A Preliminary Analysis of Psychiatric Service Dog Placements and Sleep Patterns of Partners of Veterans With PTSD.

Partners of veterans diagnosed with posttraumatic stress disorder (PTSD) are at risk of a variety of challenges, and it is unknown whether psychiatric service dogs are disruptive to their sleep or provide similar benefits that are seen in the limited literature on veterans. As part of a larger clinical trial examining the efficacy of psychiatric service dogs for veterans with PTSD and their families, this study focused on sleep patterns of veterans' partners (n = 88), incorporating both subjective (clinically validated self-report surveys) and objective sleep measures (actigraphy). Linear regression was used to analyze differences in relation to group (intervention versus control) at follow up, controlling for baseline score. Results revealed no significant differences between groups for both the subjective surveys (p = 0.15; p = 0.75) and the objective actigraphy measures (p = 0.06-0.98). This suggests that psychiatric service dogs are not disruptive, nor do they provide any benefits to partner sleep. Partners had sleep patterns on par with national norms at baseline and remained at such levels at follow up. Ultimately, using both subjective and objective measures, we found no impact of psychiatric service dogs on the sleep of veterans' partners.

Long-term consequences of mothers' and fathers' wartime deployments: Protocol for a two-wave panel study.

Multiple adjustment difficulties have been associated with children's exposure to recent parental wartime military deployments, but long-term consequences have not yet been systematically studied. This investigation will assess direct and indirect relationships between exposures to parental deployments early in life and later youth adjustment. Parents' psychological health and family processes will be examined as mediators, and parents' and children's vulnerability and support will be examined as moderators. Archival data will be combined with new data gathered from two children and up to two parents in families where children will be aged 11 to 16 at the first data collection and will have experienced at least one parental deployment, for at least one child prior to age 6. Data are being gathered via telephone interviews and web-based surveys conducted twice one year apart. Outcomes are indicators of children's social-emotional development, behavior, and academic performance. Notable features of this study include oversampling of female service members, inclusion of siblings, and inclusion of families of both veterans and currently serving members. This study has potentially important implications for schools, community organizations and health care providers serving current and future cohorts of military and veteran families.

Relationship Maintenance among Military Couples.

A burgeoning body of research on the relationship maintenance of military couples over the past two decades suggests the time is right to organize, assimilate, and critique the literature. We conducted a systematic review informed by the integrative model of relationship maintenance (Ogolsky et al., 2017) that considered issues of intersectionality (Crenshaw, 1991). Our literature search identified 81 relevant journal articles representing 62 unique samples. With respect to theory, 59.3% of the journal articles employed one or more formal theoretical frameworks. In terms of research design, 88.7% of the studies focused on the U.S. military, 83.9% of the studies recruited convenience samples, 54.8% of the studies utilized quantitative methods, and 30.6% of the studies collected longitudinal data. Among the studies reporting sample demographics, 96.8% of participants were married, 77.2% of participants identified as non-Hispanic White, and only one same-sex relationship was represented. Our narrative synthesis integrated findings about relationship maintenance from studies examining (a) relationship maintenance overtly, (b) communicating to stay connected across the deployment cycle, (c) disclosure and protective buffering, (d) support from a partner, (e) dyadic coping, and (f) caregiving and accommodating a partner's symptoms. We interpret our results with an eye toward advancing theory, research, and practice.

Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans.

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.

Focus Forward Fellowship: Evaluation of a program for women student service members and veterans.

The Focus Forward Fellowship was designed to support women student service members and veterans (SSM/Vs) in developing skills and resources to promote persistence to graduation and career attainment. Despite their accomplishments and strengths, women SSM/Vs can be challenged by their military and gender identities in a university environment surrounded by peers who differ in age and life experience (Iverson et al., 2016). Guided by King's (2004) meaning of life meta-model, the Fellowship was designed to increase sense of belonging, understanding of self, and engagement in behaviors tied to academic and career success. We gathered longitudinal evaluation data from two early program cohorts comprising 19 women. Analyses indicated that women reported significant gains in knowledge and use of personal strengths, identity integration, resume preparation, and networking skills, with baseline assessments controlled. No gains were found for sense of belonging or engagement in networking with career professionals or military peers. Based on existing literature, improvement in identity integration is a particularly positive contribution to women students' academic and career success. Program refinements will aim to strengthen contributions to the "belonging" domainof the program.

