Mary Ann Boyd, PhD, DNS, PMHCNS BC Wanda Bradshaw, RN BC, MSN Marceline Robinson, MSN, PMHCNS BC American Psychiatric Nurses Association Annual Meeting October 23, 2014 Indianapolis, IN Describe the military experiences that lead to suicide, depression, & PTSD Describe the impact of deployment on women and their families Identify nursing implications for caring for deployed women. The speakers have no conflict of interest to disclose Operation Enduring Freedom (2001 2013) Operation Iraqi Freedom (2003 2010) Operation New Dawn (2010 2011) Boyd, Bradshaw 1
ACTIVE DUTY RESERVE & GUARD Branch Number Percent USA 76,694 13.6 USMC 13,677 06.8 USN 53,385 16.4 USAF 63,522 19.1 Total DoD 207,3088 14.5 USCG 6,790 15.7 Total 214,098 14.6 WWW.WOMENSMEMORIAL.ORG, 2011 Branch Number Percent USAR 62,473 21.6 USMCR 5,704 5.7 USNR 20,549 19.9 USAFR 28,463 26.6 Total DoD 117,189 19.6 USCGR 1,592 16.7 Reserve 118,781 19.5 Total USARNG 53,290 14.6 USANG 19,500 18.5 Guard Total 72,790 15.5 Combat exposure no battlefield lines Multi causality incidents Military sexual trauma Perceived sexual discrimination Depression (Curry, et al. 2014) Poor sleep Stress of potential sexual assault Suppression of menstruation Re deployments Boyd, et al., 2013; Curry, et al., 2014 Service members, especially women, more likely to be married Three million dependents; 2 million children affected by OEF/OIF deployments. Single mothers had a particularly difficult time separating Divorce rates of deployed women 3x higher than for male service members Behavior problems appear in children of deployed service members (Boyd, et al., 2013;, Crum-Cianflone, et al., 2014) Boyd, Bradshaw 2
Regular Army suicide rate increased between 2004 2009 for current & previously deployed 40% who were non deployed Youngest soldiers have elevated suicide risk during & after deployment. Married deployed soldiers have lower suicide risk than unmarried solders without dependents. Suicide risk inversely associated with educational attainment. Among enlisted soldiers, suicide is inversely related to rank. (Schoenbaum, et al., 2014) Considered suicide during their life: 13.9% Made a suicide plan 5.3% Attempted suicide 2.4% Suicide ideation, plan, or attempts occurred in 47 60% prior to joining the Army. One third of post enlistment suicide attempt associated with pre enlistment mental disorders Prediction of post enlistment first suicide attempts Post enlistment depression Pre & post enlistment Intermittent explosive disorders Nock et al., 2014 Gender Women have significantly elevated odds of suicidal ideation, plans, and attempts Women: Increased 5.1 to 15.2 per 100,000 between 2003 & 2008 (unexpected) Suicide ideation prior to age at enlistment (57.6%); plans (45.9%); first attempt (36.%) Marital status Never married & previously married soldiers have lower odds than married soldiers Rank Lower rank have higher risk (Nock, et al., 2014) Boyd, Bradshaw 3
Military Sexual Trauma Sexual assault (21 25%); sexual harassment (24 60%) of women during military service One in 4 women seeking care at the VA experience sexual trauma while on active duty Combat Exposure Combat exposure and being responsible for the death of an enemy combatant (most severe trauma) increased dramatically from 2005 2012. 2 7 violent episodes of combat exposure strongest predictor of PTSD. (Maguen et al., 2012) PTSD: Most common mental health diagnosis of OIF/OIF veterans Men: combat and combat related experiences Women: combat related experiences & sexual trauma Depression More likely to appear in women Adult sexual trauma & combat exposures Co morbid with PTSD & MST Sleep Disturbances More common in women service members than in men (13.2% vs 8.9%) Sexual assault primary causal factor of PTSD in women Women & men who experience assault prior to deployment are more likely to develop postdeployment PTSD symptoms after combat exposure than those who had no prior assault (22% vs 10% in women and 12% vs 6% in men) Institute of Medicine, 2014 Boyd, Bradshaw 4
Service Member 2004 2012 PTSD GENDER Males 5,468 (1.1%) 100,531 (8.9%) Females 2,356 (3.8%) 22,806 (13.2%) RACE White 5,021 (1.4%) 71,170 (8.5%) Non white 2,738 (1.4%) 51,660 (11%) Institute of Medicine, 2014 Career concerns Losing security clearance Loss of coworker confidence Side effects from medications Family and friends would be more helpful than mental health professional Support outreach programs to military members and their families. Recognize impact of deployment. Assessment of veterans for PTSD symptoms. Research is needed regarding the long term effects of deployment. Boyd, Bradshaw 5
Women represent 14% of the military Unique stresses of women include sexual harassment, trauma, and biological needs Deployment significantly impacts postdeployment quality of life PTSD, suicide, depression are common mental health issues for women service members. Assessment of military experiences can identify the mental health issues and their relationship to their military experience. Boyd, M.A., Bradshaw, W., & Robinson, M. (2013). Mental health issues of women deployed to Iraq and Afghanistan. Archives of Psychiatric Nursing, 27(1), 10 22. Crum Cianflone, N.F., Fairbank, J.A., Marmar, C.R., & Schlenger, W. (2014). The Millennium cohort Family Study: a prospective evaluation of the health and well being of military service members and their families. International Journal of Methods in Psychiatric Research. doi: 10.1002/mpr.1446. Curry, J.F., Aubuchon Endsley, N., Brancu, M., Runnals, J.J., MA Mid Atlantic Mirecc Women Veterans Research workgroup, VA Mid Atlantic Mirecc Registry Workgroup, Fairbank, J.A. (2014). Lifetime major depression and comorbid disorders among current era women veterans. Journal of Affective Disorders, 152 154, 176(12):1177 84 doi: 10.1016/j.jad.2013.10.012. Hoglund, M.W. & Schwartz, R.M. (2014). Mental health in deployed and nondeployed veteran meb and women in comparison with their civilian counterparts. Military Medicine, 179(1), 19 25. Maguen, D., Cohen, B., Ren, L., Bosch, J., Kimerling, R. & Seal, K. (2012). Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan veterans with posttraumatic stress disorders. Women s Health Issues, 22(1), e61 e66. Negrusa, B. & Negrusa, S. (2014). Home Front: Post deployment mental health and divorces. Demography, 51(3):895 916. doi: 10.1007/s13524 014 0294 9. Nock, M.K., Stein, M.B., Heeringa, S.G., Ursano, R.J., Colpe, L.J., Fullerton, C.S., Hwang, I., Naifeh, J.A., Sampson, N.A., Schoenbaum, M., Zaslavsky, A.M., Kessler, R.C., for the Army STARRS Collaborators. (2014). Prevalence and correlates of suicidal behavior among soldiers. JAMA Psychiatry, 7(5), 514 522. Schoenbaum, M., Kessler, R.C., Gillman, S., Colpe, L.J., Heeringa, S.G., Stein, M.B., Ursano, R.J., Cox, K.L for the Army STARRS Collaborators. (2014). Predictors of suicide and accident death in the Army Study to Assess Risk of Resilience in Servicemembers (Army STARRS). JAMA Psychiatry, 71(5), 493 503. Boyd, Bradshaw 6