Women in Combat: Consequences for Mental Health and Well-Being

Background: The role of contemporary women in the United States military has expanded significantly. Although women remain barred from combat-related positions (Dongean, 1996), the role changes and expansion of involvement, combined with the guerilla nature of modern warfare increase their probability of exposure to combat violence and trauma. While there have been few scholarly studies on the effects of these changes on women's mental health, there are prevalence data indicating that71% of women present during an air or ground war experienced at least 1 combat exposure,(Carney, Sampson Voelker, et al., 2003).Given the probable significance of these events to women's mental health and overall well-being, more research is warranted. Although some work has been conducted on PTSD (Tanielian et al, 2008) it is clear that combat exposure may be associated with a variety of negative mental health effects beyond the PTSD sequelae. The purpose of this study was to explore the mental health profiles of a group of women who have recently served in the military. Method: Data were from WAVE IV survey ( follow-up 2008) of The National Longitudinal Study of Adolescence (ADD Health), a nationally representative sample of youth (N = 15,701). Respondents were 24 to 32 years of age, and included a subpopulation of individuals who had served in the military (n = 1,112; F = 231, M=881). Analyses were conducted using Stata 11 employing appropriate weights and complex survey design adjustments. Results: Our findings showed that men had far more combat assignments (191/44). Only 5 women in the sample reported killing or believing they had killed someone. There were no significant differences between men and women in exposure to seeing someone dead or wounded (risk ratio 1.02, risk difference .02), seeing the enemy dead (risk ratio 1.03, risk difference .02), or seeing civilian dead (risk ratio 1.03, risk difference .03). Out of 27 mental health indicators, the significant items for women who have experienced combat broke into 3 subsets: Women who had low self-esteem had greater risk for combat engagement (risk ratio 1.61, t=1.96, p,.05). They reported less life satisfaction before joining the military (risk ratio 2.38, t=2.85, p<.005), and they were less likely to enjoy life upon return (.190, t=-3.74, p<.000,) Women with moderate self-esteem had risk of depression upon return (risk ratio .318, t=-3.25, p<.001) Women with high-self esteem had greater risk of combat engagement (risk ratio 1.5, t=3.41, p<.000). They had greater risk for feeling isolated upon return (risk ratio 1.35, t=2.03, p<.04) as well as greater risk for depression (risk ratio .396, t=-4.18, p<.000). Implications: There is heterogeneity in our results which is notable for clinicians. Moreover, the findings suggest that history of mental health problems should be included in assessment. While female veterans may have more difficulty with combat trauma as reported in PTSD studies ( Tanielian et al, 2008), there may be confounding variables, such as previous or additional trauma that result in negative mental health. In general, women are more likely to recognize and report mental health problems than men.