Posttraumatic stress disorder service dogs and the wellbeing of veteran families.

Background: Benefits and challenges associated with service dogs for veterans with posttraumatic stress disorder (PTSD) may extend beyond veterans to their families. Objective: The purpose of the current study is to evaluate the impact of veterans' PTSD service dogs on spouses and families in a parallel-group, longitudinal design with assessments at baseline and three months follow-up. Method: A total of 88 United States military veteran spouses completed a survey composed of multiple standardized measures at baseline and three months later. In the intervention group (n = 48), veterans received service dogs shortly after baseline while the waitlist control group (n = 40) did not. Results: Linear regression analyses demonstrated significantly lower caregiver satisfaction, higher caregiver burden and higher participation in life activities among spouses who had service dogs in their homes compared to those on the waitlist. Though not significant, small effect sizes were present among additional measures. Conclusion: Results suggest that although previous literature demonstrates service dogs may offer significant improvements for veterans, spouses and children may not experience those same benefits. Clinicians should consider how to prepare veteran spouses and families for integrating service dogs into their home. Future studies should explore family-focused approaches for service dog integration, defining an optimal strategy for the benefit of the entire family. HIGHLIGHTS: Though service dogs may improve wellbeing for veterans with posttraumatic disorder, families of veterans may not experience those same benefits. Researchers and clinicians should consider how to best prepare veteran families for integrating service dogs into their homes.Though posttraumatic stress disorder (PTSD) service dogs are trained specifically for veterans, recent studies have demonstrated that their impact may go beyond veterans themselves (McCall, Rodriguez, Wadsworth, Meis, & O'Haire, 2020; Nieforth, Craig, Behmer, MacDermid Wadsworth, & O'Haire, 2021). PTSD service dogs may provide both benefits and challenges for veteran families.

Antecedentes: Los beneficios y desafíos asociados con los perros de asistencia para veteranos con trastorno de estrés postraumático (TEPT) pueden extenderse más allá de los veteranos a sus familias. Objetivo: El propósito del estudio actual es evaluar el impacto de los perros de asistencia en el TEPT de cónyuges y familias de veteranos en un diseño longitudinal de grupos paralelos con evaluaciones al inicio y a los tres meses de seguimiento. Método: Un total de 88 cónyuges de veteranos militares de los Estados Unidos completaron una encuesta compuesta por múltiples medidas estandarizadas al inicio y tres meses después. En el grupo de intervención (n = 48), los veteranos recibieron perros de asistencia poco después del inicio, mientras que el grupo de control en lista de espera (n = 40) no lo hizo. Resultados: Los análisis de regresión lineal demostraron una satisfacción del cuidador significativamente menor, una mayor carga del cuidador y una mayor participación en las actividades de la vida entre los cónyuges que tenían perros de asistencia en sus hogares, comparado con los que estaban en la lista de espera. Aunque no significativos, pequeños tamaños de efecto estuvieron presentes entre las medidas adicionales. Conclusión: Los resultados sugieren que aunque la literatura previa demuestra que los perros de asistencia pueden ofrecer mejorías significativas para los veteranos, es posible que las cónyuges y sus hijos no experimenten los mismos beneficios. Los clínicos deben considerar cómo preparar a las cónyuges y familias de veteranos para integrar perros de asistencia en sus hogares. Los estudios futuros deberían explorar enfoques centrados en las familias para la integración del perro de asistencia, definiendo una estrategia óptima para el beneficio de toda la familia.

Quantifying the emotional experiences of partners of veterans with PTSD service dogs using ecological momentary assessment.

