Study: Women military members at risk for mental health woes

Combat exposure increased the odds of Army enlisted women returning from Afghanistan or Iraq of developing post-deployment behavioral health problems, according to a new study led by a Brandeis University researcher.

Active duty and National Guard/Reserve enlisted women had a similar prevalence of posttraumatic stress disorder, depression and at-risk drinking, reports the study published in the August issue of the Journal of Traumatic Stress.

The U.S. Department of Veterans Affairs projects women will account for 18 percent of the veteran population by 2035, the fastest growing group. But research on military populations has generally focused on the entire population, which is mostly male.

“Sometimes women are excluded from studies. Often they’re not excluded but they’re not analyzed separately. So the experiences of women are often just unclear,” said lead author Rachel Sayko Adams, Ph.D., MPH, a scientist at the Institute for Behavioral Health at the Heller School for Social Policy & Management at Brandeis University in Waltham, Mass.

The study funded by the National Institute of Drug Abuse examined the self-reported scores of 42,397 enlisted women serving during fiscal 2008 through 2011 who were assigned combat exposure scores from zero, one, two, three or more. Two-thirds of the participants were active duty. Each servicewoman was assessed with four items drawn from the Combat Experience Scale: Were you wounded, injured, assaulted or otherwise hurt?; Did you encounter dead bodies or see people killed or wounded?; Were you engaged in direct combat where you discharged a weapon?; Did you ever feel that you were in great danger or of being killed?

A combat exposure score of 3+ made a servicewoman more than 20 times more likely to screen positive for PTSD than a no combat score and also four times more likely to screen positive for depression. They were also almost twice as likely to screen positive for at-risk drinking.

But any report of combat exposure was associated with an increased likelihood of PTSD, depression, and at-risk drinking, suggesting the impact of even one exposure event should not be overlooked.

Previous research has suggested men were more likely to report problem drinking. But Adams said that while military women tend to drink less heavily than their male counterparts, “that doesn’t mean it’s not risky.” The study found that exactly 22.6 percent of female active duty personnel and 22.6 percent of National Guard reservists had a positive screening for at risk drinking.

A striking difference was that 29 percent of National Guard/Reserve members reported being wounded, injured, assaulted or hurt compared to 17.3 percent of active duty women. “That needs to be explored,” Adams said.

National Guard/Reserve members were more likely to be first-deployers, Adams said.

“A lot of people think if you have prior deployment, that means you’re more likely to have problems,” she said. “But actually there’s this healthy warrior effect. They have more resilience. They’re actually a little bit healthier so they’re the ones getting sent back.”

Researchers said it was unclear if the screening picked up reports of military sexual assault during deployment because the questionnaire did not directly ask about it. Prior studies have suggested military sexual assault is a risk factor for PTSD and depression.

The study used data collected from a Department of Defense assessment screener tool administered to all military personnel within 30 to 60 days of the end of their deployments in combat zones. “For some people it could have been on the plane on the way home or when they’re in Germany, before they board the plane to come home and some people right when they get back,” Adams said.

“It’s important to remember that these screens are not anonymous. This data is used to share with commanders about how these members are doing. So there may be reasons why women don’t want to disclose that they’re not doing well.”

The data also did not ask if respondents experienced trauma or drinking problems prior to enlisting in the military.

Defense Secretary Ashton Carter approved final plans lifting the ban on women in combat jobs last March after announcing in December 2015 that all military career fields would be open to qualified women. So the servicewomen in the study were not officially in combat roles at the time they were deployed.

“They may not have received the same training as males because their roles weren’t specifically intended to be combat,” Adams said. “So it’s important to think about how can female service members, even if they’re not in a combat role, be prepared for witnessing trauma, experiencing trauma.”

Adams said another analysis is looking at responses to a second screening participants took three to six months post-deployment to track how well they were doing and determine the impact of early access to treatment.