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2023 HSR&D/QUERI National Conference Abstract

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4010 — Learning from Women Veterans Who Navigate Invisible Injuries, Caregiving, and Reintegration Challenges

Lead/Presenter: Nicholas Rattray,  COIN - Indianapolis
All Authors: Rattray NA (VA HSR&D Center for Health Information and Communication, Indianapolis), Natividad D (VA HSR&D Center for Health Information and Communication, Indianapolis), Kukla M (VA HSR&D Center for Health Information and Communication, Indianapolis), Do A (VA HSR&D Center for Health Information and Communication, Indianapolis), Danson L (VA HSR&D Center for Health Information and Communication, Indianapolis), Frankel R (VA HSR&D Center for Health Information and Communication, Indianapolis), True G (South Central MIRECC, Southeast Louisiana Veterans Health Care System)

Objectives:
As women comprise a greater proportion of military servicemembers, there is growing recognition of how experiences in the early phase of military to civilian transitions have an important influence on their health and reintegration outcomes (Dichter and True, 2014). While most programs have defined the “early transition” phase as the first year following service, more recent evidence suggests a protracted period of adjustment, lasting years rather than months. Current evidence suggests that women are more likely than their male counterparts to have depression, anxiety, and issues with premature separation from military service, all factors which negatively impact community reintegration (Vogt et al, 2020). We examined narratives of civilian reintegration among women Veterans to understand their experiences of living with “invisible injuries,” a term that includes traumatic brain injuries and mental health diagnoses (including PTSD, MST, depression, and anxiety).

Methods:
We interviewed 16 women who were within 5 years of separating from military service and developed a case study approach based on three participants. Participants were interviewed five times over 24 months. Interviews were audio-recorded and transcribed verbatim. Interview topics included challenges with reintegration, civilian identity, social support, benefits, and mental and physical health issues and treatment. Follow-up interviews focused on health updates, the home environment, and ongoing readjustment challenges. Inductive thematic analysis was conducted to establish categories about reintegration. Immersion/crystallization techniques were used to identify exemplary cases that illustrated salient themes.

Results:
Women Veterans identified establishing a future career direction, drawing on social support, and navigating health care services as major factors influencing how they adjusted to civilian life. However, our case studies highlight how women are also required to navigate complex and intersecting social roles (i.e., wife, mother, employee, friend, Veteran, patient, etc.) in a society where gender inequalities persist. Most women Veterans in this study were married to male Veterans. These women performed emotional labor, which is often rendered invisible and oriented toward their husbands, while simultaneously monitoring self-care activities. During the first year or two of post-military life, they described how they felt marginalized in terms of health treatment compared to their military spouses and male Veteran peers. Several cases were interviewed five years after their separation from the military but were still struggling with the vicissitudes of adjustment.

Implications:
As women comprise an increasing proportion of Veterans, a pressing need exists to better understand their transitions to civilian life. This study highlights less studied readjustment needs that arise as women servicemembers transition into post-military life. Longitudinal studies with a qualitative component have the potential to unearth trajectories of reintegration among women veterans, a high priority VA group. It is important to consider emergent ways to integrate gender into Veteran policies and programs.

Impacts:
Study findings may be disseminated with providers and veteran-based organizations to draw attention to the uncertainties that women Veterans experience in the early phase of transition into civilian contexts.