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Combat exposure increases risk for PTSD, depression, drinking in Army women
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Combat exposure was associated with significantly increased risk for PTSD, depression and at-risk drinking postdeployment among women enlisted in the Army.
“Several studies of men and women found an association between combat exposure and postdeployment behavioral health problems, including an increased risk of screening positive for posttraumatic stress disorder, depression, or at-risk drinking,” Rachel Sayko Adams, PhD, of Brandeis University, Waltham, Massachusetts, and colleagues wrote. “The generalizability of these findings to women is unclear as they were only a small proportion of the group studied.”
To assess associations between combat exposure and postdeployment behavioral problems among women, researchers analyzed data from the Substance Use and Psychological Injury Combat Study for 42,397 women enlisted in the Army who returned from Afghanistan or Iraq from 2008 to 2011.
Overall, 17.3% of active duty women and 29% of National Guard/Reserve women reported being wounded, injured, assaulted or hurt.
There were significant associations between risk for PTSD, depression and at-risk drinking and combat exposure (P < .001). As combat exposure increased, odds for these behavioral outcomes increased.
Active duty women with a combat exposure score of 1 were approximately four times more likely to screen positively for PTSD, compared with those with no combat exposure. This risk was approximately 20 times higher among active duty women with a combat exposure score of 3 or higher (OR = 20.68; 95% CI, 17.01-25.13).
Risk for PTSD was approximately 28 times higher among women in the National Guard/Reserve with a combat exposure score of 3 or higher, compared with women with no combat exposure (OR = 27.8; 95% CI, 21-36.9).
“Our findings suggest that injuries, assaults, and combat exposures experienced by women during deployment may have an additive, negative effect on their postdeployment behavioral health,” Adams said in a press release. “Ongoing force-wide screening for behavioral health problems should be coupled with development and evaluation of programs to improve the psychological well-being of the Armed Forces.” – by Amanda Oldt
Disclosure: The study was supported by the NIDA. Please see the full study for a list of all authors’ relevant financial disclosures.
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Elspeth "Cam" Ritchie, MD, MPH
This is a great addition to the literature on psychological reactions to war in female service members.
When I started working on my volume Women at War in 2011, there was very little literature on psychological reactions to war. There had been more research on the health issues of female service members prior to 9/11. With the wars in Afghanistan and Iraq, the focus narrowed to the operational needs of deploying service members.
Recently, with the opening of combat roles to women, there has been a renewed focus on the abilities and needs of military service members.
This article, and the review of recent literature, is a welcome addition to the scientific portfolio. The large population surveyed is definitely an important contribution.
However, there are some frustrating gaps in this article.
First, it concentrates on enlisted women, who tend to be younger and less educated than officers. In many fields, such as medical, officers are a substantial proportion of the population
Secondly, the article focuses on the difference between active duty and the National Guard and reserves. The National Guard population and reserves are different. Generally, reservists tend to be older and drawn from all over the nation.
National Guard units are more likely to know each other, coming from a specific state and having trained together. Reservists may be cross-leveled to other units.
Another variable, unexplored in this article, is the jobs of women. In other studies, truck drivers, for examples, have felt like “sitting ducks.” Many truck drivers have been National Guard, subject to [improvised explosive devices], and therefore at a higher vulnerability for PTSD.
So while this article is an important contribution to the literature, it raises many unanswered questions.
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