The reserve component of the United States military plays an important role in national defense, accounting for approximately 40% of deployed forces in recent conflicts (Tanielian & Jaycox, 2008). Currently, the reserves represent 53% of the total Army population, yet there is relatively little research examining mental health problems among reserve personnel (Vogt, et al., 2008). The Mental Health and Service Utilization among Reserve and National Guard Forces study (also known as the Guard and Reserve Study)* assessed the prevalence of mental health problems and related deployment characteristics in a national sample of 2,003 reserve component personnel in the United States. Baseline interviews in 2010 and three follow-up waves through 2013 consisted of structured telephone interviews inquiring about military experiences and mental health problems such as posttraumatic stress disorder (PTSD), depression and binge drinking. This article provides a selected review of key findings.
Mental health problems were common in this study, with approximately one in five reserve component personnel reporting either PTSD, depression or binge drinking (Ursano et al., 2016). The prevalence of one or more of these mental health problems varied by service, from 11% in the Air Force Reserve to 23% in the Army National Guard. Gender played a role for enlisted personnel but not officers, with prevalence estimates nearly twice as high for enlisted men relative to enlisted women. Deployment was also a significant factor. Deployed personnel were twice as likely to have a mental health problem compared to never-deployed personnel.
Reserve component personnel often deploy as individuals or small groups augmented to other units rather than deploying with their entire home unit (Granado et al., 2012). Results from the Guard and Reserve Study showed that reservists who deployed separately from their regular unit and who felt poorly prepared for deployment had higher prevalence of mental health problems (Ursano et al., 2018). Among those who deployed with their regular unit, feeling better prepared for the deployment was associated with lower risk of mental health problems. However, reservists who deployed as individual augmentees were at higher risk for adverse mental health regardless of their level of preparedness, suggesting that additional time assigned to or preparation with the receiving unit might improve mental health outcomes.
As “citizen-soldiers,” reservists often leave active service soon after their deployments, and reintegration to civilian life can be challenging (Mobbs & Bonanno, 2018). Among the reservists investigated in the Guard and Reserve Study, over one quarter left the reserves at some point during the three follow-up years (Wang et al., 2020). Transitioning out of service was associated with mental health problems at one year and 1.6 years (on average), but not at six months after leaving military service. Higher risk for depression and suicidal ideation was only found at one year after leaving the military. These results suggest that mental health problems in reserve veterans may be delayed.
The Guard and Reserve Study also identified four unique trajectories of PTSD symptoms following a deployment-related traumatic event (Wang et al., 2018). A high percentage (73%) demonstrated a resilient trajectory with few symptoms. The remaining soldiers demonstrated either early symptoms followed by recovery (11.7%), late onset of symptoms (11.6%) or a chronic trajectory with high levels of persisting symptoms (3.6%). Suicidal ideation varied across the trajectories, from 4% prevalence of suicidal ideation within the resilient trajectory to 51% prevalence within the chronic PTSD symptom trajectory. This finding suggests that differences in the trajectories of PTSD symptoms over time may have significant implications in the management of suicide risk.
Other findings from the Guard and Reserve Study have elicited relationships between trauma exposure and mental health problems (Russel et al., 2015; Cohen et al., 2016), gender and military authority in their interactive risk for PTSD and depression (Cohen et al., 2016), and prevalence of sexual violence and its mental health consequences (Walsh et al., 2014). Taken together, these multiple findings from the Guard and Reserve Study offer valuable information to develop prevention and intervention programs for an at-risk and understudied population.
*The Mental Health and Service Utilization among Reserve and National Guard Forces study was led by Dr. Sandro Galea of Boston University (formerly of Columbia University) and Dr. Robert Ursano of Uniformed Services University of the Health Sciences.
About the Authors:
Jing Wang, PhD, is a research assistant professor in the Department of Psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and a scientist at the Center for the Study of Traumatic Stress. Her research has primarily focused on risk and protective factors for military mental health problems. Her primary research interests also include application of latent variable modeling in mental health research.
James C. West, MD, is an associate professor of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and a scientist at the Center for the Study of Traumatic Stress. His research focuses on understanding psychiatric consequences of disaster and investigation of medications and psychotherapies for trauma and stressor-related disorders.
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