title: The Association of Combat Exposure With Postdeployment Behavioral Health Problems Among U.S. Army Enlisted Women Returning From Afghanistan or Iraq.
abstract: An association between combat exposure and postdeployment behavioral health problems has been demonstrated among U.S. military service members returning from Afghanistan or Iraq in predominantly male samples, yet few studies have focused on the experiences of women. Using data from the longitudinal, observational Substance Use and Psychological Injury Combat (SUPIC) Study, we explored the self-report of 4 combat exposure items and postdeployment behavioral health screening results for 42,397 Army enlisted women who had returned from Afghanistan or Iraq from fiscal years 2008 through 2011. We ran multivariate logistic regression models to examine how a constructed composite combat exposure score (0, 1, 2, 3+) was associated with screening positive postdeployment for posttraumatic stress disorder (PTSD), depression, and at-risk drinking among active duty (AD) and National Guard/Reserve (NG/R) women. AD and NG/R women commonly reported being wounded, injured, assaulted, or hurt (17.3% and 29.0%, respectively). In all 6 multivariate models, Army women with any report of combat exposure had increased odds of the behavioral health problem (i.e., PTSD, depression, or at-risk drinking). The magnitude of the association between combat exposure and PTSD was most striking, indicating increased odds of PTSD as combat exposure score increased. AD and NG/R women with a combat exposure score of 3+ had increased odds of PTSD, 20.7, 95% confidence interval (CI) [17.0, 25.1] and 27.8, 95% CI [21.0, 36.9], respectively. Women who report combat exposure may benefit from early prevention and confidential intervention to promote postdeployment health and reduce long-term behavioral health problems.
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
authors.forename: Rachel Sayko
authors.initials: RS
authors.lastname: Adams
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
authors.forename: Ruslan V
authors.initials: RV
authors.lastname: Nikitin
authors.affiliation: Military Social Work Research & Practice, University of South Carolina College of Social Work, Columbia, South Carolina, USA.
authors.forename: Nikki R
authors.initials: NR
authors.lastname: Wooten
authors.affiliation: Decision Support, Defense Health Agency, Department of Defense, Falls Church, Virginia, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Williams
authors.affiliation: Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D003130:Combat Disorders / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology; D000069581:Exposure to Violence / Q000523:psychology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D016017:Odds Ratio; D012307:Risk Factors; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D014481:United States; D055815:Young Adult