In Brief
- Nearly half of post-9/11 veterans in a study screened positive for depression, anxiety or PTSD; about four in 10 showed elevated suicide risk.
- Women reported more mental health needs but no corresponding increase in such appointments.
- Findings highlight disparities in sexual violence and PTSD across gender and race.
Nearly half of the post-9/11 veterans surveyed in a new study showed signs of depression, anxiety or post-traumatic stress disorder (PTSD). But women veterans, who reported substantially more mental health and substance use problems than men, did not see an increase in mental health appointments, finds a new study from the Brown School at Washington University in St. Louis.
“What surprised me most was how common these problems are,” said Jordan Davis, a professor at the Brown School. “Nearly half of the veterans in our study showed signs of depression, anxiety or PTSD, and about four in 10 showed signs of elevated suicide risk.”
Davis is lead author of the study, “Military service, healthcare needs, and healthcare engagement among post-9/11 veterans from the BRAVO Cohort Study,” published recently in the journal Military Psychology. It draws on data from 2,083 veterans participating in the Behavioral Research and Analysis of Veterans Outcomes (BRAVO) cohort study, co-led by Davis and his colleague Eric Pedersen, of the Keck School of Medicine at the University of Southern California.
Davis and his co-authors intentionally recruited larger numbers of women and racial and ethnic minority veterans, allowing them to look at differences that previous studies often lacked enough participants to see.
Mental health needs outpace visits
Women in the study reported 51% to 61% more types of mental health and substance use problems than non-Hispanic White men, Davis said. Yet their appointment volume did not rise accordingly: after accounting for the number of problems reported, the researchers found no significant differences in mental health and substance use visits among the groups.
At the same time, though, women’s greater number of physical health conditions generally were accompanied by more appointments.
“Our study can’t say for certain why, but it points to limits in the healthcare system,” Davis said. “Possible reasons include too few mental health providers, long waits for appointments and trouble fitting visits into busy lives.”
Getting into care is only the first step, and some veterans face additional barriers to seeking help, he said.
“Veterans who have been hurt by the very institution they served, such as through sexual violence during service, are often less likely to seek help, because trusting a large system again can feel risky,” Davis said. “Care works best when veterans feel safe and respected, and when there are enough visits to actually help.”
Sexual harm and PTSD disparities
The study found that 35.7% of participants reported military sexual violence and 50% reported sexual harassment. Among women, about six in 10 reported sexual violence, with rates approaching eight in 10 among women in the study’s combined multiracial and other underrepresented racial groups.
PTSD risk also was higher among several groups of women, including Black, Hispanic and white women, as well as non-Hispanic Black men, Davis said.
He said healthcare providers should continue screening service members and veterans for military sexual trauma and recognize that survivors may take years or decades to disclose their experiences.
“Healthcare providers need to continue to be sensitive to this possible time lapse,” he said, “and when the service member or veteran is ready to talk, be prepared to support and intervene, as appropriate, in a thoughtful and sensitive way.”
A broader picture of veterans’ health
The BRAVO cohort was designed to address a gap in research, which often has included too few women and veterans of color to examine differences across gender and race or ethnicity, Davis said.
“We set out to recruit large numbers of both, so we could compare women and men within each racial and ethnic group,” he said. “That lets us see where the needs are greatest and where they differ.
“Previous studies often didn’t include enough women and veterans of color to reliably examine these differences. By recruiting larger numbers, we can better understand how healthcare needs differ across gender and racial and ethnic groups, and where gaps in care may need more attention.”
