang et al., 2008), internal consistency reliability is not always high when a scale includes different dimensions (Boyle, 1985). A few items were reversed coded by Statistics
Canada so that for all items, higher scores delineated higher stress.
Responses for each dimension were examined as continuous
variables because their skewness indexes were less than 1. The
exception was job insecurity where the majority of participants
replied ‘strongly agree’ to their job security being good. Thus, the
item was dichotomized as ‘strongly agree’ versus the other
response choices.
2.3.3. Mental disorders
The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) version 2.1 was used to assess mental
disorders. The WHO-CIDI is a standardized diagnostic interview
with well-documented reliability and validity (Haro et al., 2006;
Kessler et al., 2004; Kessler and Ustun, 2004). The following past-
Table 1
Prevalence of sociodemographic and military factors in women and men and sex differences across these variables.
Regular
Sociodemographic Variables
Age
16e24
25e34
35e44
45e64
Marital Status
Married/Common-law
Separated/widowed/Divorced
Never married
Household Income
>80,000
50,000e79,999
30,000e49,999
<29,999
Education
Bachelor’s degree or higher
Postsecondary school below bachelor’s
High school or less
Type of Occupation
Land
Air
Sea/Communications
Rank
Junior
Senior
Officer
Reserve
Males
Females
%
%
9.7
31.4
45.9
13.1
11.3
35.8
44.1
8.8
73.5
7.9
18.6
OR (99% CI)
Males
Females
%
%
OR (99% CI)
1.00
0.97 (0.71e1.33)
0.82 (0.61e1.10)
0.57 (0.41e0.80)***
42.8
26.5
16.7
14.1
39.7
31.7
21.4
7.3
1.00
1.29 (0.99e1.68)
1.38 (1.08e1.76)***
0.56 (0.40e0.78)***
59.5
12.9
27.6
1.00
2.02 (1.53e2.66)***
1.83 (1.50e2.22)***
40.4
4.2
55.4
45.7
6.7
47.6
1.00
1.43 (0.93e2.21)
0.76 (0.63e0.93)***
38.0
43.0
15.7
3.3
53.4
25.2
17.1
4.4
1.00
0.42 (0.35e0.50)***
0.77 (0.61e0.98)**
0.93 (0.59e1.46)
38.6
31.1
18.3
12.0
34.9
27.1
24.1
14.0
1.00
0.96 (0.75e1.24)
1.46 (1.10e1.94)***
1.29 (0.91e1.84)
16.0
42.5
41.5
22.2
46.8
31.1
1.00
0.79 (0.69e0.92)***
0.54 (0.47e0.63)***
19.3
47.6
33.1
24.9
50.8
24.3
1.00
0.83 (0.65e1.05)
0.57 (0.43e0.75)***
51.7
29.8
18.5
39.2
43.7
17.1
1.00
1.93 (1.61e2.32)***
1.22 (0.98e1.53)
72.8
7.8
19.4
59.5
11.9
28.6
1.00
1.87 (1.37e2.54)***
1.81 (1.42e2.30)***
55.8
22.7
21.4
59.5
14.8
25.8
1.00
0.61 (0.50e0.74)***
1.13 (1.04e1.22)***
66.4
17.0
16.7
75.5
13.2
11.3
1.00
0.69 (0.53e0.88)***
0.60 (0.55e0.64)***
Note. Percentages are weighted.
OR e Odds Ratio.
**p < 0.01; ***p < 0.001.
Bold values represents statistically significant.
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
4
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
year disorders were examined in the present study: major depression, panic disorder, social phobia, generalized anxiety, PTSD, and
any mood or anxiety disorder. Alcohol dependence was assessed
using the CIDI Short Form, where endorsement of three or more
symptoms was considered alcohol dependence (Kessler et al., 1998).
2.3.4. Sociodemographic and military variables
The following sociodemographic variables were examined in
the present study: Age (16e24, 25e34, 35e44, 45e64 years),
household income ($29,999 or less, $30,000-$49,999, $50,000$79,999, $80,000 and greater), marital status (married/commonlaw, divorced/separated, widowed), and education (postsecondary
degree, some postsecondary education, high school or less). Military rank (Junior, Senior, Officer) and type of service (land, air, and
sea/communications) were also included. Due to a low prevalence
for the communications category, it was collapsed with sea, the
next smallest category in the variable.
2.3.5. Statistical analyses
Correct statistical weights were supplied by Statistics Canada
and applied to all analyses to make possible the representativeness
of Canadian Forces personnel. The bootstrapping method of error
estimation was also applied using SUDAAN software (Research
Triangle Institute, 2004) because it adjusts for the complex
sample design of the survey.
