Psychological aspects of the integration of women into combat roles

Integrating women into combat roles: comparing the UK Armed Forces and Israeli Defense Forces to understand where lessons can be learnt

In October 2018, women became eligible to serve in all roles in the UK Armed Forces. The Israeli Defense Forces (IDF) have employed women in limited ground close combat (GCC) roles since 1995. Integration of women into some IDF combat units has improved our understanding of injury risk for servicewomen. While the research findings from physiological studies on women in IDF GCC roles helped inform the integration of women into UK GCC roles, the applicability of the data is limited by the differences between Israeli and UK approaches to recruitment, training and operational deployability of servicewomen. Women in IDF combat roles do, therefore, not provide a good model on the health and performance implications for women in UK Armed Forces combat roles. Further original research to better understand and develop mitigations against any health risks facing UK servicewomen in GCC roles is warranted.

Women in combat roles: themes characterising adjustment in the Israel Defense Force-a pilot study

BACKGROUND

The Israel Defense Force is the only military organisation in the world that mandatorily conscripts women since its founding. Despite legislative changes, the percentage of women serving as combat soldiers is low, and the dropout rate is high. Women in these professions experience a complex and unique adaptation process.

AIMS

To characterise the experiences of female combat soldiers adjusting to combat roles in comparison with male soldiers and non-warfighter female soldiers.

METHOD

A pilot study was undertaken in order to inform further research. Mental health officers in the women's units conducted group interviews. These were composed of four stages: projection, reflection, processing and formulating solutions.

RESULTS

The themes apparent in the interviews conform to phenomena appearing in the literature such as tokenism, disruption of gender identity and internalisation of the superiority of male values. In addition, we identified distortion of body image and increased burnout.

DISCUSSION AND CONCLUSIONS

The study points to the significance of gender aspects in the mental adaptation process of women in combat positions. Issues pertaining perceptions of inequality should not be deemed to be purely sociological, but rather as a gateway facilitating adjustment. This should be taken into account in future research and in the formulation of support strategies.

Incidences of anxiety disorders among active duty service members between 1999 and 2018

PURPOSE

Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period.

METHOD

Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch.

RESULTS

Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001).

CONCLUSION

Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.

The Comprehensive Female Soldier Support Model

Women represent a small minority in the U.S. military and an even smaller minority in the military chaplaincy. Prior to this study, the U.S. Army chaplaincy did not have a gender-specific model for providing support to women soldiers. In this Delphi research project, wounded women soldiers and female military chaplains provided expert opinions to develop the comprehensive female soldier support model (CFS2). Ten military women and 11 female chaplains who had been deployed overseas contributed to the body of knowledge related to the understanding of the emotional and spiritual support needs of wounded female soldiers. Five key findings appeared in the study: (a) many women did not get the chaplain support they needed; (b) the gender of the chaplain was not significant;

A retrospective study of anxiety disorder diagnoses in the military from 2000 to 2009

The objective of this study was to describe trends in the diagnostic rates for anxiety disorders (ADs) types in the U.S. military from 2000 to 2009. Data for the numbers of diagnosed cases for the first documented occurrence of ADs during ambulatory visits while serving in the military were obtained from the Defense Medical Epidemiology Database for all active duty service members and examined across branch of service and by gender. Results indicate that Anxiety Not Otherwise Specified (ANOS) was the most frequently diagnosed AD type in each of the 10 years between 2000 and 2009, with an average rate of 0.8 per 100 service members for first service occurrence, followed by PTSD at a rate of 0.5 out of every 100. Starting in 2002, the yearly first occurrence rates of ANOS and PTSD were significantly higher (p<0.001) compared to each proceeding year, with the same pattern present among males and females separately. The majority of first occurrence AD diagnoses were diagnosed in the Army (47% of Anxiety NOS and 60% of PTSD cases) compared to the other service branches (i.e., Navy, Air Force, and Marines).

Physical and psychological stressors linked with stress fractures in recruit training

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7 ± 0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO(2)max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi = 36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796 ± 157 km, twofold the distance planned of 378 km (P < 0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866 ± 136 and 744 ± 161 km, respectively, P < 0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development.