Measurement of military combat exposure among women: analysis and implications

To examine combat exposure measurement instruments utilized since the Vietnam War, determine how these instruments were developed and psychometrically tested, and if they are appropriate for use with women veterans exposed to combat.

A literature search for articles concerning combat exposure instruments, their development, and their psychometric properties in relation to women was conducted in several electronic databases. Limited MeSH subject headings required keyword searches with terms such as combat stress, war trauma, and deployment stressors. Instruments were selected for analysis based on their inclusion of combat and combat-related traumatic event measures.

Eight instruments were retained for critical appraisal. The majority of instruments were developed and validated based on male veterans' combat experiences from the Vietnam War through the Gulf War. Located instruments explained their methodological development and indicated the type of exposure being measured. Reliability measures for the majority were acceptable, and validity was established to varying degrees and with different methods. Limitations of all instruments included retrospective self-reporting, potential recall error, and the inability to validate individual exposure objectively.

Women veterans are substantially under-represented in the development and psychometric testing of combat exposure instruments, indicating a male gender bias in most combat measures. Only two instruments utilized women veterans in their validation samples, and six instruments used gender-neutral terminology. Instruments developed and validated with male veterans for specific military conflicts may not reflect the combat experiences of women.