Differences between regular and reserve status female
personnel were calculated across outcome variables to verify that
applying a regular versus reserve stratification for remaining
analyses was warranted. All subsequent analyses were stratified in
regular versus reserve personnel. First, the prevalence of sociodemographic and military variables was calculated in men and
women. Unadjusted logistic regression analyses tested for sex
differences across these factors. Second, multiple regression analyses adjusted for the variables above calculated sex differences in
the exposure to the 28 lifetime traumatic events. Third, sex differences across each work stress variable were examined using
multiple linear regression analysis (multiple logistic regression was
used for the dichotomized variable), adjusting for sociodemographic and military variables. Lastly, multiple logistic regression
analyses were used to investigate sex differences across mental
disorders. Two models were tested. The first adjusted for sociodemographic and military covariates. The second model adjusted
for 1) sociodemographic and military variables, 2) a count variable
of the number of traumatic events experienced for each category of
traumatic event (sexual trauma, other interpersonal, accident and/
or unexpected, deployment-related, civilian in war or refugee), and
3) each work stress variable.
3. Results
Analyses examining differences across trauma exposure, work
stress, and mental disorders in regular and reserve female personnel
showed several differences. Reserve women were less likely than
regular force women to have been exposed to deployment-related
events (AOR range 0.25e0.45), to have witnessed someone being
badly injured, killed, or to have seen a dead body (AOR 0.67, 99% CI
0.50e0.91), and to have been badly beaten by parents/guardians
(AOR 0.45, 99% CI 0.26e0.78). Regular force women reported higher
levels of work stress related to job control, psychological demand,
and physical exertion. However, reserve force women were more
likely to report job insecurity (AOR 5.47, 99% CI 4.25e7.04). Finally, in
the model adjusting for sociodemographic and military variables,
trauma exposure, and work stress, reserve women were more likely
than regular force women to have panic disorder (AOR 2.41, 99 CI%
1.03e5.62). No other differences were found (results in female and
male personnel available upon request).
Table 1 shows sex differences across sociodemographic and
military variables. In regular status personnel, women were less
likely than men to be in the 45e64 year old age group, in the
$30,000-$79,999 household income range, to have an education
level below a Bachelor’s degree, and to be of senior rank. Regular
status female personnel were more likely to be separated/widowed/divorced and never married, to work in air operations, and to
be of officer rank. In reserve status personnel, women were less
likely to be in the 45e64 age range, to have never been married, to
have an education of high school or less, and to be of officer or
senior status. Reserve female personnel were more likely than their
male counterparts to be between 35 and 44 years, to be in the
$30,000-$49,999 household income category, and to work in air,
sea, or communications.
Table 2 shows sex differences in exposure to each lifetime
traumatic event. Hypothesis 1a, that female personnel would
endorse less combat exposure and accidents than male personnel,
was supported. Women in both regular and reservist roles were less
likely than males to report lifetime exposure to deployment-related
traumas (adjusted odds ratio [AOR] range 0.10e0.43) and less likely
to experience several events in the accidents/other unexpected
events category (AOR range 0.23e0.62). Other events for which
women showed a lower likelihood of exposure included being
civilians in war, badly beaten by anyone else, mugged, held up or
threatened with a weapon, and endorsing ‘other’ traumatic events
(AOR range 0.20e0.62). Regular force female personnel were
additionally less likely than regular force males to have been
kidnapped or held captive (AOR 0.45, 99% CI 0.23e0.87) and more
likely to have witnessed physical violence as a child at home (AOR
1.29, 99% CI 1.00e1.65). Hypothesis 1b, that female personnel
would endorse more sexual trauma and intimate partner violence
than males, was also supported. Both regular and reserve women
were more likely than men to have experienced spousal/partner
abuse, being stalked, and sexual trauma (AOR range 3.60e13.63).
Table 3 displays sex differences across the dimensions of pastyear work stress, adjusted for covariates. Hypothesis 2, that female
personnel would show higher levels than males on several dimensions of work stress, was only partially supported. Regular force
women reported higher levels than regular force males with regard
to stress related to job demand and social support from co-workers
and supervisors. However, both regular and reserve force women
reported significantly lower levels than men of stress related to
physical exertion, and no other significant differences were found.
Sex differences in past-year mental disorders are displayed in
Table 4. Hypothesis 3a, that female personnel would show a higher
prevalence of depression and anxiety disorders, was partially
supported in regular force personnel, and mostly supported in
reserve force personnel. In the fully adjusted statistical model,
reserve force women were more likely than men to have PTSD (AOR
1.88, 99% CI 1.01e3.50). Meanwhile, in reserve force personnel,
women were more likely than males to have depression, panic
disorder, and any mood or anxiety disorder in the same model (AOR
range 1.87e6.98). Finally, Hypothesis 3b, that there would be lower
rates of alcohol dependence in military women than in men, was
supported. Women were less likely to have alcohol dependence
both in regular (AOR 0.30, 99% CI 0.15e0.63) and reserve force
personnel (AOR 0.34, 99% CI 0.16e0.72).
