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It has been a ground-breaking year for women serving in the military. In the U.S., the Marine Corps Recruiting Depot in San Diego welcomed its first female platoon (Athey, 2020) and President Biden appointed two female generals to lead Transportation and Southern Command (Hoffman & Starr, 2021). Outside of the U.S., Officer Cadets Chuki Wangmo, Midya Masti and Firushana Thaufeeq were the first women from Bhutan, the Kurdistan region of Iraq, and the Maldives to graduate from the Royal Military Academy Sandhurst (Forces Net, 2021b). Additionally, Major General Sharon Nesmith became the first female Army Officer in the U.K. to serve at the division level (Forces Net, 2021a). To honor this progress and recognize the mental health needs of women in the military, the ISTSS Military Special Interest Group offers this   brief overview of gender differences in posttraumatic stress disorder (PTSD) symptomatology and treatment within the field of military psychology. 

What are the gender differences in PTSD treatment in the military?

Prevalence rates of PTSD in the general U.S. population suggest that women may be at higher risk for developing PTSD than men for a myriad of reasons, including biological differences, trauma type and differential responses to emotions (Mitchell et al., 2012; Richardson et al., 2010). In U.S. military samples, research indicates that female service members and veterans may be less likely to screen positively for PTSD, especially if they are receiving treatment from the Department of Veterans Affairs (VA) (Haskell et al., 2010). However, research suggests that when female veterans and service members are diagnosed with PTSD, they report increased symptomatology across diagnostic domains (Hourani et al., 2015) and are more likely to engage in negative emotional avoidance and internalization (Bryant & Harvey, 1995; Craske et al., 2003; Sachs-Ericsson & Carolo, 2000; Shick et al., 2020).

In the U.K., female service members were more likely to report symptoms of anxiety and depression than male service members (Jones et al., 2019). While researchers did not find a significant difference in prevalence of PTSD between male and female service members, female service members reported feeling less stigmatized by mental health symptoms (Jones et al., 2019). Interestingly, female service members and veterans in the U.K. were more likely to have sought formal mental health treatment but less likely to rely on informal social support than their male counterparts (Jones, 2019b). These results contrast with research from Israel and the U.S. which has found that female service members and veterans are more likely to use informal social support structures and less likely to seek treatment from military hospitals and service organizations (Huss & Cwikel, 2015; Kehle-Forbes et al., 2020). 

What does this mean for treatment and future research?

More research with larger samples of female veterans and service members is needed to better understand the unique experiences of women with PTSD who have served and who are currently serving. Such research may help elucidate cross-cultural gender differences in PTSD prevalence rates, as well as the unique challenges women may face accessing care. Additionally, the help-seeking behaviors of female service members and veterans should be considered as new treatment programs and protocols are developed. More research is also needed to understand the cultural, societal and health system factors that may influence a woman’s decision to access mental health care—be it through military or civilian facilities. 

Resources

California Veteran’s Association Women’s Center
The California Department of Veteran’s Affairs has created a toolkit for outreach organizations, clinicians, advocates and other professionals. This toolkit contains demographic information on the U.S. female veteran population as well as research and statistics on the unique behavioral and physical health needs of female veterans.  

U.S. Department of Veteran Affairs Community Provider Toolkit
Created for behavioral health professionals working with female veterans and service members within the community, this toolkit provides educational materials, treatment considerations and additional resources.
 
Disabled Veteran’s of America (DAV) Female Veteran Report
Updated in 2018, this report contains research, statistics and resources regarding health care, mental health care, legal issues and transition needs. 

Forward Assist “Salute Her”
Forward Assist's Women Veterans Task Force aims to highlight the lived experience of women veterans past and present. By giving women veterans a political voice the team aims to positively influence government policy, highlight unfair and discriminatory practice whilst influencing future decision making.  

YourNexStage
This collaborative organization is foregrounding the needs of women veterans in order to create opportunities for success in transition, with emphasis on employment, housing, physical and mental health, education, financial and legal support, benefits access and community engagement. 

Women Veterans Needs Assessment (University of Alabama) 
This national survey of women veterans focuses on challenges of transitioning to civilian life in order to provide veteran service organizations with data needed to expand outreach and better meet needs. 

Mission Statement of the ISTSS Military SIG

Modern combat trauma, military sexual trauma and the effects of these traumas on military families create the need for a deeper understanding of this population and more integrated forms of working with those affected by these stressors before, during and after service. The purpose of the ISTSS Military SIG is to unite experts from around the world in partnership with military service members, veterans and their families to move towards a more effective conceptualization of combat stress and its systemic aftereffects on the lives of members, families and communities. As part of this process, this SIG seeks to create a more effective link between mental health providers who serve within military organizations and providers in the veteran and civilian communities who are now faced with the challenges of treating military trauma.
 
The Military SIG promotes the larger mission of ISTSS by:

  1. Educating the broader ISTSS community about the complexities of military culture and the importance of such cultural knowledge when conducting research or providing services to military service members, veterans and their families.
  2. Providing a platform for fostering more inclusive and participative research into the stress-inducing experiences of military service members, veterans and their families by establishing a network of interested professionals (both clinicians and researchers across different mental health disciplines) and providing communication between them.
  3. Disseminating information regarding the outcomes of such research and lessons gained from informed practice to the larger mental health field. 