The objective of this study was to investigate the day-to-day experiences of positive and negative emotions among partners of veterans assigned service dogs for posttraumatic stress disorder (PTSD). As part of a larger clinical trial, a total of N = 87 partners of post-9/11 veterans with PTSD were recruited from a nonprofit service dog provider and participated in an ecological momentary assessment (EMA) protocol. The sample included partners of veterans who received a PTSD service dog after baseline (n = 48, treatment group) and partners of veterans on the waitlist for a service dog (n = 39, control group). Data were collected twice daily for two weeks at baseline and again at follow-up three months later, for approximately 56 assessments per participant (28 at baseline, 28 at follow up). Participants completed an average of 84% of questionnaires at baseline (n = 23.6) and 86% (n = 24.1) at follow-up. A total of 3780 EMA questionnaires were collected among partners for this analysis. Data were analyzed using a generalized linear mixed model. Three months following baseline, partners of veterans with service dogs reported statistically significant higher levels of positive emotions than the control partners (p = .01, d = 0.39) with small-to-medium effect sizes for each individual positive emotion. No statistically significant differences were reported for negative emotions (p = .77, d = 0.21). This study quantitatively identifies higher levels of positive emotion in partners who are cohabitating with a PTSD service dog compared to those partners who remained on the waitlist. Given the influence that positive emotions have on well-being and coping, findings suggest that the influence of service dogs may go beyond veterans to influence their cohabitating partners.

Military couples' experiences in the aftermath of a cancelled deployment.

Deployment requires considerable preparation for military families and changes to these plans may create notable stress. The current study leveraged data from a sample of military couples who experienced the cancellation of an overseas deployment to learn more about their experiences as they adjusted to this change. Guided by family stress and anticipatory stress perspectives, we analyzed qualitative data from 28 service members and their significant others (i.e., spouses or cohabitating partners) to understand their overall reactions to the deployment cancellation. We identified three overall reactions (positive, negative, and ambivalent) that were based on participants' appraisals of-and preparations for-deployment, as well as ambiguity about family roles and relationships. Further, participants across groups experienced uncertainty about whether or not the deployment would occur, and altered timelines for other life events. Together, our findings highlight the post-cancellation period as a significant time of stress and transition for military families. However, our findings also signify the need to help all military families cope with uncertainty about when or if deployments will occur given that the military's priorities are often in flux. We therefore describe coping efforts that may be particularly adaptive for families to engage in as they prepare for uncertain, anticipated stressors.

La comisión militar exige una preparación considerable para las familias de militares, y los cambios en estos planes pueden generar bastante estrés. En el presente estudio se utilizaron datos de una muestra de parejas de militares a quienes se les suspendió una comisión fuera del país para averiguar más acerca de sus experiencias mientras se adaptaban a este cambio. Guiados por las perspectivas de estrés familiar y de estrés anticipatorio, analizamos datos cualitativos de 28 miembros del servicio militar y sus parejas (p. ej.: cónyuges o concubinos) para comprender sus reacciones generales a la suspensión de la comisión militar. Identificamos tres reacciones generales (positiva, negativa y ambivalente) que se basaron en las apreciaciones de la comisión y en los preparativos para esta que hicieron los participantes, así como en la ambigüedad acerca de los roles y las relaciones familiares. Además, los participantes de los distintos grupos sintieron incertidumbre acerca de si se produciría o no la comisión y cambiaron programas por otros acontecimientos de la vida. Juntos, nuestros resultados destacan el periodo posterior a la suspensión como un momento de estrés considerable y de transición para las familias de militares. Sin embargo, nuestros resultados también indican la necesidad de ayudar a todas las familias de militares a afrontar la incertidumbre acerca de cuándo ocurrirán las comisiones o de si estas ocurrirán, dado que las prioridades de los militares generalmente cambian constantemente. Por lo tanto, describimos los esfuerzos de afrontamiento que pueden ser particularmente adaptables para las familias mientras se preparan para factores desencadenantes de estrés anticipados e inciertos.