4. Discussion
The present study had several important findings with regard to
sex differences across work stress, trauma, and mental disorders in
military personnel. First, both regular and reserve force women were
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
5
Table 2
Sex Differences in Exposure to Traumatic Events.
Regular
Males
Lifetime Traumatic Events
Deployment-Related
Combat Exposure
%
21.1
AOR (99% CI)
1.00
Peacekeeper or Relief Worker
%
48.4
AOR (99% CI)
1.00
Purposely Caused Injury, Tortured, or Killed Another
%
4.4
AOR (99% CI)
1.00
Witnessing Atrocities
%
17.1
AOR (99% CI)
1.00
Accident or Other Unexpected
Life-Threatening Motor Vehicle Accident
%
28.1
AOR (99% CI)
1.00
Other Life-Threatening Accident
%
19.2
AOR (99% CI)
1.00
Toxic Chemical or Substance Exposure
%
25.4
AOR (99% CI)
1.00
Natural Disaster
%
21.1
AOR (99% CI)
1.00
Manmade Disaster
%
14.4
AOR (99% CI)
1.00
Someone Close Dying Unexpectedly
%
40.4
AOR (99% CI)
1.00
Son or Daughter with Life-Threatening Illness/Injury
%
6.3
AOR (99% CI)
—
Life-Threatening Illness
%
7.7
AOR (99% CI)
1.00
Witnessed Someone Being Badly Injured, Killed, or Dead Body
%
50.3
AOR (99% CI)
1.00
Accidentally Caused Injury or Death of Someone Else
%
3.4
AOR (99% CI)
1.00
Sexual Trauma
Sexual Assault
%
AOR (99% CI)
Sexual Harassment
%
AOR (99% CI)
Reserve
Females
Males
Females
8.8
0.39 (0.28e0.54)***
7.9
1.00
3.6
0.43 (0.25e0.75)***
23.7
0.37 (0.30e0.46)***
14.8
1.00
5.6
0.30 (0.19e0.47)***
0.4
0.10 (0.03e0.33)***
4.5
1.00
0.7
0.15 (0.05e0.50)***
4.6
0.25 (0.17e0.35)***
7.1
1.00
2.1
0.31 (0.16e0.58)***
15.5
0.47 (0.38e0.58)***
23.2
1.00
13.3
0.50 (0.37e0.66)***
6.5
0.30 (0.21e0.41)***
14.5
1.00
5.5
0.34 (0.22e0.54)***
11.0
0.38 (0.29e0.48)***
18.0
1.00
6.9
0.31 (0.21e0.44)***
13.6
0.62 (0.49e0.78)***
14.2
1.00
10.3
0.72 (0.51e1.02)
5.8
0.39 (0.27e0.57)***
10.3
1.00
4.2
0.40 (0.25e0.64)***
38.9
0.97 (0.81e1.16)
32.1
1.00
32.6
1.00 (0.78e1.27)
4.4
—
3.4
1.00
2.6
0.80 (0.43e1.47)
6.9
0.83 (0.59e1.16)
6.9
1.00
6.0
0.92 (0.58e1.46)
26.3
0.37 (0.31e0.45)***
36.4
1.00
18.3
0.38 (0.29e0.50)***
0.9
0.26 (0.13e0.52)***
3.1
1.00
0.7
0.23 (0.06e0.84)**
2.6
1.00
22.4
10.38 (7.34e14.70)***
1.8
1.00
19.2
13.63 (8.22e22.60)***
6.9
1.00
38.5
8.23 (6.48e10.46)***
5.7
1.00
34.1
9.30 (6.61e13.07)***
7.6
1.15 (0.82e1.62)
5.3
1.00
4.5
0.72 (0.42e1.25)
7.9
6.59 (3.96e10.99)***
0.6
1.00
6.1
9.21 (3.47e24.42)***
3.3
0.22 (0.14e0.33)***
12.8
1.00
3.0
0.20 (0.12e0.36)***
7.3
0.29 (0.22e0.40)***
21.2
1.00
8.3
0.34 (0.24e0.49)***
Other Interpersonal
Badly Beaten by Parents/Guardians
%
6.6
AOR (99% CI)
1.00
Badly Beaten by Spouse or Romantic Partner
%
1.4
AOR (99% CI)
1.00
Badly Beaten by Anyone Else
%
13.4
AOR (99% CI)
1.00
Mugged, Held Up, Threatened With Weapon
%
22.2
AOR (99% CI)
1.00
Stalked
%
3.7
16.0
4.3
13.8
(continued on next page)
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
6
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
Table 2 (continued )
