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Women Veterans: Combat, Sexual Assault, PTSD, and Depression in Reserve & National Guard Compared to Regular Military Members
Sadler AG, Mengeling M, Torner J, Booth BM. Women Veterans: Combat, Sexual Assault, PTSD, and Depression in Reserve & National Guard Compared to Regular Military Members. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
Identify differences in current PTSD and depression between military women by service type (Reserve or National Guard, Regular Military, both), deployment (combat or not) and sexual assault histories (lifespan and in-military).
1004 women veterans (ages 20 - 52) participated in a retrospective cohort study of current health, health risk behaviors, sexual assault history and health care utilization. Participants had enrolled in Iowa City, Des Moines Veterans Administration Medical Centers or their outlying clinics within the 5 years preceding research interview. PTSD and depression were assessed using the Post-Traumatic Stress Diagnostic Scale and CIDI, respectively.
The majority of participants were white, employed, married, and well educated. Most served in the regular military (RM) (60%, n = 598), 12% were Reserve or National Guard (R/NG) (n = 123), and 23% served in both RM and R/NG (28%, n = 282). Almost two thirds (62%) of the sample acknowledged one or more sexual assaults (SA, attempted and/or completed) during their lifetime; 28% acknowledged SA during military. Notably, R/NG service women reported no SA during military. Deployment to a combat zone was experienced by 29% of all participants; 17% of RM vs 74% R/NG. Of deployed RM, 21% experienced SA during military in comparison to 32% of those not combat deployed (p = .0007). One-fourth of the sample met criteria for a current PTSD diagnosis, and 30% for depression. There was no statistically significant difference in PTSD or depression between those who had served in a combat zone or not, and no difference in either by service type. Rates of PTSD and depression were greater for those who had experienced sexual assault in comparison to un-assaulted peers (p < .0001). These rates were even higher for those who had experienced SA during military service (PTSD: 33% v 11%; depression: 39% v 16%; p < .0001). Women with PTSD reported a median of 2 SAs during lifetime compared to a median of 0 for those without PTSD. The in-military median SA was 0 for women with and without PTSD.
Our findings indicate that service women's lifetime sexual assault exposure is a more useful clinical marker of current PTSD and depression in comparison to deployment or SA during military. Furthermore, deployment did not elevate rates of SA in RM and R/NG reported no SA during military service. R/NG were generally healthier with lower rates of PTSD and depression despite high rates of deployment to war.
Although deployment and SA exposure are both common experiences in military women, this research indicates that service type (RM, R/NG or both) results in different exposures and different mental health outcomes and therefore should be a routine clinical consideration. Furthermore, current VA screening practices focus on military SA screening whereas clearly lifespan SA must also be assessed. The high rates of PTSD and depression found in this study have implications for mental health services unique to military women, and consequently resource allocation. Further study of differential health risks and outcomes by service type is clearly indicated.