A Synthesis of the Evidence:
Health Effects of Military Service on Women Veterans
With Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), women comprise a larger percentage of the military (11.3%) compared to prior military campaigns. In addition, as of FY10, a substantially greater percentage of female OEF/OIF Veterans had enrolled in VA healthcare, compared to women from previous conflicts (51.3% vs. 11%). And of the OEF/OIF women Veterans currently enrolled in VA healthcare, 88% have used it more than once.
To better understand the needs of this growing segment of VA healthcare users, VA research also has expanded. For example, two previous systematic reviews examined the literature on women Veterans' health and healthcare up to 2008. This review specifically focuses on two areas: post-deployment reproductive health and post-trauma sequelae. Investigators at the VA Evidence-Based Synthesis Program (ESP) Center, located within the Greater Los Angeles Healthcare System, evaluated 44 articles to answer the following two key questions.
What research has been published on the effects of deployment on post-deployment reproductive outcomes?
- The evidence base is modest, mainly consisting of single-studies of specific deployments and particular outcomes.
- There have been no published assessments of reproductive effects on women in the current OEF/OIF deployments.
- Data about reproductive effects from past deployments are insufficient to reach strong conclusions. Generally, pregnancy outcomes do not appear to differ among deployed vs. non-deployed women. However, several studies demonstrate non-significant differences by deployment status, while others show contradictory evidence on the influence of military service on rates of miscarriage, stillbirths, and ectopic pregnancies.
What research has been published on post-trauma sequelae in OEF/OIF women Veterans, including: mental health problems, suicide, cardiovascular disease, risky health behaviors (i.e., tobacco use, substance abuse, eating disorders) and other post-trauma sequelae?
- Thirteen studies on post-deployment mental health of OEF/OIF Veterans found increased risks for new-onset depression, suicide, and suicide by firearm. Results from these studies also show discrepancy between mental health needs and use of mental health services; greater risks for hospitalization for mental disorders; higher use of non-mental health medical services for Veterans with mental health diagnoses; and higher risks for mental diagnoses among certain subgroups.
- Post-trauma sequelae highlights three issues:
- Early traumatic brain injury (TBI) data focus mainly on male service members; more research is needed to understand any gender issues in regard to TBI that might affect ongoing care.
- Alcohol use in recently returning women Veterans presents greater risk at lower levels of consumption for women with other risk conditions (i.e., PTSD, military sexual trauma, combat trauma).
- Healthcare use by gender and diagnosis requires ongoing follow-up, because while women may initiate contact with VA sooner, healthcare use did not differ (e.g., once initiated, frequency of visits over time did not differ by gender). Moreover, some conditions examined for deployed or post-deployed women manifest differently than for men (e.g., among Veterans with pain, women were less likely to report persistent pain).
VA's research portfolio on OEF/OIF Veterans' health and healthcare will contribute to the emerging literature on the consequences of military service among OEF/OIF women Veterans. The current literature lays some of the groundwork, but is not yet sufficiently comprehensive (e.g., spanning topics of mental health, physical health, social function, etc.). Future research should begin to fill these gaps to produce an increasingly detailed portrait of their post-trauma sequelae.
This report is a product of the HSR&D Evidence-based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers -- and to disseminate these reports throughout VA.
Batuman F, Bean-Mayberry B, Goldzweig C, Huang C, Miake-Lye I, Washington DL, Yano EM, Zephyrin L, and Shekelle PG. Health Effects of Military Service on Women Veterans. VA-ESP Project #05-226;2011.
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