IMHS Literature Review

PHCoE conducted a refresh of the Integrated Mental Health Strategy (IMHS), Strategic Action #28 Task Group’s summary literature review, 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.

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.

  • The prevalence of depression among female service members was estimated to range from 4.3 percent, to 7.5 percent.

  • 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.

  • 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.

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

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,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 .

  • 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.

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.

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.

Other Disorder

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

  • The incidence rate of eating disorders (ED) is over 20 times higher in female active duty service members than in male service members.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.