In the face of numerous challenges, women service members often transition successfully to civilian life, securing high-ranking business or government positions. However, despite the success of some, the transition to civilian life leaves female veterans’ mental health at higher risk than male veterans’ or civilian females’. And worse still, women service members lack appropriate resources after their service.
How much of this has to do with the system, and what needs to change?
The veteran population continues to become more female, as more inclusive recruitment translates to more female service members in the first place. Every year, more than 30,000 women leave the military for any given reason; by 2043, they’re expected to make up about 17% of all veterans. And that will require a shift in how we approach female veterans’ mental health.
Depression represents a greater issue for female veterans than non-veteran women. A recent report from the VA noted that the suicide rate of women veterans is 2.1 times higher than that of civilian women. In fact, female veterans are so impacted by depression, that it’s one of the most common disabilities reported by this demographic. In 2015, it constituted the second most prevalent service-connected disability, with 26,501 women veterans receiving compensation for Major Depressive Disorder that year.
Women veterans also experience severe depression more frequently than their male counterparts. The suicide rate among male veterans is 1.3 times higher than civilian males, compared the 2.1 times higher for veteran versus non-veteran females. Several studies have also observed that more female veterans screen positive for depression than male veterans.
So what accounts for these differences?
It’s not that women are “softer,” but that they go through more experiences that can impact mental and emotional wellbeing.
Military sexual trauma (MST) is one of the most prominent stressors for female military personnel. MST refers to sexual assault or harassment experienced during military service. This includes forced sexual encounters, inappropriate sexual jokes or comments, and requests for sexual favors.
An estimated 1 in 4 women reported experiencing MST, which results in increased risk depression and suicidal ideations. Despite efforts to prevent sexual assault and harassment, women service members remain vulnerable to unwanted advances.
What’s more, many choose not to report cases due to fear of retaliation. And unfortunately, the statistics justify their fears. 64% of women who reported sexual assault faced retaliation, and 66% of them identified their retaliators as members of their own chain of command.
To make matters worse, victims actually had harsher discharges – 24% of them discharged with less than fully honorable conditions, compared to 15% of all service members. Evidently, women service members must grapple with the possibility of punishment for speaking up. This represents one source of disproportionate, chronic stress for female veterans.
It should be noted that not all hostile behaviors towards women are sexually-oriented. Past studies have also noted the perception of gender harassment as a bigger problem than sexual harassment among female military personnel.
Gender harassment occurs when one person degrades another on the basis of their gender or the gender they identify with. One example is telling a woman she is not strong or smart enough to do work typically done by males. Another example would be a male service member sabotaging a woman’s assigned equipment.
Gender harassment often reinforces traditional gender stereotypes. We must acknowledge this fact, especially in a male-dominated space like the military. Women who serve clearly contradict gender norms. And despite their contributions, over 50% of them experience gender harassment.
These findings highlight one major problem in military culture: the perpetuation of sexual assault and harassment. Detrimental as that is for women veteran mental health, there is another side of military culture many women veterans are harmed by: the weaponized concept of resilience.
In 2017, the Service Women’s Action Network (SWAN) held its annual summit, where they assessed the mental wellness of their participants: about 1,300 military women. After participants discussed mental health in focus groups, some highlighted the shared experience of wearing a mask to “drive on” through their careers. Participants consciously projected a certain persona, like wearing a mask, to meet standards of “resilience” despite harmful conditions or experiences.
But these masks, which they wore to protect themselves, had the exact opposite effect: “masking” worsened their mental health and made them feel isolated. In other words, they adopted a “fake resilience.”
While everyone agreed they came out stronger because of their service, they also agreed that getting there cost them too much of their well-being and produced feelings of isolation. As one group summarized, a female veteran “journeys through an unknown, uninformed transition where image is protected at all cost to wellbeing.”
Having a solid support network is critical to anyone’s success in the military. Multiple studies have demonstrated that positive relationships buffer military-related stressors, like combat exposure. The relationships also improve well-being, on their own.
Female veterans, however, are missing out on this. Female service members who deployed during the Gulf War, for example, reported receiving less social support from their peers and supervisors than their male counterparts. This problem may be worse for women in the National Guard and Reserves. Their part-time status reduces opportunities to connect and access resources through peers.
In addition to a lack of resources within the system, female service members may have less adequate support networks than than males upon discharge. Compared to male veterans, female veterans are more likely to be divorced or single, to have lower incomes, and to have principal custody over children. In addition to their mental health impact, these are all risk factors for homelessness.
