Female combat amputees have higher rates of posttraumatic stress disorder disability

The civilian trauma literature suggests that the sexes differ in physical and mental health outcomes following traumatic injury. In order to determine if the reaction to combat injury is different between the sexes in a specific war wounded population, service members with amputations, we examined the disability profiles of male and female amputees.

All US combatants who sustained a major extremity amputation between October 2001 and July 2011 were examined for demographic and injury information from the Department of Defense Trauma Registry and for disability outcomes in the service specific Physical Evaluation Boards. The proportions of women versus men with various disabling conditions were compared using Fisher's Exact Test and the mean disability ratings for each condition were compared using student's t tests.

Among 1,107 amputees, 21 were female. There was no difference in the average age, military rank, or Injury Severity Score between the sexes. While the most common military occupation of male amputees was infantry service, the most common occupation for the female amputee was military police. The overall disability ratings between females and males were not different (82% for females, 75% for males). Female amputees had more frequent disability from posttraumatic stress disorder (PTSD, 8/21 [38%] vs 168/818 [17%]). Disability ratings from PTSD tended to also be higher in women.

Outside of variable occupational descriptions, both male and female amputees were exposed to explosions resulting in their injuries. Consistent with many civilian trauma and veterans' population studies, female amputees have higher frequencies of disability from PTSD. These results support the need for additional effort and attention directed towards optimizing physical and mental fitness following deployment in order to reduce disability and promote return to duty. Because certain conditions, such as PTSD, may be more or less common in men versus women veterans, postdeployment fitness may need to be tailored in a gender specific way.