Regular
Reserve
Males
Females
AOR (99% CI)
1.00
Witnessing Physical Violence As Child at Home
%
12.7
AOR (99% CI)
1.00
Kidnapped or Held Captive
%
2.9
AOR (99% CI)
1.00
Civilian in War or Refugee
Unarmed Civilian
%
5.1
AOR (99% CI)
1.00
Civilian in Ongoing Terror
%
4.4
AOR (99% CI)
1.00
Refugee
n (%)
0.5
AOR (99% CI)
—
Traumatic Experience of Someone Close
%
16.3
AOR (99% CI)
1.00
Other
%
8.7
AOR (99% CI)
1.00
Males
Females
4.87 (3.47e6.84)***
1.00
3.60 (2.37e5.47)***
15.7
1.29 (1.00e1.65)**
9.4
1.00
13.0
1.41 (0.99e2.02)
1.3
0.45 (0.23e0.87)**
1.4
1.00
1.6
1.12 (0.41e3.06)
3.1
0.62 (0.38e1.00)**
4.8
1.00
2.6
0.48 (0.26e0.90)**
2.6
0.56 (0.33e0.94)**
6.2
1.00
3.2
0.49 (0.29e0.84)***
0.3
—
1.2
—
0.8
—
17.5
1.00 (0.79e1.27)
14.9
1.00
16.6
1.03 (0.75e1.41)
3.6
0.39 (0.26e0.57)***
7.9
1.00
3.2
0.41 (0.24e0.72)***
Note. AOR- Adjusted for age, marital status, household income, education, type of service, and rank.
**p < 0.01; ***p < 0.001.
—Not shown due to data warnings that the statistical model was approaching infinity.
Bold values represents statistically significant.
more likely than their male counterparts to endorse exposure to
sexual trauma. This finding is consistent with previous research
showing that female personnel experience more military-related
and pre-military/lifetime sexual harassment and abuse (Belik
et al., 2009; Carter-Visscher et al., 2010; Haskell et al., 2010; King
et al., 2006; Murdoch et al., 2007; Rosen and Martin, 1996; Street
et al., 2007, 2009; Vogt et al., 2005). In the current study, women in
both types of forces were also much more likely to report intimate
partner violence and being stalked. Further, regular force women
were more likely than regular force men to have witnessed domestic
violence as a child, and this difference approached significance in
reserve personnel. No sex difference was found with regard to
observing physical fights between parents in the study by CarterVisscher et al. (2010), and the current study identified similar rates
in males and females in being badly beaten by parents/guardians.
Nonetheless, it is possible that military women come from more
Table 3
Sex Differences in Work Stress.
Regular
Work Stress
Subscales
Demand
Control
Psychological
Demand
Physical
Exertion
Social Support
Insecurity
Reserve
Males
Females
Males
Females
Mean (SE)
Mean (SE)
Mean (SE)
Mean (SE)
3.77 (0.03)
2.99 (0.03)
5.07 (0.03)
4.03 (0.05)***
3.11 (0.05)
5.14 (0.05)
4.17 (0.05)
3.06 (0.04)
4.61 (0.04)
4.19 (0.07)
3.19 (0.06)
4.70 (0.06)
2.20 (0.02)
1.95 (0.03)***
2.31 (0.03)
1.87 (0.04)***
3.85 (0.04)
4.08 (0.06)***
3.64 (0.05)
3.87 (0.07)
AOR (99% CI) AOR (99% CI)
AOR (99% CI) AOR (99% CI)
1.00
0.96 (0.78e1.18) 1.00
0.91 (0.73e1.14)
Note. Mean and AOR e Adjusted for age, marital status, household income, education, type of service, and rank.
**p < 0.01; ***p < 0.001.
Bold values represents statistically significant.
Table 4
Associations Between Sex and Mental Disorders.