The VA predicts, in fact, that female veterans are at least twice as likely to experience homelessness as nonveteran women. An unstable living situation due to a lack of support can amplify, if not incite, depressive thoughts and suicidal ideations.
Speaking of living situations, it’s worth highlighting the disruption to family life many women veterans experience. For one, women in general are more likely to act as caregivers, whether it’s for their children or their parents. Deployments interfere with their ability to cultivate relationships or look after their loved ones. This is a potential source of chronic stress that may lead to depression.
Furthermore, female veterans experience a higher rate of domestic violence. 1 in 3 women veterans experience lifetime physical and/or sexual intimate partner violence, according to a report from the Disabled American Veterans. That’s higher than the domestic abuse rate in civilian women, 1 in 4.
So far, it’s clear that female veterans can become depressed from their time in service. But some may already be at risk even before joining. This is where pre-military trauma comes into play. To illustrate, one study saw that female military personnel reported more severe childhood sexual abuse and are more likely to endorse extended childhood sexual abuse than women civilians.
Adverse childhood experiences, particularly instances of sexual assault, associate strongly with suicidal thoughts. The impact of pre military trauma can not be discounted whatsoever; just one traumatic incident can increase suicide risk. A study even found that pre-military trauma was more predictive of suicidal ideations than serving in a combat zone.
Trauma has lasting effects on the brain, especially earlier in life. It’s also cumulative: the more trauma a person has, the greater the toll on their brain. Given that more women than male veterans have pre-military trauma, this is yet another unfortunate example of a gender-specific mental health challenge.
All the issues discussed so far implicate a greater need for accessible, quality mental health services to women veterans. The VA is working on removing barriers to these services. For example, the agency now funds the Women’s Health Research Network (WHRN) to increase research focused on women veterans and therefore improve gender-specific treatments. The VA has also launched the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) initiative. This initiative aims to increase women veteran engagement and retention in several areas of healthcare, including mental health.
More women veterans have been using VA services over the last several years, but unfortunately, evidence suggests that the military system is not effective. The suicide rate among women veterans has actually been increasing, and those who use VA services are just as likely to attempt suicide as those who do not.
There are several possible explanations for these alarming statistics–most to do with staffing and training within the system. For one, the VA has a lengthy hiring process for mental health providers; a hired candidate may not start working until 4-8 months later. This also costs the VA good candidates, who may job-search while awaiting a response.
A big problem is the overall shortage of mental health professionals. Despite the VA’s hiring initiatives, most clinics are understaffed. That, coupled with the bureaucratic nature of the VA, results in a high-stress environment that burns out therapists fast. Consequently, they may leave the VA facilities, which forces some veterans to adjust to a new therapist multiple times.
Along with poor retention rates, some therapists lack critical skills to treat women veterans. A report from the Veterans of Foreign Wars of the United States, for example, pointed out that not all providers are trained to address conditions like postpartum depression and conditions related to sexual trauma and menopause.
Lastly, peer counseling, an effective and often-demanded resource, is not actively managed by the VA. This means not all facilities will have women peer counselors. Without a provider they can relate to, women veterans may have less motivation to seek mental health care.
Poor customer service and scheduling practices, the lack of convenient appointments, and long distances to facilities can inhibit female veterans from actively seeking care. According to interviews conducted in VA facilities, there were reports of frustration with employees not acknowledging their status as a combat veteran and instead assuming they were wives accompanying their husbands. Some female visitors also felt uncomfortable being outnumbered by men in waiting rooms. Many also reported unwanted sexual attention, like catcalls and stares, while inside – a particularly painful trigger for those with MST. Others have also pointed out that the VA does not make clear if they qualify for benefits that will help them receive mental health care treatment.
Stigma presents one final barrier to veteran mental health. Military mental health stigma is a by-product of a culture that encourages members to solve problems alone. As such, active duty members may worry that seeking help reflects poorly on their character or could negatively impact their careers.
Stigma also causes problems in relation to veterans’ treatment; some may doubt its effectiveness, or whether it’s worth pursuing. By causing veterans to neglect their mental health, stigma takes a toll on mental wellbeing both during and after active duty.
Though the military is raising awareness on invisible war wounds, particularly among women, many still feel uncomfortable seeking mental health treatment. Therefore, greater advocacy for female veteran mental health is needed.
In short, women veterans face multiple gender-specific challenges with their mental health. The armed forces and the VA have acknowledged this, but after serving men for so long, they’re playing catch-up to help a more diverse force. Until they’re up to speed, women veterans may continue to struggle with their psychological health. Fortunately, there are resources outside of the military that can help female warriors combat depression. Some of those resources are listed below.