Trajectories of depression symptoms during the process of deployment in military couples.

Informed by life course theory, we estimated depression symptom trajectories for couples throughout a deployment cycle using data from a longitudinal study of National Guard couples (n= 339). One-third of couples served as a comparison group by participating in data collection after their deployments were canceled. We proposed that 1) service members and partners would display multiple trajectories of depression symptoms that differ as a function of role (i.e., service member or at-home partner) and exposure to deployment; 2) trajectory patterns would be associated with indicators of human capital; 3) service members' and partners' depression symptoms would be linked to each other. We found that depressive symptom trajectories varied by exposure to deployment and role, and that higher levels of human capital were mostly associated with lower depressive symptoms, although we did not find support for partner interdependence. Results were considered in the context of life course theory and emotional cycles of deployment.

Female U.S. Military Veterans' (Non)Disclosure of Mental Health Issues with Family and Friends: Privacy Rules and Boundary Management.

Grounded in communication privacy management (CPM) theory, this study explores the criteria female U.S. military veterans rely on when creating privacy rules regarding (non)disclosure of their mental health information with others as well as how female veterans manage privacy boundaries. Interviews with a diverse sample of 78 female veterans recently diagnosed with PTSD revealed examples of all five criteria for privacy rules proposed by CPM theory and illustrate how factors such as military culture, trauma, and risk/benefit assessments are interconnected. Female veterans also altered their boundary linkages, permeability, and control in response to tensions between revealing and concealing mental health information. Findings suggest the potential utility of drawing connections between tensions that motivate concealing/revealing and boundary management operations and highlight the need to further develop and evaluate programs such as peer support counseling within the Department of Veteran Affairs where female veterans can serve as support resources for their peers.

Youth's Sibling Relationships Across the Course of a Parent's Military Deployment: Trajectories and Implications.

The present exploratory study explored the trajectories and implications of at-home (military unaffiliated) parents' perceptions of youth's sibling relationships across the course of a parent's military deployment. Participants included 109 families with at least two siblings (older sibling and younger siblings age: M = 10.85, SD = 3.92 and M = 7.89, SD = 3.58, respectively) and one parent serving in the National Guard. Data were collected via in-home interviews, at six time points across the deployment cycle. A series of multilevel models revealed increases in sibling disharmony during the months a deployed parent was away, but showed signs of recovery in the year after they returned. Increases in sibling disharmony were positively associated with increases in youth's externalizing behaviors above and beyond the effects of parenting.

Continuity in Psychological Health and Role Functioning Across Deployment.

INTRODUCTION: Scholars have described military deployments as one of the most stressful aspects of life for military couples. Deployment affects multiple roles and family members, yet little is known about the degree to which postdeployment outcomes are accounted for by predeployment functioning independent of deployment experiences. METHODS: Data collection included in-person interviews with National Guard couples experiencing a deployment and a comparison group whose deployment was canceled abruptly. Using hierarchical regression, this study assessed (a) how much variance in postdeployment functioning was explained by predeployment functioning and (b) whether variance accounted for by predeployment functioning differed by domain, respondent, or deployment status. Posthoc analyses revealed which combinations of predeployment functioning accounted for the most variance in postdeployment outcomes. RESULTS: We found evidence of modest continuity between predeployment and postdeployment functioning, particularly for psychological functioning and partner role functioning, and fewer differences than expected in patterns between groups. Certain demographic characteristics, risk factors, and resources accounted for significant variance in postdeployment outcomes in addition to baseline levels of role functioning. CONCLUSIONS: Study findings reinforce the importance of predeployment preparation, providing families with resources to maximize resilience in response to the stress of deployment.

Military Spouses' Self- and Partner-Directed Minimization in the Context of Deployment.