Regular
Males
Reserve
Females
Past Year Mental Disorders
Major Depression
%
7.6
11.0
AOR-1 (99% CI)
1.00 1.44 (1.05e1.97)**
AOR-2 (99% CI)
1.00 1.26 (0.82e1.94)
Panic Disorder
%
2.0
2.1
AOR-1 (99% CI) —
—
AOR-2 (99% CI) —
—
Social Phobia
%
3.4
5.4
AOR-1 (99% CI)
1.00 1.55 (1.02e2.35)**
AOR-2 (99% CI)
1.00 1.55 (0.88e2.71)
Generalized Anxiety Disorder
%
1.8
2.8
AOR-1 (99% CI)
1.00 1.37 (0.75e2.50)
AOR-2 (99% CI)
1.00 1.11 (0.49e2.49)
Posttraumatic Stress Disorder
%
2.7
4.0
AOR-1 (99% CI)
1.00 1.41 (0.88e2.25)
AOR-2 (99% CI)
1.00 1.88 (1.01e3.50)**
Any Mood or Anxiety Disorder
%
11.9
17.4
AOR-1 (99% CI)
1.00 1.50 (1.17e1.93)***
AOR-2 (99% CI)
1.00 1.33 (0.94e1.88)
Alcohol Dependence
%
4.6
1.7
AOR-1 (99% CI)
1.00 0.33 (0.18e0.60)***
AOR-2 (99% CI)
1.00 0.30 (0.15e0.63)***
Males
Females
3.2
1.00
1.00
8.0
2.45 (1.45e4.13)***
1.87 (1.01e3.46)**
0.7
1.00
1.00
3.3
4.56 (1.56e13.37)***
6.98 (2.20e22.13)***
2.0
1.00
1.00
3.3
1.78 (0.85e3.77)
1.80 (0.71e4.57)
1.0
1.00
1.00
1.1
1.06 (0.36e3.11)
0.71 (0.20e2.50)
0.9
1.00
1.00
2.4
2.31 (0.83e6.44)
3.34 (0.87e12.82)
5.9
1.00
1.00
14.0
2.59 (1.74e3.87)***
2.18 (1.35e3.50)***
7.0
1.00
1.00
3.1
0.43 (0.23e0.81)***
0.34 (0.16e0.72)***
Note. AOR-1- Adjusted for age, marital status, household income, education, type of
service, and rank.
AOR-2 e Adjusted for age, marital status, household income, education, type of
service, rank, each category of traumatic events, and each work stress variable.
**p < 0.01; ***p < 0.001.
—Not shown due to data warnings that the statistical model was approaching
infinity.
Bold values represents statistically significant.
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
disruptive childhood environments than men (King et al., 2006).
Investigating sex differences in childhood adversity in military
populations remains an important future direction.
Both regular and reserve force women were less likely than men
to report war-related events, a number of accidents and other
unexpected events (e.g., chemical or substance exposure, motor
vehicle accidents), and events relating to non-domestic physical
violence. These findings are mostly consistent with past research
(Hourani et al., 2003; King et al., 2006; Vogt et al., 2005; Vogt et al.,
2008a). For several of these events, for example, witnessing
atrocities and seeing a dead body, the sex differences found are
likely reflective of the larger numbers of men who get deployed in
combat-related operations (Canadian Forces National Report to the
Committee for Women in NATO Forces, 2009). Further, men in
general tend to be involved in more physical aggressiveness and
risk-taking behavior (Byrnes et al., 1999; Harris and KnightBohnhoff, 1996; Zeichner et al., 2003).
Regular force women also reported higher levels than men on
two of the six aspects of work stress, including job demand and
social support from colleagues and supervisors. The relationship
between sex and social support in reserve personnel approached
statistical significance. Civilian women also report more job
demand than men (Wang et al., 2008), and the current finding may
not be unique to the military environment. Regarding the sex
difference in social support at work, this finding has been supported by other military studies (King et al., 2006; Vogt et al., 2005).
It is recommended that the military continue exerting effort on
achieving the full integration of female personnel, particularly for
those women who have made a career out of their military service.
Finally, both regular and reserve force men reported more physical
exertion than women. This finding is likely reflective of more men
than women participating in more physically taxing military roles
(e.g., combat).
In the present study, several sex differences were found with
regard to mental disorders. Both regular and reserve female
personnel were more likely than male personnel to have past-year
major depression and any mood and anxiety disorder. Additionally,
regular force women were more likely to have social phobia, while
reserve force women were more likely than men to have panic
disorder. Both regular and reserve force men showed higher rates of
alcohol dependence. Such findings are generally in line with several
studies in military samples showing higher rates of some psychopathology in women (Ames et al., 2007; Ferrier-Auerbach et al., 2010;
Jones et al., 2006; Sareen et al., 2008; Vogt et al., 2005). In the more
adjusted model, the sex differences in major depression, social
phobia, and any mood and anxiety disorder in regular force personnel
failed to reach significance, suggesting that exposure to traumatic
events and work stress were accounting for women’s higher likelihood of having these disorders. Conversely, the relationship between
sex and PTSD became stronger and reached significance in the more
stringent model in regular force personnel, with women showing
higher rates than males. Finally, all previous sex differences in reserve
personnel remained, even after adjustments.
It is not surprising that numerous sex differences in mental
disorder prevalence failed to reach significance after adjusting for
work stress and trauma. Kanter’s theory explains why the military
environment, with its sex ratio of 85:15, may be especially stressful
for women (Kanter, 1997, in Hunt and Emslie, 1998). Due to being
the minority sex, this theory posits that women are treated as the
‘others’ and given stereotyped traits, which could contribute to
greater work stress and also influence well-being. However, in the
present study, female reservists were more likely than males to
have several disorders, even after adjusting for traumatic events
and work stress. Civilian women have also been found to have more
internalizing psychopathology than males (Piccinelli and
7
Wilkinson, 2000; Seedat et al., 2009), and the differences
between military men and women with respect to these mental
disorders may not be unique to this environment. Moreover,
women have been found to experience a higher level of certain premilitary stressors, including childhood sexual abuse and adult
sexual assault (Carter-Visscher et al., 2010; Rosen and Martin, 1996).
