Publication year
2010
Citation Title
Deployment and the use of mental health services among U.S. Army wives.
Journal Name
The New England Journal of Medicine
Journal Volume
362
Issue Number
2
Page Numbers
101-109
DOI
10.1056/NEJMoa0900177
Summary
Deployment is often stressful, not only for Service members, but also for their partners. Using Army wives’ medical records from 2003 to 2006, the association between Service member deployment and wives' mental health visits and diagnoses was examined. Wives whose husbands deployed had more mental health visits and diagnoses than wives whose husbands did not deploy, and longer deployments were also associated with more mental health visits and diagnoses than shorter deployments.
Key Findings
Military wives whose husbands were deployed during 2003-2006 were more likely to seek mental health services than those with non-deployed husbands, with 19% higher rates for women whose husbands deployed 1-11 months and 27% higher rates for women whose husbands deployed 11 or more months.
Women who experienced a spouse’s deployment were more likely to be diagnosed with a mental health disorder (37%), compared to women who did not experience a spouse’s deployment (31%).
Lengthier deployments were associated with higher rates of mental health diagnoses, with wives experiencing 1-11 months of deployment receiving 4% more diagnoses and wives experiencing 11 or more months of deployment receiving 6% more diagnoses.
Mental health diagnoses associated with the largest increases among wives experiencing spousal deployment were sleep, anxiety, acute stress, depressive, and adjustment disorders.
Implications for Program Leaders
Offer classes that provide information and skills about mental health resilience and healthy coping to wives of deployed Service members
Disseminate information regarding both military and community mental health resources for military spouses
Provide childcare military spouses can utilize when seeking mental health services
Implications for Policy Makers
Recommend collaboration with mental health service professionals and the military to increase accessible, affordable services for military family members
Encourage education and professional development for professionals who serve military families about the special mental health needs of this population
Promote awareness campaigns that reduce the stigma surrounding seeking mental health services for military family members
Methods
Data regarding mental health visits and diagnoses of wives of Active Duty Soldiers were gathered from billing and diagnosis codes in electronic medical records from military facilities and military medical insurance records from 2003-2006.
Military information (e.g., rank, deployment, length of service) about wives' Active Duty Soldiers were gathered from the Defense Manpower Data Center from 2003-2006.
The relationships between husbands' deployment and wives' mental health visits and diagnoses were examined.
Participants
Records were gathered for 6,585,224 outpatient visits by 250,626 Army wives, who were 18-49 years of age.
Wives' Service members had been Active Duty for at least 5 years and had either been deployed to Iraq (55%), Afghanistan (7%), or both (7%) or had not been deployed (31%).
Race/ethnicity was not reported due to 53% missing data.
Limitations
Service members’ deployment dates were not gathered; therefore, the temporal relationship between deployment and wives’ mental health visits and diagnoses could not be assessed.
The generalizability of the sample was limited in several ways (e.g., exclusing spouses who were male, over the age of 48 years, married to National Guard or Reserve members, and users of non-military facilities and insurance).
The validity and reliability of the medical records and diagnostic codes are unknown, potentially influencing results.
Avenues for Future Research
Conduct a similar study with a more diverse sample (e.g., ethnicity, gender, service branch)
Examine other variables that may influence the relationship between Service member deployment and spousal mental health concerns (e.g., Service member mental health, spouses' additional responsibilities, financial strain)
Explore whether brief, preventative mental health services pre-deployment can decrease mental health concerns among military spouses across deployment
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: Military operations in Iraq and Afghanistan have involved the frequent and extended deployment of military personnel, many of whom are married. The effect of deployment on mental health in military spouses is largely unstudied. Methods: We examined electronic medical-record data for outpatient care received between 2003 and 2006 by 250,626 wives of active-duty U.S. Army soldiers. After adjustment for the sociodemographic characteristics and the mental health history of the wives, as well as the number of deployments of the personnel, we compared mental health diagnoses according to the number of months of deployment in Operation Iraqi Freedom in the Iraq–Kuwait region and Operation Enduring Freedom in Afghanistan during the same period. Results: The deployment of spouses and the length of deployment were associated with mental health diagnoses. In adjusted analyses, as compared with wives of personnel who were not deployed, women whose husbands were deployed for 1 to 11 months received more diagnoses of depressive disorders (27.4 excess cases per 1000 women; 95% confidence interval [CI], 22.4 to 32.3), sleep disorders (11.6 excess cases per 1000; 95% CI, 8.3 to 14.8), anxiety (15.7 excess cases per 1000; 95% CI, 11.8 to 19.6), and acute stress reaction and adjustment disorders (12.0 excess cases per 1000; 95% CI, 8.6 to 15.4). Deployment for more than 11 months was associated with 39.3 excess cases of depressive disorders (95% CI, 33.2 to 45.4), 23.5 excess cases of sleep disorders (95% CI, 19.4 to 27.6), 18.7 excess cases of anxiety (95% CI, 13.9 to 23.5), and 16.4 excess cases of acute stress reaction and adjustment disorders (95% CI, 12.2 to 20.6). Conclusions: Prolonged deployment was associated with more mental health diagnoses among U.S. Army wives, and these findings may have relevance for prevention and treatment efforts.
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