1. Nikki R. Wooten, PhD, LISW-CP
Assistant Professor, University of South Carolina
Lieutenant Colonel, U. S. Army Reserves
Cite as: Wooten, NR, Adams, RS, Mohr, BA, Jeffery, DD, Funk, W, Williams, TV, & Larson, MJ. (2016, June). Pre-deployment year mental health diagnosis and
treatment in deployed Army women. Oral presentation, Women and Gender Health Interest Group, Annual Research Meeting of Academy Health. Boston, MA.
Pre-deployment Year Mental Health
Diagnoses and Treatment in Deployed Army Women
@ArmyWomen_USCSW

2. ACKNOWLEDGMENTS
Funded by the National Institute on Drug Abuse #1R01DA030150 and 1R01DA030150-S1 (PI: Dr. Larson), #K01DA037412 (PI: Dr. Wooten). Drs. Williams and
Jeffery were the Defense Health Agency government project managers who sponsored access to the DoD data sources. Ms. Wendy Funk and Kennell &
Associates, Inc. created the mental health research file and the Ill, Injured, and Wounded dataset for this study. The opinions and assertions herein are those of the
authors and do not necessarily reflect the views of the DoD or the National Institutes of Health. This research has been conducted in compliance with all
applicable federal regulations governing the protection of human subjects.
Rachel S. Adams, PhD, MPH
Beth A. Mohr, MS
Diana D. Jeffery, PhD
Wendy Funk, MS
Thomas V. Williams, PhD
Mary Jo Larson, PhD, MPA
Forthcoming: Wooten, NR, Adams, RS, Mohr, BA, Jeffery, DD, Funk, W, Williams, TV, & Larson, MJ. (in press). Pre-deployment year mental health diagnosis
and treatment in deployed Army women. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-016-0744-3.

3. Military Women’s Risk for MHDX
• Women’s military and deployment roles are similar
to men’s
• Recent Department of Defense (DoD) policy allow
women’s roles in:
– Combat-related training and military occupations
• New roles may expose women to:
– Combat exposures
– Being prisoner’s of war
– Sexual assaults in military units and captivity
– Severe physical injury
– Gender discrimination
Kamarck, 2015; Schafer et al., 2015

4. Military Women’s Need for MHT
• Military and deployment experiences and their
cognitive appraisals of those experiences may
differ from men
– Military sexual trauma
– Intimate partner violence
– Gender discrimination
– Perceived public or self stigma
– Low social support from military leadership and peers
• Higher incidence and prevalence of MHDX than
military men
• These factors may increase their need for MHT
Armed Forces Health Surveillance Center, 2010; Wells et al., 2010

5. Why Pre-deployment Mental Health
Diagnosis and Treatment?
• Pre-existing mental health conditions among military service
members (SMs)
– Identify SMs more susceptible to deployment-related problems
– Significant contributors to psychiatric morbidity during
deployment and post-deployment
• Pre-deployment MHDX is the strongest predictor of a
recurrence of the same MHDX during post-deployment among
military women
• MHDX primary reason women medically evacuated during
Afghanistan and Iraq deployments
• In 2012, only 34% of SMs newly diagnosed with PTSD and
24% newly diagnosed with depression received treatment
within 8 weeks of diagnosis
Armed Forces Health Surveillance, 2012; Center, Larson et al., 2011; Polusny et al., 2014; RAND, 2016

6. Purpose
Among Army women returning from Afghanistan or
Iraq deployments ending in FY2010 (N=14,633):
1. To estimate the prevalence of select mental
health diagnoses (MHDX; mood, adjustment,
anxiety, and PTSD) and mental health treatment
(MHT) in the pre-deployment year (365 days
before deployment begin date).
2. Identify demographic, military, deployment, and
behavioral health characteristics associated with
pre-deployment MHT.

7. Methods
• Substance Use and Psychological Injury Combat
Study (SUPIC; NIDA #R01DA030150, PI: Mary Jo Larson, PhD)
• Retrospective observational study
– Gelberg-Anderson Behavioral Model for Vulnerable Populations
• All active duty Army women (N=14,633) who
returned from Afghanistan or Iraq deployments in
FY2010 of the total 152,447 Army service members
– FY2010 = 1 October 2009 – 30 September 2010
– Identified from demographic and deployment data
• Defense Enrollment Eligibility Reporting System (DEERS)
• Contingency Tracking System (CTS) Gelberg et al., 2000; Larson et al., 2013; Wooten et al., 2013

8. Methods
• Data Sources
– DEERS (demographic)
– CTS (deployment)
– Military Health System Data Repository (MDR)
• Medical claims
• Ill, Injured, & Wounded database (physical & psychological injury flags)
• Time Periods
– Index deployment
• Deployment ending FY2010
• Average deployment = 10.2 months
– Pre-deployment year
• 365 before the index deployment begin date
– Post-September 11th military service
• Since FY2002 (1 October 2001) to day before pre-deployment year begin
date

