Anxiety Disorder and Millennium Cohort Essay

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American Journal of Epidemiology
© The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of
Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Vol. 176, No. 2
DOI: 10.1093/aje/kwr496
Advance Access publication:
July 6, 2012

Original Contribution
Prospective Evaluation of Mental Health and Deployment Experience Among
Women in the US Military

Amber D. Seelig*, Isabel G. Jacobson, Besa Smith, Tomoko I. Hooper, Gary D. Gackstetter,
Margaret A. K. Ryan, Timothy S. Wells, Shelley MacDermid Wadsworth, and Tyler C. Smith for the Millennium Cohort Study Team
* Correspondence to Amber D. Seelig, Deployment Health Research Department, Naval Health Research Center,
140 Sylvester Road, San Diego, CA 92106-3521 (e-mail: amber.seelig@med.navy.mil).

Initially submitted August 16, 2011; accepted for publication December 7, 2011.

Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001–2008) carried out among US military women (n = 17,481), the authors examined positive screens for depression, anxiety, panic, and posttraumatic stress disorder in relation to deployment in support of the operations in Iraq and Afghanistan, while adjusting for relevant baseline and time-varying covariates. Women who were deployed and reported combat-related exposures had greater odds than nondeployed women of reporting symptoms of a mental health condition (odds ratio = 1.91, 95% confidence interval: 1.65, 2.20), after adjustment for demographic, military, and behavioral covariates. In addition, higher stress, problem drinking, and a history of mental illness were significantly associated with increased risk of later mental health conditions. In contrast, women in the Reserves or
National Guard and those with higher education were at decreased risk of mental health conditions (all P ’s <
0.01). As the roles and responsibilities of women in the military expand and deployments continue, designing better prevention and recovery strategies specifically for women are critical for overall force health protection and readiness. anxiety disorders; depression; military personnel; panic disorder; stress disorders, post-traumatic; women

Abbreviation: PTSD, posttraumatic stress disorder.

The effects of deployment on the physical and mental health of US service members continue to receive significant attention from the Department of Defense, veterans,
Congress, the American public, and the media. Research has shown that deployment and combat exposures increase the risk of posttraumatic stress disorder (PTSD) (1–3), depression (4), binge drinking (1, 5, 6), and smoking (7, 8), as well as disrupted sleeping patterns (9, 10). Despite the fact that women have been involved in some capacity in every major US military conflict and that millions of biomedical research dollars have been spent to better understand the health and physical abilities of women in the military (11), prospective studies of postdeployment health among women in combat-related deployments remain sparse (12).

Previous research has suggested that women are at risk for postdeployment health issues and that their experiences may be unique (13–17). The expanded roles for women in the military have resulted in their incurring potentially toxic occupational exposures, as well as witnessing death and trauma (18). Recent findings also suggest that military women are at increased risk for postdeployment hospitalization (19) and may have less a favorable health status than men (20), demonstrating the need for deployment health research focused on women.
The Millennium Cohort Study is a population-based prospective study of US service members (21, 22) in which women were…