From previous studies of Army men we know that combat exposure leads to increased symptoms of posttraumatic stress disorder (PTSD), depression and adjustment problems. However, even though women have comprised approximately 10 percent of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) deployments, we know very little about their combat exposure and the consequences of such exposure. While research on women veterans receiving care at Veterans Health Administration (VHA) facilities is increasing, this group is not necessarily representative of all women returning from deployments because many do not use care at a VHA (Harris et al., 2014; Vanneman et al., 2015).
Using data from our longitudinal, observational study of Army service members returning from OEF/OIF deployments in fiscal years 2008 to 2011, we investigated how combat exposure affects women’s reporting of problems including PTSD, depression and at-risk drinking after coming home. We analyzed health questionnaire data that the Department of Defense (DoD) gathers from all service members returning from deployments, which included behavioral health screening items and four items about combat exposure. The sample consisted of 42,397 Active Duty (AD) and National Guard and Reservists (NG/R) women. We believe this to be the largest representative sample of deployed women ever studied.
We found high rates of women who reported being injured, wounded, assaulted or hurt during their deployment, including 17 percent of AD and 29 percent of NG/R. It is unclear if this item captured military sexual assault during deployment as the DoD’s health questionnaire did not include a direct assessment of instances of military sexual assault. Almost 20 percent of women reported feeling in great danger of being killed, and 16 percent of AD and 12 percent of NG/R reported encountering dead bodies or seeing people killed even though firing a weapon was not common (about 1 percent). We found that approximately 10 percent of women screened positive for PTSD, 10 percent for depression, and almost 23 percent screened positive for at-risk drinking.
Our findings are the first to indicate a noteworthy relationship between combat exposure and postdeployment behavioral health problems among enlisted Army women. As the number of types of combat exposure increased, so did the odds of screening positive for PTSD and depression. For instance, compared to women with no combat exposure, women who reported one type of combat exposure had four times the odds of screening positive for PTSD, and women who had three or four types of combat exposure had more than 20 times the odds of screening positive for PTSD compared to women with no combat exposure. These results are consistent with findings reported by Gallaway et al. (2013) on lifetime combat exposure among a smaller sample of a mostly male population of Army OIF members. Importantly, we also found that any
report of combat exposure among Army women was associated with increased odds of each postdeployment behavioral health problem (PTSD, depression, and at-risk drinking), suggesting that the impact of even one exposure event should not be overlooked. This is consistent with findings reported for PTSD and depression based on earlier and smaller cohorts (Maguen, Luxton, Skopp, & Madden, 2012; Seelig et al., 2012).
Given our findings, we suggest that pro-active attention be paid to injuries, assaults or combat exposures experienced among women as well as men during deployment so that effective prevention strategies can be implemented. Our findings confirm support for ongoing force-wide screening for behavioral health problems, while highlighting the importance of launching and testing public health interventions such as screening and brief intervention for alcohol misuse. Force-wide programs to improve the psychological wellbeing of the Armed Forces, such as suicide prevention programs, should be evaluated for both women and men service members. Even though women are one of the fastest growing groups using the Veterans Health Administration (VHA) (Bean-Mayberry et al., 2010), additional outreach is needed to increase the likelihood that Army women who served in OEF/OIF will receive appropriate care within the VHA.
Adams, R.S., Nikitin, R.V., Wooten, N.R., T.V., Williams, & Larson M.J. (In Press). 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.
- How can the DoD and VHA improve behavioral health programming targeted to women?
- What are some ways to improve the transition and likelihood of use of the VHA among women combat veterans who leave the military?
Rachel Sayko Adams, PhD, MPH
is a Scientist at the Institute for Behavioral Health at Brandeis University’s Heller School for Social Policy and Management. Her research focuses on the postdeployment substance use and behavioral health needs of military service members, veterans, and their families. She has led several publications examining the association between combat-acquired traumatic brain injury, PTSD, and their relative associations with postdeployment unhealthy alcohol use.
Mary Jo Larson, PhD, MPA
is a Senior Scientist at the Institute for Behavioral Health at Brandeis University’s Heller School for Social Policy. She led the Substance Use and Psychological Injury Combat (SUPIC) study (NIDA, R01 DA03015, PI: Larson), a longitudinal study of the postdeployment psychological health and substance use outcomes of Army service members. Currently, along with Dr. Adams, she is analyzing use of complementary and integrative medicine as a substitute or complement to opioids when treating Army members with chronic pain (NCCIH, R01 AT008404, PI: Larson). She served on two IOM committees examining the substance use and psychological health of the Armed Forces.
Bean-Mayberry, B., Huang, C., Batuman, F., Goldzweig, C., Washington, D. L., Yano, E. M., & Miake-Lye, I. M. (2010). Systematic review of women veterans health research 2004-2008
. Washington DC.
Gallaway, M. S., Fink, D. S., Millikan, A. M., Mitchell, M. M., & Bell, M. R. (2013). The association between combat exposure and negative behavioral and psychiatric conditions. The journal of nervous and mental disease, 201
(7), 572-578. doi:10.1097/NMD.0b013e318298296a
Harris, Alex H.S., Chen, Cheng., Mohr, Beth A., Adams, Rachel Sayko., Williams, Thomas V., & Larson, Mary Jo. (2014). Predictors of Army National Guard and reserve members use of Veterans Health Administration health care after demobilizing from OEF/OIF deployment. Military Medicine,, 179
(10), 1090-1098, [PMCID - in process]. doi:10.7205/MILMED-D-13-00521
Maguen, S., Luxton, D. D., Skopp, N. A., & Madden, E. (2012). Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. Journal of Psychiatric Research, 46
(3), 311-316. doi:10.1016/j.jpsychires.2011.11.007
Seelig, A. D., Jacobson, I. G., Smith, B., Hooper, T. I., Gackstetter, G. D., Ryan, M. A., . . . Smith, T. C. (2012). Prospective evaluation of mental health and deployment experience among women in the US military. American Journal of Epidemiology, 176
(2), 135-145. doi:10.1093/aje/kwr496
Vanneman, Megan E., Harris, Alex H.S., Chen, Cheng, Mohr, Beth, Adams, Rachel Sayko, Williams, Thomas V., & Larson, Mary Jo. (2015). Army Active Duty Member's Linkage to Veterans Health Administration Services after Deployments to Iraq or Afghanistan and Following Separation. Mil Med, 180