9. Methods
• Dependent variables
– Receipt of any pre-deployment year MHT
• Principal MHDX (MDC 19; mental diseases/disorders) on one inpatient
record or two outpatient encounters
– Number of outpatient encounters in the pre-deployment year (1 vs 2+)
• Independent variables
– Predisposing
• Age (years), marital status, race/ethnicity
• Number of child dependents, single parent status
• Any prior behavioral health treatment
– Enabling
• Military rank, length of military service (defined # months TRICARE eligible)
– Need
• Any select pre-deployment year MHDX (mood, PTSD, adjustment, anxiety)
• Any physical injuries during post-September 11th military service
– Vulnerability
• Enlisted rank, prior deployments, short dwell time (<365 days between deployments)

10. Demographics
• Mean age: 27.7 years, 42.5% 18-24 years
• 39.2% White, 35.7% Black
• 46.9% Married, 40% Single, 15.3% Single parents
• 81.5% Enlisted (military rank = E1 - E9)
• 49.7% 2 or more Afghanistan or Iraq deployments
• 12.5% Short dwell time (<365 days between deployments)
• ~5% physical injury since FY2002
• 27.8% behavioral health treatment history (since FY2002,
but before begin date of the pre-deployment year)

11. Prevalence of Pre-deployment
Mental Health Diagnoses & Treatment
MENTAL HEALTH
DIAGNOSES, 26.2% MENTAL HEALTH
TREATMENT, 18.1%
MHDX & MHT,
83.2%
Mood
Adjustment
Anxiety
PTSD
Inpatient
Outpatient

12. Prevalence of Pre-deployment
Mental Health Diagnoses
ANY
SELECT
MHDX,
26.2%
MOOD,
20.1%
ADJUSTMENT,
9.5%
ANXIETY,
5.8%
PTSD, 1.9%
TYPE OF DIAGNOSES
1 MHDX,
68.8%
2 MHDX,
20.9%
3+ MHDX,
10.3%
NO. OF DIAGNOSES
Mood
Adjustment
Anxiety
PTSD

13. Prevalence of
Pre-deployment Mental Health Treatment
(n = 2647)
ANY MHT, 18.1%
ANY OUTPATIENT,
17.5%
ANY INPATIENT,
0.5%
2+ OP VISITS,
66.3%
Mean number of encounters: 5 (sd = 6.4), range 1-58

14. Associations with
Pre-deployment Mental Health Treatment
Model 1: Any Pre-deployment Year MHT$
(n = 14,633)
Army women with any prior behavioral health treatment or physical injuries during their post-September 11th military service (i.e., since
FY2002 and before the pre-deployment year) had increased odds of receiving MHT in the pre-deployment year. Minority women,
commissioned/warrant officers, and women who had been in the military longer reduced odds of receiving pre-deployment year MHT.
***p < 0.0001. **p < 0.001. *p < 0.05.
$Logistic regression model also
controlled for age and marital status.

15. Associations with
Pre-deployment Mental Health Treatment
Model 2: Number of Outpatient MHT Encounters$
(1 vs 2+; n = 2647)
Officers/warrant officers had 35% fewer expected number of MHT encounters, compared to enlisted women (RR 0.65, 95 % CI 0.50–0.84). Army
women with any behavioral health treatment during their post-September 11th military service had 61% higher expected number of MHT
encounters compared to those without prior behavioral health treatment (RR 1.61, 95 % CI 1.38–1.88).
RR and 95% CI ***p < 0.0001. **p < 0.001. *p < 0.05.
Percent change = RR – 1.
$Zero-truncated negative binomial regression
model also controlled for age and marital status.

16. Discussion and Conclusions
• A substantial proportion (26.2%; n=3835) of active duty Army
women had diagnoses of PTSD, mood, adjustment, or other
anxiety disorders in the 365 days before the begin of their military
deployments ending in FY2010.
• An overwhelming majority (83.2%) of Army women with pre-
deployment MHDX received pre-deployment MHT, and those who
received any BH treatment during their post-September 11th
military service had 61% more pre-deployment outpatient visits
than those without any prior BH treatment.
• Minority women, commissioned/warrant officers, and those
who had been in the Army longer were less likely to receive pre-
deployment MHT, whereas women with physical injuries and
any BH treatment during their post-September 11th military
service, but before the pre-deployment year were more likely to
receive pre-deployment MHT.

17. Discussion and Conclusions
• Any prior BH treatment was a predisposing factor and any
physical injuries (i.e., amputations, fractures, burns, concussion,
shrapnel) since FY2002 increased need for pre-deployment MHT.
• Future research should determine whether pre-deployment
MHDX reflect vulnerability for post-deployment MHDX among
Army women, or if pre-deployment MHT provides protection
from exacerbation of symptoms during deployment or chronic
symptoms during post-deployment.
• Inform U. S. Army’s Deployment Health Assessment Program
– Assist Commanders’ decision-making about whether to deploy women with
pre-existing mental health conditions
– Assist military behavioral health providers identify women who may need in-
theater assessment and/or treatment; confidential in-theater referrals
• Inform DoD overall goals of health promotion, population health,
and deployment readiness among diverse U. S. armed forces

18. QUESTIONSEmail: nwooten@sc.edu
Twitter: @ArmyWomen_USCSW