It is possible that women enter military service with an increased
vulnerability for developing mental illness. Future work needs to
examine mental disorders in women in non-traditional gendered
workplaces like the military in relation to other, more genderbalanced occupations. In addition, future research needs longitudinal designs with baseline as well as post trauma/military service
assessments of mental illness (Fear et al., 2010). This work is
needed in order to examine the temporal role of trauma and work
stress on sex differences across mental disorders.
The current findings offer a number of important clinical
implications. Mental health professionals working with female
personnel should assess and monitor those traumatic events, types
of work stress, and mental disorders to which this population is
most vulnerable. Clinicians should also recognize that the likelihood of experiencing certain events varies with both sex and
regular versus reserve personnel status. Finally, treating trauma
histories in regular force female personnel and working with them
to manage challenges in the workplace may decrease sex differences in the prevalence of some mental disorders.
The findings of this study should be interpreted in the context of
the following limitations. First, the CCHS-CFS is a cross-sectional
survey and the temporal relationship of stressor exposure and the
development of mental disorders in relation to military service
cannot be discerned. This is particularly true of the traumatic
events in the study, for which lifetime exposure was assessed.
Second, trained lay interviewers rather than clinicians assessed
mental disorders in the CCHS-CFS, although overall good concordance has been shown with clinician-based diagnoses (Kessler
et al., 2004). Third, drug abuse and dependence were not
assessed in the CCHS-CFS. Finally, the survey was collected in 2002,
and future studies are required in Canadian Forces samples
involved in Afghanistan.
The present study examined sex differences in trauma exposure,
mental disorders, and work stress in a representative sample of
regular and reserve Canadian Forces personnel. Several sex differences were found across constructs. Results can assist mental
health professionals working with military men and women by
identifying specific areas that may need screening within each sex.
Role of funding source
The present study was funded by a Canadian Institutes of Health
Research (CIHR) New Investigator Award (#152348) (Sareen),
a CIHR operating grant (Sareen), and a Social Sciences and
Humanities Research Council (SSHRC) Graduate ScholarshipDoctoral Award (Mota). These funding agencies had no role in any
part of the present study or in manuscript preparation and approval.
Conflict of interest
No author has any conflicts of interest to disclose.
Contributors
Natalie Mota assisted in the study design, conducted the
statistical analyses, analyzed and interpreted the data, and wrote
the manuscript. Maria Medved, JianLi Wang, Gordon Asmundson,
and Debbie Whitney assisted in interpreting the data and reading
several drafts of the manuscript for intellectual content. Jitender
Sareen assisted in study design and conceptualization,
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
8
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
interpretation of the data, reading through several manuscript
drafts for intellectual content and mentored the first author on the
project. All authors contributed to, and approved, the final
manuscript.
Acknowledgement
The authors wish to thank Mrs. Shay-Lee Bolton for her assistance with statistical matters.
References
Ames GM, Cunradi CB, Moore RS. Military culture and drinking behavior among U.S.
Navy Careerists. Journal of Studies on Alcohol and Drugs 2007;68:336e44.
Belik S-L, Stein MB, Asmundson GJG, Sareen J. Relation between traumatic events
and suicide attempts in Canadian military personnel. Canadian Journal of
Psychiatry 2009;54:93e104.
Boyle GJ. Self-report measures of depression: some psychometric considerations.
British Journal of Clinical Psychology 1985;24:45e59.
Bray RM, Fairbank JA, Marsden ME. Stress and substance use among military
women and men. American Journal of Drug and Alcohol Abuse 1999;25:
239e56.
Bray RM, Camlin CS, Fairbank JA, Dunteman GH, Wheeless SC. The effects of stress
on job functioning of military men and women. Armed Forces & Society 2001;
27:397e417.
Bray RM, Pemberton MR, Lane ME, Hourani LL, Mattiko MJ, Babeu LA. Substance use
and mental health trends among U. S. military active duty personnel: Key
findings from the 2008 DoD Health Behavior Survey. Military Medicine 2010;
175:390e9.
Bridger RS, Brasher K, Dew A, Kilminster S. Occupational stress and strain in the
Royal Navy 2007. Occupational Medicine 2008;58:534e9.
Browne T, Hull L, Horn O, Jones M, Murphy D, Fear NT, et al. Explanations for the
increase in mental health problems in U.K. reserve forces who have served in
Iraq. British Journal of Psychiatry 2007;190:484e9.
Byrnes JP, Miller DC, Schafer WD. Gender differences in risk taking: a meta-analysis.
