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Defense public health experts investigate whether minority group service members are more likely to experience behavioral health problems

By V. Hauschild, MPH Defense Centers for Public Health-AberdeenJuly 17, 2023

Defense public health experts investigate whether minority group service members are more likely to experience behavioral health problems
A recent Department of Defense study found American Indian and Alaska Native U.S. Army Soldiers had higher rates of suicidal ideation than white Soldiers. The DOD is investigating behavioral health disparities among minority groups in the military to see how they might mirror similar disparities in the civilian population. (Defense Centers for Public Health-Aberdeen graphic illustration by Steven Basso) (Photo Credit: Steven Basso) VIEW ORIGINAL

ABERDEEN PROVING GROUND, Md. – U.S. public health agencies such as the National Institute of Mental Health have recognized that certain minority groups appear to experience greater risk for certain behavioral health disorders. The higher rates of adverse health problems in minority groups are often referred to as “disparities.”

Behavioral health, sometimes called mental health, includes medical conditions that affect a person’s well-being. Examples include substance use disorder, anxiety disorders, mood disorders to include depression, and suicidal ideation.

Less is known about whether similar behavioral health disparities exist among military service members.

“While there is evidence that suggests behavioral health disparities exist among military subgroups, the specific factors that contribute to disparities need further research,” says K’Juanji Hamilton, a nurse who is currently the deputy chairperson of the Defense Centers for Public Health–Aberdeen’s Diversity, Equity, Inclusion and Accessibility, or DEIA, Advisory Council.

“Factors that may influence behavioral health include race, ethnicity, gender, sexual identity, and social and economic status,” says Hamilton. “Additionally, deployment history, including placement in distant geographic locations like Alaska or Korea, may isolate service members from family networks.”

To help the Department of Defense address the needs of service members and improve force readiness, the RAND Corporation conducted an independent study in 2020 to determine if minority-group service members were more likely to experience behavioral health, or BH, problems than service members in majority demographic groups.

According to the RAND study, BH disparities between minority and majority groups in the military are similar to those in the civilian world, with a few exceptions. For example, in the military, Hispanic and Non-Hispanic Black service members had higher rates of suicide attempts than their white peers, whereas an opposite pattern was found among civilians.

The higher risks for experiencing BH conditions have been largely attributed to socioeconomic and environmental circumstances, sometimes referred to as social determinants of health. Examples include income, education, access to medical care and healthy food, community safety, and social and recreational activities.

Recent data from the U.S. Substance Abuse and Mental Health Services Administration found that among race and ethnicity groups, American Indian or Alaskan Natives had the highest rates of heavy drinking and use of illicit drugs, cigarettes and vaping. These data provided further evidence of disparities for high-risk behaviors among certain U.S. minority groups.

 So what is the military doing?

The DOD recognizes the need to continue to investigate the potential unique risk factors and health outcomes among demographic subgroups in military populations. As a recent example, the Army published a public health study titled Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis.

“This study, conducted from 2020 to 2021, demonstrates that racial health disparities exist even in a socialized health system where all service members and their beneficiaries have access to health care,” says Dr. Matthew Beymer, a principal investigator and co-author of the study, who works for the Behavioral and Social Health Outcomes Practice Division of the DCPH-A.

The study found that in general, the American Indian and Alaska Native U.S. Army Soldiers had higher rates of suicidal ideation than white Soldiers.

“This study represents an important step in studying an understudied population and calls for further investigation into the reasons for disparities in suicide ideation between American Indian and white service members,” says Beymer.

Such findings support the 2020 RAND report recommendation that the DOD focus attention on suicide disparities, particularly among minority military personnel.

Hamilton advocates for additional public health studies of military minority group sociocultural environmental risk factors to address underlying causes of disparities.

“Studies that provide evidence of specific disparities and groups, such as the recent Army study, are helpful to target preventive actions and provide medical and BH services to specific minority populations,” says Hamilton. “Future studies can also help determine what factors contribute to military health outcome disparities, such as being at isolated locations.”

For information regarding current military public health studies about BH outcomes conducted at the DCPH-A, go to https://phc.amedd.army.mil/topics/healthsurv/bhe/Pages/default.aspx.

Resources to assist American Indians and Native Alaskans with mental health questions can be found at www.cms.gov/outreach-education/american-indianalaska-native/behavioral-health.

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