November is filled with various health observances and holidays, including Veterans Day. Celebrated on November 11 since 1938, this national holiday acknowledges military service members who have bravely served our country and protected our freedoms. Veterans Day may call to mind heroic peacekeeping missions or dangerous combat situations. In addition to remembering Veterans’ service, we must be attentive to their specific health needs, particularly those of our women service members.
The demographics of our veteran population are changing, with women comprising the fastest-growing group of veterans. It is projected that women will continue to increasingly join and serve in the military in upcoming years, participating and advancing in various leadership positions and responsibilities. Despite their growing numbers, women veterans are less likely to utilize the VA health system when compared with their male counterparts. Women veterans receive a substantial portion of their healthcare services outside of the VA Health System, necessitating all healthcare professionals to become more aware of the issues affecting this particular population.
While women veterans encounter similar injuries and medical conditions related to their deployment as their male counterparts, including mental health conditions, they carry a greater burden of psychiatric illness. For example, a 2016 study including a nationally representative sample of US veterans found that the lifetime prevalence of PTSD was 19.4% among women, compared with 6.8% in men. Women veterans are also more likely to suffer from depressive disorders than civilian women, resulting in a 2.5 times higher risk of suicide. Mental health conditions affecting female veterans also have reproductive health implications, including higher risk pregnancies. Gaps in our understanding of how sexually transmitted infections, infertility, and menopause specifically impact women veterans hinder healthcare professionals’ ability to address how these reproductive health issues—often associated with mental health concerns—should best be addressed in this population. Military sexual trauma (MST) plays a major role in psychiatric illness in women veterans. The Department of Veterans’ Affairs defines MST as “sexual harassment that is threatening in character or physical assault that is sexual in nature that occurred while the victim was in the military.” MST in women veterans is at epidemic levels, with prevalence estimates ranging from 20% to 40%, compared with 1% to 5% in men. MST is a known risk factor for developing PTSD and other mental health conditions, and more work is needed to address MST and its consequences.
Lack of access to gender-sensitive mental health services is a major barrier for female veterans accessing services within the VA Health System. Research is emerging on the optimal context in which to provide medical interventions for female veteran’s mental health. A recent study that evaluated whether treatment interventions for PTSD in female veterans is best provided in female-only settings versus mixed gender settings found that those treated in female-only programs had longer lengths of stay and, at discharge, clinician reports of greater commitment to treatment when compared with women treated in mixed-gender programs.
More research is needed to specifically address the needs of our women veterans. Physicians and other healthcare professionals must understand the nuances, complexities, and specific needs affecting this group, so that we can ensure that all veterans receive the healthcare they so richly deserve.