Depression in Female Veterans Returning from Deployment: The Role of Social Factors

Scoping review of the role of social support in women veterans' psychosocial and health outcomes

Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.

Social Support and Social Stress Among Suicidal Inpatients at Military Treatment Facilities: A Multidimensional Investigation

ABSTRACT

The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.

Psychosocial and Economic Impacts of the COVID-19 Pandemic on the Mental Health of Veteran Men and Women

Purpose: The psychosocial impacts of the coronavirus disease-2019 (COVID-19) pandemic on women Veterans' mental health compared to men are understudied, with few studies examining the differential impact of COVID-19 stressors on depression and post-traumatic stress disorder (PTSD). Furthermore, little is known about whether social support may buffer against adverse pandemic-related outcomes for this population. In the present study, we examined (1) gender differences in the impact of the COVID-19 pandemic on numerous life domains, including economic, work, home, social, and health; (2) how pandemic impacts in these domains were associated with depression and PTSD symptoms; and (3) whether social support buffered against worse mental health outcomes. Materials and Methods: Data from 1530 Veterans enrolled in the Longitudinal Investigation of Gender, Health, and Trauma (LIGHT) study were analyzed using descriptive statistics and multiple groups' path analyses. Results: Women reported higher pandemic impact scores across life domains. For both men and women, higher health impacts were associated with increased PTSD symptoms; differential findings emerged for depressive symptoms. Home and economic impacts were associated with increased depression for both men and women, social and health impacts were associated with depression for women, and work impacts were associated with depression for men. Higher social support was associated with decreased depressive symptoms for both men and women; however, social support moderated the relationship between pandemic impacts and both PTSD and depressive symptoms for women only. Conclusions: Findings highlight the value of social support in mitigating effects of pandemic-related stress, particularly for women Veterans.

Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review

Introduction

As U.S. Veterans reintegrate from active duty to civilian life, many are at risk for negative modifiable social determinants of health. The prevalence of mental health conditions among Veterans is also high. Awareness of the associations between these two factors is growing. This systematic review provides a comprehensive analysis of the current state of knowledge of the associations between modifiable social determinants and mental health among U.S. Veterans.

Methods

The authors systematically searched four databases and identified 28 articles representing 25 unique studies that met inclusion criteria. Findings from the studies were extracted and synthesized on the basis of modifiable social determinants. Study quality and risk of bias were assessed using the Methodological Quality Questionnaire.

Results

The studies identified in the systematic review examined three modifiable social determinants of health: 1) housing stability, 2) employment and finances, and 3) social support. Although the lack of validity for measures of housing stability, employment, and finances compromised study quality, the overall evidence suggests that Veterans with access to supportive social determinants had better mental health status. Evidence was particularly robust for the association between strong social support and lower symptoms of posttraumatic stress disorder.

Discussion

Current evidence suggests the need to consider modifiable social determinants of health when designing mental health interventions. However, more research encompassing a wider range of modifiable social determinants such as food security, education, and transportation and using comprehensive methods and validated instruments is needed. Future research also needs to intentionally include Veterans from diverse racial-ethnic groups.

Unique health stressors impacting female veterans

ABSTRACT

Over 30,000 female soldiers leave the US military each year. This article examines health concerns unique to female veterans and outlines ways for nurses to recognize and address the psychological, physical, and other medical concerns of female soldiers transitioning to civilian healthcare.

Women's Mental Health in the U.S. Military - Where Are We Now? A Review of Recent Research

PURPOSE OF REVIEW

The field of women's mental health has grown in the military healthcare system, which has begun to acknowledge and address the sex-specific differences in mental health for service women. The purpose of this review is to examine recent research in active duty populations addressing perinatal mental health, post-traumatic stress disorder (PTSD), depression, and gender isolation.

RECENT FINDINGS

Within the examined literature focused on active duty populations, analyses by sex and gender continue to exist as notable gaps, and a majority of studies reviewed either do not aim to examine sex or gender-based differences, and/or do not analyze data with an eye towards these paradigms. Within perinatal mental health, the lack of studies led to an inability to make any notable conclusions. PTSD was the area with the most robust publications focused on active duty women, studies of major depression showed significant occupational impact, and the area of gender isolation continues to grow as a promising field with practical implications. We discuss current promising research and advance ideas for future research trajectories that will provide clinicians, policy makers, and scientists with more data to support improved mental healthcare for both military women and men.

Unit Cohesion and Social Support as Protective Factors Against Suicide Risk and Depression Among National Guard Service Members

Introduction: Suicide and depression continue to be pervasive problems across military populations, including within the National Guard. Existing literature highlights the protective effects of social support and unit cohesion for both suicide risk and depression, yet to our knowledge, these associations have never been confirmed in National Guard populations. Thus, the aim of this study was to investigate the impacts of social support resources (i.e., general social support and unit cohesion) on depression and suicide risk among a large sample (n = 877) of National Guard service members.

Methods: Multilevel modeling was used to examine the impact of social support resources on depression and suicide ideation at both the individual and unit level.

Results: Results indicated that higher levels of perceived social support were associated with lower levels of depression and suicide ideation at both the individual and unit levels. Additionally, higher levels of perceived unit cohesion significantly predicted lower levels of depression and suicide ideation at the individual, but not unit level.

Discussion: Limitations include self-report measurement and cross-sectional nature of the data. These findings hold implications for improvement of operational climate within military units and reduction of suicide risk and depressive symptoms among National Guard service members.

Characteristics of younger women Veterans with service connected disabilities

OBJECTIVES

There has been an increase in the number of women Veterans with service connected disabilities, which are illnesses or injuries incurred or aggravated during military service. We compared military service and disability characteristics in women and men ≤50 years of age.

METHODS

This study included 4,029,672 living Veterans who had at least 1 service connected condition and an active award status as of October 1, 2016. The date of last award as well as demographic, military service, and disability characteristics were obtained from the Veterans Benefits Administration (VBA) VETSNET file.

RESULTS

Among 388,947 women Veterans with service connected conditions, almost 60% (n = 231,364) were ≤50 years of age. Roughly 55% of both women and men ≤50 years had a ≥50% combined rating, although there were differences with respect to individual service connected conditions. Women less often had service connected post traumatic stress disorder (23% vs 32%), but more often had major depression (15% vs 7%). While traumatic brain disease was more common in men, migraine headache was much more common in women (32% vs 18%). Less than half had a VA outpatient visit in the previous year.

CONCLUSIONS

The findings of significant numbers of younger women with service connected PTSD, depression, or migraine headache should be considered within the context of post deployment health. These findings raise questions regarding outreach to women Veterans who have these conditions, but do not use VA health care.