Many soldiers returning from war suffer from invisible wounds. One of the common injuries seen today are traumatic brain injuries (TBI), which can be caused by a blow to the head or being in the vicinity of an explosion. But are female soldiers affected differently than men by this trauma?
One researcher with extensive background in brain trauma and neurosurgery led some research to find out. Meet Dr. Odette Harris: associate professor of Neurosurgery and director of Brain Injury at Stanford University School of Medicine, as well as the Associate Chief of Staff, Polytrauma at the VA Palo Alto Health Care System, and the Site Director/Principal Investigator of the Defense Veterans and Brain Injury Center Palo Alto site.
Most research performed thus far on TBIs have been done on men, especially since males make up majority of injured veterans. So when Dr. Harris’ team realized women’s issues may be being overlooked just because of the sheer numbers of them in the pool of patients, they decided to dive deeper to see what was really happening.
Dr. Harris took a few minutes to discuss her research with us, as well as how she hopes her work will lead to a better understanding of how to treat and assist these veterans as they try to recover. Below is an edited, condensed version of our conversation.
TSR: What made you decide to take on this research and explore the differences in how women are affected differently by TBI injuries than men?
Dr. Harris: What sort of started it all was our own [Quality Improvement] projects that we were doing looking at the population that we are serving to sort of assess the effectiveness of our stewardship of the resources. We wanted to understand the decisions that we were making in terms of admissions and referrals and redirecting referrals were all valid decisions.
So while assessing that data we thought that we noticed there were some discrepancies in admissions patterns. As we narrowed in on the data we realized that there really wasn’t that bias introduced at all, but that in fact it had a lot to do with the female population was so small, that subtle changes in the data caused great swings.
So 1 patient in a cohort of 4 for instance is 25% allows and can cause an exaggerated statistic. And so what we found was that the cohort was so small that we needed to have special attention to how we were applying the methodologies and that became the springboard to sort of understand what was happening to women in the general cohort.
TSR: What results from the research were more striking or interesting to you?
Dr. Harris: I think a lot of what was published is actually what one would expect. It was not as if our data deviated so dramatically from the established data. However, what was interesting is that the percentages to which things were represented in the female cohort were so either under-representing or over-represented.
The example I give is that of depression. In the lay media and in the research arena a lot of attention has been given to mental health and its effect on this population, and rightfully so. What was striking to us was take something like depression. Where you’ve got numbers of 33% or so when you look at published literature but we were finding that to be greater than 90% in our female cohort so far in our preliminary analysis. Even the numbers of Post-Traumatic Stress Disorder, which are striking in the existing cohort, somewhere around 68% or so. In our [female] cohort we found that to be closer to 90%.
So, the extent to which this was affecting our cohort was very striking.
The other statistics that were very surprising and striking to us, or to me anyway, was that we knew that unemployment was a factor in this cohort as a whole and we knew that unemployment rates are quite striking and they are higher than the general unemployment rate, and so on and so forth.
But what was amazing to us was that women tended to have a higher percentage of unemployment, despite having higher education levels. And that is not something that one would expect in any literature. You would think that education would be coupled with lower unemployment rates or higher employment rates and we did not find that. We also found homelessness to be higher among the cohort as well, and again, coupled with a higher education that was not something that we expected.
TSR: Do you think we will – and should – see more research specifically done on the female population to decipher if there are striking and important differences in how men and women are affected by illness and injury?
Dr. Harris: Yes and I don’t think we are first to publish in this arena and I hope we are not the last to publish in this arena. I think what our project has done, and I hope it continues to do as we get more and more data, is to add to this gap in understanding of this population. And it is supported by other people who have looked at it as well.
The Institute of Medicine came out with their data in March 2013 and has similar recommendations in terms of improved methodologies when examining these issues specific to a subpopulation. There’s also been set specific reporting on scientific research has also been released by the National Academy of Press that is another group that said we need to pay more attention to gender division.
The Clayman Institute of Gender Research at Stanford has been really, really active in this arena. Londa Schiebinger is at the Clayman institute and she is actually the chairperson on the report of the expert group of Innovations through Gender that was presented to the European Commission, how gender analysis contributes to research.
And so Stanford has been at the forefront of this and our research has support from the Clayman Institute and the community and is more reflective of that movement as opposed to driving the movement. I think we are actually in line with the movement.
TSR: What do you hope to see as an outcome from the research?
Dr. Harris: I think research begets more research. And I think the fact that all of these different reports are coming out supporting the significance will improve the methodologies of research that is being done
I think that when people go to make funding decisions they look to the research that is available and if the research is not there, then a lot of times these gaps persist because they are not funded. So my hope is that our research is used and referenced when decisions are made as to what to fund further.
And specifically, when I talk about the gap between education and employment, a natural inclination when one sees unemployment rates is to think well lets direct funding toward education to increase opportunities, etc. But I think that is only part of the story as reflected in the data in the female cohort.
Unemployment as secondary to education is not the whole picture and there are other things that we are not understanding in that particular cohort. So I’m hoping the research asks more questions that we can then engage in more research to be able to answer. So I do hope it serves as a platform for that further discussion, which I think up to now the data has not been there to be able to have a data-driven analysis of these questions so I hope to be able to provide that.
TSR: Anything else you would like to add?
Dr. Harris: There has been an incredible amount of support for this population of polytrauma individuals, both male and female, and I think the infrastructure that that support has provided has really led to be able to do research like this. I think there is a lot of care and concern for the population evidenced by the resources that have been allocated and the infrastructure that has been developed. And we are being stewards of those resources and saying how can we use this information and use these resources to better that population.
I’m very grateful for that and hope it is understood and appreciated. People have really sort of reflected and appreciated that this particular population is unique and under unique stressors and so forth. I think we have not had the ability in previous conflicts for whatever reason to focus on these populations to get that information as to how they can be affected and different in their own ways. I think that the current stressors are unique in allowing that.
Dr. Odette Harris is an Associate Professor of Neurosurgery and Director of Brain Injury at Stanford University School of Medicine. She is the Associate Chief of Staff, Polytrauma at the VA Palo Alto Health Care System. Harris is also the Site Director/Principal Investigator of the Defense Veterans and Brain Injury Center Palo Alto site. Upon completing her neurosurgical residency, Harris was awarded the William VanWagenen Fellowship from the American Association of Neurological Surgeons. She is a Clayman Institute Faculty Research Fellow.
Dr. Harris graduated from Dartmouth College and received her MD degree from Stanford University School of Medicine. She completed internship and residency at Stanford University Medical Center and earned a MPH from the University of California, Berkeley.
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