Depression in Female Veterans Returning from Deployment: The Role of Social Factors
Objective
Women are serving in the armed forces and deployed to areas of conflict in increasing numbers. Problems such as depressive symptoms and risks related to combat exposure can have negative effects on adjustment following service; understanding the relationship between these problems may contribute to strategies providers can use to facilitate healthy adjustment after deployment. The purpose of this study is to examine social factors as they relate to mental health adjustment, namely depressive symptoms among female veterans who served in Iraq and Afghanistan as part of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OND). We hypothesized that combat exposure would predict higher levels of depressive symptoms and that social support would moderate the relationship between combat exposure and depression.
Methods
In a cross-sectional design, 128 female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans completed an online survey about combat experience, social support, depression, demographic characteristics, and behavioral health symptom history. We conducted multiple regression analyses to examine linear and moderating relationships.
Results
There was no significant relationship between combat exposure and depression; social support did not significantly moderate the relationship between combat exposure and depression. However, higher levels of social support and financial comfort were significantly related to lower levels of depression.
Conclusion
This study highlights the role of social factors, specifically social support and perceived financial status, as potential barriers to healthy emotional readjustment following deployment. These findings suggest that it may be beneficial for mental health providers to screen female veterans and refer them to appropriate services to reduce financial stressors and strengthen their use of social support. More research should continue to examine more fully the impact of combat exposure on female service members’ mental health and work to isolate the factors most strongly related to depression.
Background
This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger 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 results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support.
Results
Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medications in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses.
Conclusion
Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.
Risk Factors for Postpartum Depression in Active Duty Women
Introduction
Postpartum depression (PPD) is a common perinatal complication. Risk factors previously found to correlate with PPD in civilians include prenatal depression, childcare stress, limited social support, difficult infant temperament, and maternity blues. Previously identified risk factors in military spouses include spouse deployment/redeployment cycles. It is unclear if these previously identified risk factors are also a risk factor for AD women or if the additional stressors associated with being on active duty (AD) are risk factors for PPD. The purpose of this review is to determine if civilian risk factors have been found to put AD women at risk for PPD and to identify unique risk factors for PPD in AD women.
Materials and Methods
A scoping literature review was performed using PubMed, Defense Technical Information Center, and PsychINFO. The searches were conducted using relevant medical subject headings and keywords. The inclusion criteria included articles published since 1948 (the year women were legally allowed to join the military) that reference risk factors for postpartum/peripartum depression in AD women serving in the U.S. military. The following exclusion criteria were also applied: in a language other than English, opinion papers, and/or not published in a peer-reviewed journal. Articles meeting criteria were evaluated and mapped to stressors previously identified in the literature for civilian and military spouses with PPD with novel stressors identified as mapping outside this framework.
Results
Only two articles met the inclusion criteria. The first study included 87 AD women. The second study, a cohort study between 2001 and 2008, included 1660 AD women. Unique risk factors identified in AD women include previous deployments, serving in the Army, smoking status, alcohol use, and low self-esteem.
Conclusions
Few studies have investigated the risk factors for PPD in AD women. It appears that AD women share many risk factors, or variants of those risk factors, for PPD as their civilian and AD spouse counterparts, but there are also unique risks to consider. More work is needed to improve screening and prevention efforts.
Background and Purpose:
Research suggests that female veterans of the United States military are more likely than their male counterparts to report mental health concerns such as posttraumatic stress, depression and suicidal thoughts. The purpose of this study was to explore the interaction of service era (time period during which active duty service occurred), social support, and beliefs about mental health care utility as they relate to depression in female veterans in the hope of improving health programming for this priority population.
Materials & Methods:
Secondary analysis of data from the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) involved logistic regression analysis of a large, nationally-sourced sample of 54,060 veterans, of whom 8.5% were women (n = 4,544). Correlations were found between social support, service era, and treatment stigma variables as they predicted outcome variables of diagnosed and undiagnosed depression.
Results:
Of the nationally-sourced sample of 4,544 female veterans, 25.5% reported a medically-diagnosed depression condition of mild, moderate, or major severity. Of veterans in the sample who did not already have a depression diagnosis, 12% indicated the presence of symptoms that indicate undiagnosed depression of mild, moderate, or major severity. Female veterans from recent wars in Iraq and Afghanistan were more likely than older peers to be struggling with symptoms that may indicate undiagnosed depression or to have a depression diagnosis.
Conclusion:
The findings of this study aided in identifying three demographic and behavioural health predictors of diagnosed depression and one predictor of undiagnosed depression in the female military veteran population that demonstrated both practical and statistical significance.
Female military personnel, rising in both number and in rank, are key to the success of the US military. Currently 16% of active-duty enlisted personnel and 18% of all officers in the US military are women (Department of Defense 2018). Unique stressors for women in the military now include combat stress, the stress of a minority status, military sexual violence, divorce and parenting. Our aim was to investigate these issues related to professionalism, personal health and support networks among female military officers while they also develop and maintain a command presence. The results of our pilot with 73 female US Army Officers support generalized research with female military personnel which illustrate high self-reporting and diagnoses of stress, anxiety and depression (Haskell et al. 2010; Bean-Mayberry et al. 2011; Shekelle et al. 2011). Importantly, 65.7% of servicewomen in our sample self-reported feelings of stress, anxiety, and depression as a direct result of their leadership role in the military. When women were asked how their psychological condition impacts their family as a wife and/or mother (caregiver), they responded with comments such as low energy, less patience and family discord because of distinct roles in and out of the military. As a result of these dichotomous roles, some reported that they hid their distress from their families. These findings offer important insight for US veteran support services and highlight an under-researched set of health challenges experienced by US female military officers facing mental fatigue who simultaneously serve as a caregiver.
Gender Microaggressions That Target Women in the U.S. Military: Examining Links with Depression and the Moderating Role of Rank and Coping - Free full text access unavailable
In this study, we examined active-duty women's experiences with gender microaggressions in the U.S. military and their associations with depressive symptoms. We also tested if rank and coping strategies would moderate the link between gender microaggressions and depressive symptoms. Participants comprised 682 self-identified women from the U.S. Air Force, Army, and Navy. Results from an online survey indicated that active-duty women's experiences with gender microaggressions were positively and significantly associated with their scores on a measure of depressive symptoms. Military rank moderated this association but coping strategies did not. Specifically, among those in lower military ranks (i.e., enlisted service members) we found a stronger association between gender microaggressions and depressive symptoms, whereas higher rank (i.e., officers) served as a buffer. Our results suggest that clinicians should be aware of the potential effects of gender microaggressions on active-duty women's mental health, especially among enlisted women. Commanding officers and military policymakers should consider potential implications of gender microaggressions on unit cohesion, unit performance, and mission effectiveness.