Document Type


Date of Degree

Spring 2013

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Lutgendorf, Susan K

First Committee Member

Lawrence, Erika

Second Committee Member

Marchman, James

Third Committee Member

Sadler, Anne

Fourth Committee Member

Segre, Lisa

Fifth Committee Member

Vander Weg, Mark


BACKGROUND: Female veterans are at risk for stress-related physical disorders given unique environmental stress factors, high rates of trauma exposure and a heightened physiologic stress response. There is a need to identify modifiable risk factors which may help minimize the emergence and impact of veteran illness. RESEARCH QUESTION: The present study investigated the contributions of posttraumatic stress symptoms, maladaptive repetitive thought (MRT), depression, childhood trauma and health behaviors (sleep, alcohol use and smoking) to physical disease as operationalized by immune-mediated inflammatory disease occurrence and related functional disability. METHOD: Female Reserve or National Guard veterans (N = 643) enrolled in a parent study conducted through the Iowa City Veteran's Affairs Hospital completed a one-time computer-assisted telephone interview. The current study examined self-report measures of posttraumatic stress symptoms, MRT, depression, childhood trauma, smoking, alcohol use, sleep, inflammatory disease incidence and physical functioning. RESULTS: Proposed models of primary hypotheses were tested using structural equation modeling. Results indicated that both physical disease and functional decline were greater in veterans reporting a history of trauma. Physical disease was associated with greater depression and childhood trauma but lower levels of alcohol use after accounting for covariates. Unexpectedly, greater MRT was associated with less physical disease, although it was only related to disease when depression was included as a covariate. Reduced sleep was linked with greater disease but only when depression was not included in the model, and depression was found to fully mediate the relationship between sleep and physical disease. Smoking and the interaction between posttraumatic stress symptoms and MRT were generally unrelated to physical disease in this sample. CONCLUSIONS: Results of this study are consistent with the hypothesis that physical disorders and related functional decline are greater in trauma-exposed individuals and that depression, childhood trauma, repetitive thought and alcohol use have independent associations with physical disease. This study offers support for further research and interventions which address these relationships to protect female veteran health.


inflammatory disease, physical disease, posttraumatic stress disorder, repetitive thought, veterans, women


ix, 130 pages


Includes bibliographical references (pages 89-110).


Copyright 2013 Elizabeth Ann Mullen-Houser

Included in

Psychology Commons