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Women in the military and mental health trends in the UK armed forces
e-mail: dipti_p_patel{at}hotmail.com
Women now make up 9% of the total military strength in the UK, and 20% in the USA, and this is likely to rise [1,2]. Despite this, few studies have focused on women's psychological health in the military, and the results have generally been inconsistent; some indicating that mental disorders are more common in women, others suggesting that they are equally common in women and men. There is also uncertainty over whether psychological symptoms have increased over time.
To help resolve some of these uncertainties, Rona et al. [3] performed a study to assess whether there were differences in the pattern of psychological symptoms in women and men, to compare trends in psychological symptoms in the two groups, and to assess the effect of deployment.
The authors used two cross-sectional studies based on random samples of the Armed Forces to assess the effects of deployment to the 1991 Gulf War and the 2003 Iraq War. The former took place in 1997 (Gulf War Study), and the latter took place between June 2004 and March 2006 (Iraq War Study). All the women who completed a questionnaire in the Gulf and Iraq War Studies and a 20% random sample of men who completed a questionnaire stratified by rank were selected for the analyses.
Using a number of outcome measures, the authors assessed psychological distress, number of symptoms, post-traumatic stress reaction (PTSR), chronic fatigue and alcohol misuse. Multiple logistic regression analysis was carried out to compare each psychological health outcome for men and women in the two studies, adjusting for age, rank, educational status, enlistment type and marital status.
In total, 3358 men and 1678 women were included in the analyses. The results indicated an increase in psychological symptoms, including alcohol misuse, in those not deployed to the Gulf or Iraq Wars. This was especially marked in woman. Alcohol misuse was more common in men, whereas psychological distress and chronic fatigue were more common in women. In women, psychological symptoms were positively associated with deployment in the Gulf War, but not the Iraq War.
The authors concluded that there has been an increase in psychological symptoms in the Armed Forces over time regardless of gender, in those not deployed, but the trend is more marked in women. This is in contrast to psychiatric morbidity surveys in the civilian population which found negligible changes in the prevalence of neurotic disorders in women and a small increase in males [4]. While different methodologies make comparison difficult, the results suggest that the pattern of psychological symptoms in the military might not be the same as for the civilian population.
A possible explanation of the more noticeable increase in women is that service women who enlisted when it was less common to do so, had better psychological health than women who enlisted when it was more commonplace. However, this could have been offset by the uncertainty of roles and the difficulty in finding other women in whom to confide.
The authors also concluded that the prevalence of psychological distress and fatigue are consistently higher in women than in men in the UK military, although the greater prevalence of psychological symptoms in women, commonly reported in civilian populations, was not shown for PTSR and physical symptoms. This small or moderate effect size of the gender effect could be explained by personality traits of women in the Armed Forces or by their reluctance to acknowledge psychological symptoms.
Finally, the authors considered that a deployment effect on psychological symptoms in women in the military was marked in relation to the Gulf War and non-existent in the Iraq War. This is consistent with results reported for the UK Armed Forces, and could be explained by the fact that while the distribution of roles of those deployed was similar in both wars, the exposure to enemy fire and handling injured or dead personnel was more commonly reported in those who were deployed to the Gulf War. However, as the questions were drafted in a slightly different manner and the time gap between deployment and completion of the questionnaire in the two studies differed, interpretation of these results needs some caution.
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References |
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 Top References |
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- DASA (Ministry of Defence). In: UK Defence Statistics 2005. A National Statistics Publication. London, UK: The Stationery Office. P61.
- Goldzweig CL, Balekian TM, Rolon C, Yano EM, Shekelle PG. The state of women's veterans' health research. Results of a systematic literature review. J Gen Int Med (2006) 21:S82–S92.[CrossRef][Web of Science][Medline]
- Rona RJ, Fear NT, Hull L, Wessely S. Women in novel occupational roles: mental health trends in the UK Armed Forces. Int J Epidemiol (2006) doi:10.1093/ije/dyl273.
- Singleton N, Bumpsted R, O'Brien M, Lee A, Meltzer H. Office for National Statistics. Psychiatric Morbidity among Adults Living in Private Households, 2000 (2001) London, UK: The Stationery Office.
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