Psychological Bulletin 1999;125:367e83.
Canadian Forces National Report to the Committee for Women in NATO Forces
(CWINF). 2009; Retrieved February 21, 2010, from http://www.nato.int/issues/
women_nato/meeting-records/2009/national-reports/canada-national-report2009.pdf.
Carter-Visscher R, Polusny MA, Murdoch M, Thuras P, Erbes CR, Kehle SM. Predeployment gender differences in stressors and mental health among U. S.
National Guard troops poised for Operation Iraqi Freedom deployment. Journal
of Traumatic Stress 2010;23:78e85.
Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The
psychological risks of Vietnam for U. S. veterans: a revisit with new data and
methods. Science 2006;313:979e82.
Fear NT, Jones M, Murphy D, Hull L, Iversen AC, Coker B, et al. What are the
consequences of deployment to Iraq and Afghanistan on the mental health of
the UK armed forces? A cohort study. Lancet 2010;375:1783e97.
Ferrier-Auerbach A, Erbes CR, Polusny MA, Rath CM, Sponheim SR. Predictors of
emotional distress reported by soldiers in the combat zone. Journal of Psychiatric Research 2010;44:470e6.
Fikretoglu D, Brunet A, Poundja J, Guay S, Pedlar D. Validation of the Deployment
Risk and Resilience Inventory in French-Canadian veterans: findings on the
relation between deployment experiences and postdeployment health. Canadian Journal of Psychiatry 2006;51:755e63.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, et al.
Concordance of the Composite International diagnostic interview version 3.0
(CIDI 3.0) with standardized clinical assessments in the WHO World mental
health Surveys. International Journal of Methods in Psychiatric Research 2006;
15:167e80.
Harris MB, Knight-Bohnhoff K. Gender and aggression II: Personal aggressiveness.
Sex Roles 1996;35:27e42.
Haskell SG, Gordon KS, Mattocks K, Duggal M, Erdos J, Justice A, et al. Gender
differences in rates of depression, PTSD, pain, obesity, and military sexual
trauma among Connecticut war veterans of Iraq and Afghanistan. Journal of
Women’s Health 2010;19:267e71.
Hotopf M, Hull L, Fear NT, Browne T, Horn O, Iversen A, et al. The health of U.K.
military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet
2006;367:1731e41.
Hourani LL, Yuan H, Bray RM. Psychosocial and health correlates of types of traumatic event exposures among U.S. military personnel. Military Medicine 2003;
168:736e43.
Hourani LL, Williams TV, Kress AM. Stress, mental health, and job performance
among active duty military personnel: findings from the 2002 Department of
Defense Health-Related Behaviors Survey. Military Medicine 2006;171:
849e56.
Hunt K, Emslie C. Men’s work, women’s work? Occupational sex ratios and health.
In: Orth-Gomér K, Chesney MA, Wenger NK, editors. Women, stress, and Heart
Disease. Mahwah: Lawrence Erlbaum Associates, Inc.; 1998. p. 87e108.
Iowa Persian Gulf Study Group. Self-reported illness and health status among
Gulf War veterans. Journal of the American Medical Association 1997;277:
238e45.
Iversen AC, van Staden L, Hughes JH, Browne T, Hull L, Hall J, et al. The prevalence of
common mental disorders and PTSD in the U.K. military: using data from
a clinical interview-based study. BMC Psychiatry 2009;9.
Jones M, Rona RJ, Hooper R, Wessely S. The burden of psychological symptoms in
U.K. Armed Forces. Occupational Medicine 2006;53:322e8.
Karasek R, Brisson C, Kawakami N, Houtman I, Bongers P, Amick B. The Job Content
Questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health
Psychology 1998;3:322e55.
Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U. The World health
Organization Composite International diagnostic interview Short-form
(CIDI-SF). International Journal of Methods in Psychiatric Research 1998;7:
171e85.
Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME, et al. Clinical
calibration of DSM-IV diagnoses in the World mental health (WMH) version of
the World health Organization (WHO) Composite International diagnostic
interview (WMH-CIDI). International Journal of Methods in Psychiatric
Research 2004;13:122e39.
Kessler RC, Ustun TB. The World mental health (WMH) survey Initiative version of
the World health Organization (WHO) Composite International diagnostic
interview (CIDI). The International Journal of methods in. Psychiatric Research
2004;13:93e121.
King LA, King DW, Vogt DS, Knight J, Samper RE. Deployment Risk and Resilience
Inventory: a collection of measures for studying deployment-related experiences of military personnel and veterans. Military Psychology 2006;18:
89e120.
King LA, King DW, Bolton EE, Knight JA, Vogt DS. Risk factors for mental, physical,
and functional health in Gulf War veterans. Journal of Rehabilitation Research &
Development 2008;45:395e408.
