Current State of Women’s Mental Health Research

PHCoE conducted a refresh of the Integrated Mental Health Strategy (IMHS), Strategic Action #28 Task Group’s summary literature review [ Reference 1 ], by reviewing research from 2010-2016 to better understand the current state of the science of the unique mental health needs of female service members, both active duty and veterans. Studies that examined gender differences and disparities in the delivery, effectiveness, barriers and access to mental health treatment and prevention services were also included in the review. The review’s key findings include:

Prevalence

  • A study by the Armed Forces Health Surveillance Branch (AFHSB) assessed gender differences in prevalence rates of mental health diagnosis in active duty service members. Overall, mental health diagnoses were more frequently diagnosed in female active duty service members than male active duty service members. [ Reference 2 ]

Depression

  • Anxiety and depressive disorders were 1.4 to 1.9 times more often diagnosed, respectively, in active duty service women compared to active duty men. [ Reference 2 ]

  • The prevalence of depression among female service members was estimated to range from 4.3 percent[ Reference 3 ], to 7.5 percent.[ Reference 4 ]

  • The incidence of perinatal depression (PND), which includes both the prenatal and postpartum periods, is estimated to be as high as 24 percent in female service members. Similar civilian studies provided incidence rates ranging from 5 to 25 percent.[ Reference 5 ]

  • The highest prevalence of PND symptoms (16.6 percent) was found in female service members who had deployed after childbirth and who experienced combat exposure.[ Reference 5 ],[ Reference 6 ]

  • As the level of combat exposure increases, the risk of depression in female service members increases.[ Reference 7 ]

Posttraumatic Stress Disorder (PTSD)

  • A large cross-sectional study of female Army enlisted members concluded that combat exposure is a risk factor for post-deployment PTSD, with cumulative exposures having greater odds for mental health problems[ Reference 7 ],suggesting that males and females respond similarly to experiencing combat trauma.

  • Results from studies that examine gender differences and PTSD suggest that female service members are at a higher risk for post-deployment PTSD than male service members .[ Reference 8 ], [ Reference 9 ]

  • Results from female veterans studies show a significant predictive relationship between deployment-related traumatic stressors, most notably combat experiences and sexual assault and sexual harassment, and PTSD outcomes.[ Reference 10 ], [ Reference 11 ], [ Reference 12 ], [ Reference 13 ], [ Reference 14 ], [ Reference 15 ]

Alcohol and Substance Use

  • Stressors that are high in a military population, such as combat and deployment, increase the rates of both substance use disorder and alcohol use disorder in both male and female service members.[ Reference 16 ], [ Reference 17 ]

Suicide

  • From 2000 to 2010, the number of completed suicides in women veterans increased by 40 percent  as reported in a cross-sectional study of the VA suicide database.[ Reference 18 ]

Other Disorder

  • Adjustment and personality disorders were more than twice as often diagnosed in active duty service women compared to active duty men. [ Reference 2 ]

  • The incidence rate of eating disorders (ED) is over 20 times higher in female active duty service members than in male service members.[ Reference 19 ] Overall, among female service members, EDs were highest for younger service members, Caucasian service members and members of the Marine Corps.

*The use of the term “female service members” in this study refers to both active duty and veterans

References

  1. VA/DoD Integrated Mental Health Strategy Strategic Action 28 Task Group. (2013). Summary Report of a Systematic Literature Review: Female Mental Health Needs and Military Sexual Trauma, Assault, and Harassment among Military Service Members and Veterans of Both Genders.

  2. AFHSB. (2012b). Mental disorders and mental health problems, active component, U.S. Armed Forces, 2000-2011. MSMR, 19(6), 11–17.

  3. Seelig, A. D., Jacobson, I. G., Smith, B., Hooper, T. I., Gackstetter, G. D., Ryan, M. A. K., … Millennium Cohort Study Team. (2012). Prospective evaluation of mental health and deployment experience among women in the US military. American Journal of Epidemiology, 176(2), 135–145. https://doi.org/10.1093/aje/kwr496

  4. Ursano, R. J., Wang, J., Ramsawh, H., Russell, D., Benfer, N., Gifford, R. K., … Fullerton, C. S. (2016). Post-traumatic stress disorder, depression, and binge drinking in the Reserve component of the U.S. Armed Forces. Military Medicine, 181(10), 1287–1293. https://doi.org/10.7205/MILMED-D-15-00445

