Risk and Protective Factors Associated Mental Health among Female Military Veterans: Results from the Veterans’ Health Study (original) (raw)

2019, Research Square (Research Square)

Background: This study focuses on factors that may affect female veterans' mental health, compared to men, and is part of a large study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods: We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our models for confounding factors, including history of childhood abuse, combat exposure, stressful life events, alcohol misuse, psychological resources, and social support. Results: Among the veterans studied, 5% (N=85) were female, 96% were White, 22.9% were Iraq/Afghanistan veterans, and the mean age was 59 years old. Compared to males, female veterans were younger, unmarried, college graduates, have less combat exposure, but more likely to have lifetime PTSD (29% vs. 12%.), lifetime depression (46% vs. 21%), and lifetime suicide ideation (27% vs. 11%). Females were more likely to have low psychological resilience and use psychotropic medicines and psychiatric services in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, lifetime depression, and lifetime suicidal thoughts, compared to men. Since the 95% of the population in this study were men and these results may have been statistically biased, we reran our analyses using propensity score matching. The results were the same. Conclusion: Using a sample of post-deployment veterans receiving services from a non-VA healthcare system, we nd that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these ndings and their implications for service providers. Background Currently, women are one the fastest growing demographic groups in the military, and the proportion of female military service members and veterans is at its highest level ever in the United States and other industrialized countries. 1,2 Although women currently comprise only 17% of US active duty forces, this percentage is expected to grow. Growth is even greater in the National Guard/Reserve component of the US military. Given current trends, by 2042, women veterans in the US will comprise over 16% of the total veteran population. 1 These trends are even more pronounced in other advanced industrial countries. 3,4 Thus, it is critical that we conduct research on factors affecting the well-being of women serving in the armed forces. The goal of this research project is to assess both military deployment factors and post-deployment experiences that may contribute to lifetime psychological disorders, especially Posttraumatic Stress Disorder (PTSD), in female veterans, post-deployment, compared to their male counterparts, in order to plan better interventions. Based on previous research, we hypothesize that female veterans receiving healthcare will have higher rates of PTSD and other mental health problems, compared to male veterans. This hypothesis is tentative, however, as research on sex differences in psychological problems among veterans is inconsistent. Some research reports similar combat experiences and stress exposures for men and women among active duty military personnel and few sex differences in rates of mental health problems. 5, 6 Other research shows that women's military experiences and their response to those experiences are often different from men's, placing them at higher risk for psychological problems. 3, 7−9 For example, women experience signi cantly more sexual harassment and sexual assault prior to and during military service. 3, 10 Finally, some research nds that male veterans are at greater psychological risk for mental health problems. 11 Our analysis examines if (1) trauma experiences (both military and non-military) and psychological well-being differ between male and female veterans and (2) if we can explain the well-being differences using multivariate statistical analysis controlling for confounding and other risk factors. Possible reasons for these sex differences include exposure to different types of trauma, genetics, emotional learning, gender socialization, and memory processing. 2 Many of the inconsistent results related to sex differences found in empirical studies of US veterans are also seen in studies of veterans from other industrialized countries. In their study of Canadian veterans, Brunet et al. (2015) report that females were less likely to experience combat related traumas, but more likely to suffer from sexual assaults compared to male Canadian veterans. 3 Like some US studies, 7 female Canadian veterans were also more likely to meet criteria for PTSD than male Canadian veterans. Woodhead et al., in contrast, report few mental health differences between male and female UK veterans, although these results may be due to the relatively few women in the sample. 4 Much of the previous research on deployment and veteran well-being analyze data from veterans seeking services from the US Veterans Administration (VA), 11−13 or other government funded healthcare systems. 4 Our sample, in contrast, comes from a community population of veterans receiving healthcare from a large non-VA system, since many veterans in the US do not use VA healthcare services and recent policy changes will likely increase the number of veterans seeking care from other providers in the future. 14−16 It should be noted, however, that many participants in our study also receive healthcare from the VA. Thus, this study provides insight into a population of veterans that may overlap with VA-based samples, but is different from those used in previous studies. Seeking treatment outside of traditional military healthcare systems may also inform policy planning in other countries to the extent that their military institutions are undergoing change and veterans are seeking care in the civilian healthcare system. Methods Procedure Data were collected via a telephone survey from a sample of community-based U.S. military veterans recruited to assess the health effects of military service. 15 All participants were outpatients of Geisinger Clinic, the largest multi-hospital system in central and northeastern Pennsylvania (see: www.geisinger.org), serving more than 3 million residents. Starting in 2007, Geisinger Clinic began to keep records on veteran status and patients were asked to complete a military history questionnaire. Participants were randomly selected using Geisinger's Electronic Health Record (EHR) system. We excluded