About the Authors

Kristen Walter, PhD, is a co-chair of the ISTSS Military SIG. Dr. Walter works at the Naval Health Research Center and can be contacted at Kristen.h.walter.civ@mail.mil.
 
Barton Buechner, PhD, is a co-chair of the ISTSS Military SIG. Dr. Buechner works at Adler University and can be contacted at bbuechner@adler.edu.
 
Allison Baier, MA, is a student co-chair of the ISTSS Military SIG. Allison attends Case Western Reserve University and can be contacted at alb184@case.edu.
 
Grace Seamon-Lahiff, MS, LMFT, is a student co-chair of the ISTSS Military SIG. Grace attends The Catholic University of America and can be contacted at seamon@cua.edu. 

References

Athey, P. (2020, December, 15). Women will attend boot camp at San Diego Marine Corps Recruit Depot for the first time in history. The Marine Corps Times. https://www.marinecorpstimes.com/news/your-marine-corps/2020/12/15/women-will-attend-boot-camp-at-marine-corps-recruit-depot-san-diego-for-first-time-in-history/

Bryant, R.A. & Harvey, A.G. (1995). Avoidant coping style and post-traumatic stress following motor vehicle accidents. Behaviour, Research, and Therapy, 33(6), 631-635. doi: 10.1016/0005-7967(94)00093-Y

Craske, M.G. (2003). Origins of phobias and anxiety disorders: Why more women than men? (BRAT Series in Clinical Psychology), Oxford, UK: Elsevier Ltd.
 
Forces Net. (2021a, January, 06). First female army officer to command at two-star level appointed [Press release]. https://www.forces.net/news/female-british-army-officer-command-two-star-level-first-time
 
Forces Net. (2021b, March, 24). Sandhurst: Female army officers feature in landmark commissioning [Press release]. https://www.forces.net/news/sandhurst-landmark-commissioning-female-army-officers

Haskell, S.G., Gordon, K.S., Mattocks, K., Duggal, M., Erdos, J., Justice, A., & Brandt, C.A. (2010). Gender Differences in Rates of Depression, PTSD, Pain, Obesity, and Military Sexual Trauma Among Connecticut War Veterans of Iraq and Afghanistan. Journal of Women’s Health, 19(2), 267-271. doi: 10.1089=jwh.2008.1262
 
Hoffman, J. & Starr, B. (2021, March, 08). Biden nominates two female generals to 4-star commands after promotions delayed under Trump administration. Cable News Network. https://www.cnn.com/2021/03/08/politics/female-generals-nominations-biden/index.html

Hourani, L., Williams, J., Bray, R., & Kandel, D. (2015). Gender differences in the expression of PTSD symptoms among active duty military personnel. Journal of Anxiety Disorders, 29, 101-108. doi: 10.1016/j.janxdis.2014.11.007

Huss, E. & Cwikel, J. (2015). Women’s stress in compulsory army service in Israel: A gendered perspective. Work, 50, 37-48. Doi: 10.3233/wor-141930

Jones, N., Greenberg, N., Phillips, A., Simms, A., & Wessely, S. (2019a). British military women: Combat exposure, deployment and mental health. Occupational Medicine, 69, 549-558. doi:10.1093/occmed/kqz103

Jones, N., Greenberg, N., Phillips, A., Simms, A., & Wessely, S. (2019b). Mental health, help-seeking behaviour, and social support in the UK armed forces by gender. Psychiatry, 8(3), 256-271. https://doi.org/10.1080/00332747.2019.1626200

Kehle-Forbes, S.M., Gerould, S.H., Polusny, H., Sayer, N.A., & Partin, M.R. (2020). “It leaves me very skeptical” Messaging in marketing prolonged exposure and cognitive processing therapy to veterans with PTSD. Psychological Trauma, Theory, Research, Practice, and Policy, ePub ahead of print. 1-4. doi: 10.1037/tra0000550

Mitchell, K. S., Mazzeo, S. E., Schlesinger, M. R., Brewerton, T. D., & Smith, B. N. (2012). Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the National Comorbidity Survey-Replication Study. International Journal of Eating Disorders, 45, 307-315. doi: 10.1002/eat.209652

Richardson, L.K., Frueh, B.C., & Acierno, R. (2010). Prevalence estimates of combat-related PTSD: A critical review. Aust N Z J Psychiatry, 44(1), 4-19. doi: 10.3109/00048670903303597

Sachs-Ericsson, N. & Ciarlo, J.A. (2000). Gender, social roles, and mental health: An epidemiological perspective. Sex Roles, 43, 605-628.

Schick, M.R., Weiss, N.H., Contractor, A.A., Suazo, N.C., & Spillane, N.S. (2020). Post-traumatic stress disorder’s relation with positive and negative emotional avoidance: The moderating role of gender. Stress and Health, 2020, 1-7. doi: 10.1002/smi.2920