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Women and Post-Deployment Health

More than 200,000 women have been deployed and, like their male counterparts, experienced the high stress of deployment, work, or travel in combat areas. While women are not technically in combat roles, their duties and service environments can place them at constant risk. Now comprising approximately 15 percent of the U.S. armed forces overall and 17 percent of Reserve and National Guard (R/NG) forces, women are among the fastest growing groups of new VA users. After a history of caring primarily for males and members of the Regular Military, VA is now challenged with meeting the health care needs of this unique population of women.

Unfortunately, the health effects of combat, post-deployment readjustment, and additive trauma exposure (such as sexual assault) are not yet well characterized in servicewomen, particularly R/NG members. Women Veterans in general report a higher burden of medical illness and worse quality of life outcomes. Studies of military populations posted at permanent bases have had results consistent with research on civilian women in finding higher rates of depression, anxiety, and post-traumatic stress disorder (PTSD) in servicewomen compared to their male counterparts. A potential explanation for this difference is that women are significantly more likely to experience rape during their lifetime than men, and rape is a high risk trauma exposure for PTSD and other mental health sequelae.¹

A key concern for returning women Veterans is reintegration within family and relationship roles. Little is known about the ways that women warriors struggle to balance family and service. This is especially important given the repeated and prolonged deployments that have characterized OEF/OIF/OND service and that military women are much more likely to be a single parent than male peers. Returning women are demonstrating a higher risk for family readjustment problems as marriages of female troops are failing at almost three times the rate of male service members.²

Facilitating post-deployment access to health services, and mental health in particular, for OEF/OIF/OND female Veterans is challenging and has required new outreach approaches. Such interventions to promote prompt access to needed care are urgently needed to mediate the severity of post-deployment mental health conditions and to interrupt the cycle of chronicity found in many with depression and PTSD. In focus groups with a Mid-Western cohort of R/NG and Regular Military servicewomen (Veteran and active duty), fear of an elevated risk of harassment or assault in the VA setting was common as were concerns about confidentiality. ³ Participants reported that entry to VA care is confusing and that they did not know about health care benefits or the availability of gender-specific services.

To attend to access concerns, community outreach by VA OEF/OIF/OND teams has been implemented to promote education and enrollment of returning Veterans. Increasingly, VA is forming partnerships with community services and agencies addressing Veteran needs (e.g., Brain Injury Association, Workforce Development). My HealtheVet was developed to respond to changing generational and societal expectations for greater electronic access to health care and information. Community-based outpatient clinics have been established in Veteran-rich communities along with telehealth services to address distance and other access barriers.

Increase in Gender-Specific Services

Once women are VA-enrolled, services and the environment and process of care must be sensitive to their needs and preferences if women Veterans are to continue to choose, maintain, and endorse VA care. Gender-specific health services have increased in VA and care silos are becoming obsolete as multidisciplinary teams evolve to treat women's complex health issues and decrease fragmentation of care (e.g., Women's Health Clinics, Patient Aligned Care Teams). An unprecedented VA implementation of evidence-based practices and clinician training to treat trauma and mental health consequences is in process. Recognition of the impact of deployment on family reintegration or caretaking roles has resulted in the inclusion of licensed marital and family therapists within mental health teams and recent family caretaker initiatives.

VA has a research agenda and funding that is responsive to the scope, immediacy of health concerns, and readjustment problems women face post-deployment. The establishment of the Women's Health Research Consortium and Practice-Based Research Network is an additional VA investment in the growth of women's health research and in the engagement and mentoring of both new and senior investigators in women's health research.

References

1. Institute of Medicine. Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and their Families. Washington, DC: The National Academies Press 2010.
2. Mulhall, E (2009). Women Warriors: Supporting she who has Borne the Battle (Rep. No. October 2009). NY, NY: Iraq and Afghan Veterans of America (IAVA).
3. Sadler AG et al. Physical and Sexual Assault in Deployed Women: Risk, Outcomes & Services, HSR&D DHI 05-059; Combat, Sexual Assault, and Post-Traumatic Stress in OIF/OEF Military Women, DoD # PTO74819 &HSR&D # DHI-08136. Iowa City, IA: VA Health Care System.
4. Ibid.