Adverse Childhood Experiences, Military Adversities, and Adult Health Outcomes Among Female Veterans in the UK
Abstract: Adverse childhood experiences (ACEs) are well-documented risk factors for poor outcomes in adulthood, including worse physical and mental health. A higher prevalence of ACEs has been reported in military populations compared with the general population. Although there is a body of literature exploring childhood adversities in military populations, research focusing on the female Veteran population in the United Kingdom is limited. Data were collected through a cross-sectional, self-report survey. The survey was completed by female army Veterans recruited via a female military association. The response rate was approximately 45%, and the efective sample for this study consisted of 750 female UK army Veterans. Participant histories of ACEs, military adversities, and current mental and physical health difculties were assessed. The most frequently reported ACEs were emotional abuse, physical abuse, and feeling unloved by family. Experiencing childhood adversities was most strongly associated with mental health difculties such as posttraumatic stress disorder and military adversities such as emotional bullying, sexual harassment, and sexual assault during military service. This study provides insight into the prevalence rates of ACEs in a largely under-researched population and into the relationship between military adversities and adult health outcomes. Further research is needed to better understand the unique needs of female Veterans in the United Kingdom and how they compare with those of their male counterparts and women in the UK general population.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.