  5. Klaman, S. L., & Turner, K. (2016). Prevalence of perinatal depression in the military: A systematic review of the literature. Maternal and Child Health Journal, 20(Suppl 1), 52–65. https://doi.org/10.1007/s10995-016-2172-0

  6. Nguyen, S., Leardmann, C. A., Smith, B., Conlin, A. M. S., Slymen, D. J., Hooper, T. I., … Millennium Cohort Study Team. (2013). Is military deployment a risk factor for maternal depression? Journal of Women’s Health (2002), 22(1), 9–18. https://doi.org/10.1089/jwh.2012.3606

  7. Adams, R. S., Nikitin, R. V., Wooten, N. R., Williams, T. V., & Larson, M. J. (2016). The association of combat exposure with postdeployment behavioral health problems among U.S. Army enlisted women returning from Afghanistan or Iraq. Journal of Traumatic Stress, 29(4), 356–364. https://doi.org/10.1002/jts.22121

  8. Crum-Cianflone, N. F., & Jacobson, I. (2014). Gender differences of postdeployment post-traumatic stress disorder among service members and veterans of the Iraq and Afghanistan conflicts. Epidemiologic Reviews, 36, 5–18. https://doi.org/10.1093/epirev/mxt005

  9. Jacobson, I. G., Donoho, C. J., Crum-Cianflone, N. F., & Maguen, S. (2015). Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan. Journal of Psychiatric Research, 68, 30–36. https://doi.org/10.1016/j.jpsychires.2015.05.015

  10. Cobb Scott, J., Pietrzak, R. H., Mattocks, K., Southwick, S. M., Brandt, C., & Haskell, S. (2013). Gender differences in the correlates of hazardous drinking among Iraq and Afghanistan veterans. Drug and Alcohol Dependence, 127(1–3), 15–22. https://doi.org/10.1016/j.drugalcdep.2012.06.003

  11. Kelly, U. A., Skelton, K., Patel, M., & Bradley, B. (2011). More than military sexual trauma: interpersonal violence, PTSD, and mental health in women veterans. Research in Nursing & Health, 34(6), 457–467. https://doi.org/10.1002/nur.20453

  12. Kintzle, S., Schuyler, A. C., Ray-Letourneau, D., Ozuna, S. M., Munch, C., Xintarianos, E., … Castro, C. A. (2015). Sexual trauma in the military: Exploring PTSD and mental health care utilization in female veterans. Psychological Services, 12(4), 394–401. https://doi.org/10.1037/ser0000054

  13. Klingensmith, K., Tsai, J., Mota, N., Southwick, S. M., & Pietrzak, R. H. (2014). Military sexual trauma in US veterans: Results from the National Health and Resilience in Veterans study. The Journal of Clinical Psychiatry, 75(10), e1133-1139. https://doi.org/10.4088/JCP.14m09244

  14. Maguen, S., Cohen, B., Ren, L., Bosch, J., Kimerling, R., & Seal, K. (2012). Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan veterans with posttraumatic stress disorder. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 22(1), e61-66. https://doi.org/10.1016/j.whi.2011.07.010

  15. Street, A. E., Gradus, J. L., Giasson, H. L., Vogt, D., & Resick, P. A. (2013). Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq. Journal of General Internal Medicine, 28 Suppl 2, S556-562. https://doi.org/10.1007/s11606-013-2333-4

  16. Gobin, R. L., Green, K. E., & Iverson, K. M. (2015). Alcohol misuse among female veterans: Exploring associations with interpersonal violence and mental health. Substance Use & Misuse, 50(14), 1765–1777. https://doi.org/10.3109/10826084.2015.1037398

  17. Hoggatt, K. J., Jamison, A. L., Lehavot, K., Cucciare, M. A., Timko, C., & Simpson, T. L. (2015). Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiologic Reviews, 37, 23–37. https://doi.org/10.1093/epirev/mxu010

  18. Hoffmire, C. A., Kemp, J. E., & Bossarte, R. M. (2015). Changes in suicide mortality for veterans and nonveterans by gender and history of VHA service use, 2000-2010. Psychiatric Services (Washington, D.C.), 66(9), 959–965. https://doi.org/10.1176/appi.ps.201400031

  19. AFHSB. (2014). Diagnoses of eating disorders among active component service members, U.S. Armed Forces, 2004-2013. MSMR, 21(9), 8–12.