Kinley DJ, Walker JR, Mackenzie CS, Sareen J. Panic attacks and panic disorder in
a population-based sample of active Canadian military personnel. Journal of
Clinical Psychiatry 2011;72:66e74.
Mather AA, Stein MB, Sareen J. Social anxiety disorder and social fears in the
Candian military: prevalence, comorbidity, impairment, and treatment-seeking.
Journal of Psychiatric Research 2010;44:887e93.
Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health
problems among active and reserve component soldiers returning from the Iraq
war. Journal of the American Medical Association 2007;298:2141e8.
Murdoch M, Pryor JB, Polusny MA, Gackstetter GD. Functioning and psychiatric
symptoms among military men and women exposed to sexual stressors. Military Medicine 2007;172:718e25.
Pflanz SE, Ogle AD. Job stress, depression, work performance, and perceptions
of supervisors in military personnel. Military Medicine 2006;171:861e5.
Piccinelli M, Wilkinson G. Gender differences in depression: Critical review. The
British Journal of Psychiatry 2000;177:486e92.
Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Rivers AJ, Morgan CA, et al.
Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom:
the role of resilience, unit support, and postdeployment social support. Journal
of Affective Disorders 2010;120:188e92.
Research Triangle Institute (RTI). Software for survey data analyses (SUDAAN)
Version 9.01 [software]. Research Triangle Park (NC): RTI 2004.
Rona RJ, Fear NT, Hull L, Wessely S. Women in novel occupational roles: mental
health trends in the U.K. Armed Forces. International Journal of Epidemiology
2007;36:319e26.
Rosen LN, Martin L. Impact of childhood abuse history on psychological symptoms
among male and female soldiers in the U. S. Army. Child Abuse & Neglect 1996;
20:1149e60.
Sareen J, Cox BJ, Afifi TO, Stein MB, Belik S-L, Meadows G, et al. Combat and
peacekeeping operations in relation to prevalence of mental disorders and
perceived need for mental health care: findings from a large representative
sample of military personnel. Archives of General Psychiatry 2007;64:
843e52.
Sareen J, Belik S-L, Afifi TO, Asmundson GJ, Cox BJ, Stein MB. Canadian military
personnel’s population attributable fractions of mental disorders and mental
health service use associated with combat and peacekeeping operations.
American Journal of Public Health 2008;98:2191e8.
Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, et al. Crossnational associations between gender and mental disorders in the World health
Organization World mental health Surveys. Archives of General Psychiatry
2009;66:785e95.
Statistics Canada: Canadian forces 2002 CCHS Supplement: Briefing Document.
Ottawa (ON), 2003.
Street AE, Gradus JL, Stafford J, Kelly K. Gender differences in experiences of sexual
harassment: data from a male-dominated environment. Journal of Consulting
and Clinical Psychology 2007;75:464e74.
Street AE, Vogt D, Dutra L. A new generation of women veterans: stressors faced by
women deployed to Iraq and Afghanistan. Clinical Psychology Review 2009;29:
685e94.
Virtanen M, Honkonen T, Kivimäki M, Ahola K, Vahtera J, Aromaa A, et al. Work
stress, mental health and antidepressant medication findings from the health
2000 study. Journal of Affective Disorders 2007;98:189e97.
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014
N.P. Mota et al. / Journal of Psychiatric Research xxx (2011) 1e9
Vogt DS, Pless AP, King LA, King DW. Deployment stressors, gender, and mental
health outcomes among Gulf War I veterans. Journal of Traumatic Stress 2005;
18:115e27.
Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ. Validation of scales from the
deployment risk and resilience inventory in a sample of operation Iraqi
Freedom veterans. Assessment 2008a;15:391e403.
Vogt DS, Samper RE, King DW, King LA, Martin JA. Deployment stressors and
posttraumatic stress symptomatology: Comparing active duty and national
guard/reserve personnel from Gulf War I. Journal of Traumatic Stress 2008b;21:
66e74.
9
Wang J. Perceived work stress and major depressive episodes in a population of
employed Canadians over 18 years old. Journal of Nervous and Mental Disease
2004;192:160e3.
Wang JL. Work stress as a risk factor for major depressive episode(s). Psychological
Medicine 2005;35:865e71.
Wang JL, Lesage A, Schmitz N, Drapeau A. The relationship between work stress and
mental disorders in men and women: findings from a population-based study.
J Epidemiol Community Health 2008;62:42e7.
Zeichner A, Parrott DJ, Frey FC. Gender differences in laboratory aggression under
response choice conditions. Aggressive Behavior 2003;29:95e106.
Please cite this article in press as: Mota NP, et al., Stress and mental disorders in female military personnel: Comparisons between the sexes in
a male dominated profession, Journal of Psychiatric Research (2011), doi:10.1016/j.jpsychires.2011.09.014