Female Soldiers Twice as Likely to Be Diagnosed with Mental Health Conditions in Theater Than Males, Study Finds

U.S. Marines watch their Combat Instructor teach.
U.S. Marines watch their Combat Instructor teach during their third week of training, Camp Geiger, N.C., Oct. 7, 2013. (U.S. Marine Corps photo by Staff Sgt. Christine M. Wilcox, SOI-E, Combat Camera)

Female U.S. Army soldiers were diagnosed with a mental health condition at more than twice the rate of male troops while deployed to a combat theater, and they exceeded the rate for males for all 12 of the mental health categories examined, a new study has found.

From 2008 to 2013 -- a period selected for the study because of its high operations tempo -- female troops who were deployed "consistently had higher rates than their male counterparts" for mental health diagnoses that included stress and adjustment disorders, depression, anxiety, sleep issues and attention-deficit hyperactivity disorder, or ADHD, according to the research, published Wednesday by the Armed Forces Health Surveillance Division.

The authors theorized that their findings may indicate that deployed female soldiers may actually have more mental health problems than males, with the effects of combat, family separation, sexual assault or harassment playing more of a role.

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But they also said health care providers may be more likely to diagnose a female service member with a psychiatric disorder as a result of sex-based biases.

"Implicit biases among primary care physicians resulted in female patients receiving less accurate diagnoses, made with less confidence, and less appro­priate treatment recommendations than male patients," wrote the authors, led by Maegan Paxton Willing, a postdoctoral fellow at the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences.

Women were diagnosed at more than twice the rate of men for anxiety disorders and adjustment disorders and nearly four times the rate for personality disorders, a condition that is considered by the Defense Department and the Department of Veterans Affairs to have existed before military service and is not eligible for service-connected disability compensation.

Most notably, according to the Medical Surveillance Monthly Report, female service members were diagnosed with ADHD at rates 50% higher than male troops -- a "striking contrast" to the diagnostic rate in the civilian population where males are diagnosed with the disorder far more frequently than females, according to the researchers.

The authors said they decided to examine in-theater mental health diagnoses because much of the research to date on mental health among deployed active-duty service members has focused on post-deployment health assessments.

They said focusing on after-the-fact data in lieu of diagnoses during deployment "ignores a wealth of important information about the disease burden and resources necessary to care for deployed service members," the authors of the study wrote.

The researchers examined data from various DoD personnel and health sources on 530,404 soldiers deployed to overseas contingency operations over the six-year period. They felt that using this time frame would capture a period of frequent combat and combat support deployments.

The report found that, across the board, soldiers had the highest rates of diagnoses for anxiety, depression, adjustment disorders, post-traumatic stress disorder, ADHD, and alcohol or drug dependency disorders and lower rates for eating disorders and sleep problems, bipolar disorder and schizophrenia.

According to the research, the case rates for nearly all the examined disorders were highest among "non-Hispanic/White" soldiers. But Hispanic and Black soldiers received schizophrenic disorder, psychosis and paranoia diagnoses at higher rates.

Previous studies have found that female service members are medically evacuated from theater for a mental health reason at a rate 64% higher than their male counterparts and that women seek mental health treatment at higher rates than males, perhaps because, for the most part, they are more likely to discuss experiences and feelings and aren't dissuaded by the stigma associated with mental health treatment.

Since women make up 17% of the armed forces, the DoD should consider implementing unique policy, training, and clinical interventions."

"These results emphasize the crucial need for in-theater behavioral health providers to be competent in the delivery of effective, short-term treatments for stress, anxiety, depres­sion, and sleep disruptions," Paxton Willing wrote. "Further, these findings may contribute to the development of new policies and interventions to better pre­pare, support, and treat soldiers during de­ployments."

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime

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