In light of technological advances enabling military couples to communicate throughout deployment, spouses of deployed service members often make decisions about what to share with service members, and how to respond to service members' concerns. In doing so, they manage an emotional boundary between service members and their families. This study focused on two behaviors military spouses may use when managing this boundary, namely their minimization of (1) their own concerns (i.e., self-directed minimization) and (2) service members' concerns (i.e., partner-directed minimization). The purpose of the current study was to identify correlates and consequences of these behaviors. Findings from a longitudinal structural equation model utilizing three waves of data from a sample of 154 married military couples in which the husband was a male National Guard soldier indicated that spouses were more likely to minimize both their own-and service members'-concerns when they themselves reported higher levels of depressive symptomology prior to deployment. Spouses' minimization of service members' concerns during deployment, in turn, predicted higher levels of service members' depressive symptomology at reintegration, even after accounting for their initial depressive symptomology and combat exposure. Implications for intervention efforts aimed at promoting individual and couple adjustment to deployment are discussed.

The Many Faces of Military Families: Unique Features of the Lives of Female Service Members.

Female service members' family structures differ from the traditional male service member-female spouse composition of military families. Consequently, this mixed-methods study reviewed demographic data, empirical evidence, and presented findings from secondary analyses of the 2010 wave of the Military Family Life Project regarding structural differences in male and female service members' families and perceptions and experiences of military spouses. In addition, to gain an understanding of the influence of women's service on their family functioning, we conducted in-depth telephone interviews with 20 civilian husbands residing in 11 states around the United States. Empirical evidence suggests service women had higher rates or remarriage and divorce than service men. Women were also more likely than men to be part of nontraditional family forms. Civilian husbands of female service members, however, reported lower marital satisfaction, less support from the community, and less satisfaction with the military lifestyle than military wives. Husbands' accounts indicated that their families experienced both benefits and challenges from wives' service. Integration in the military community and separation presented major challenges for women's families. Implications of benefits and challenges of women's service for their families are discussed.

Evaluation of a Multimedia Intervention for Children and Families Facing Multiple Military Deployments.

Repeated military deployments have been a common experience for many military families in the past 15 years. While there has been an increase in research and intervention focused on the effects on families of military deployments, much of this work has not focused specifically on the particular needs of young children. Talk, Listen, Connect: Multiple Deployments (TLC-II MD), a multimedia kit designed for home use, is among the first interventions directed toward young children. Created by Sesame Workshop and using popular Sesame Street characters, TLC-II MD was designed to support and equip families with young children with skills to address challenges associated with multiple deployments. This study utilized a randomized experimental design to evaluate the impact of TLC-II MD relative to a control condition using a Sesame Workshop multimedia kit not tailored to military families. Parents in both groups reported that children enjoyed the video overall and watched it repeatedly. Also in both groups, caregivers' depressive symptoms and children's aggressive behaviors declined significantly over time. Caregivers in the test group reported significantly larger increases in comfort discussing the deployment with their child and stronger perceptions that the DVD helped children to cope. Thus, the resilience-oriented materials were helpful to both groups, but those tailored to military families were significantly more likely to be perceived as helpful. Findings offer evidence regarding the ability of multimedia self-administered interventions to assist military families.

Factors Associated With Civilian Employment, Work Satisfaction, and Performance Among National Guard Members.

OBJECTIVE: Employment is a vital part of the postdeployment return to civilian life. This study investigated factors associated with employment-related outcomes (employment status, self-reported work performance, and self-reported work satisfaction) among National Guard members returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments. METHODS: The sample consisted of 1,151 National Guard service members who had returned from overseas deployments approximately six months earlier. Bivariate and multivariable analyses were performed to examine associations between predictors and employment-related outcome variables. RESULTS: Higher-risk alcohol use was associated with reduced odds of being employed as well as with lower ratings of work satisfaction, whereas psychiatric symptom load was associated with lower self-reported work performance and work satisfaction ratings. Perceived social resources were associated with higher self-reported work performance and work satisfaction, whereas better physical functioning was associated with better self-reported work performance. CONCLUSIONS: Policy makers and clinicians may need to consider and assess alcohol use among unemployed National Guard members. They may also need to consider psychiatric symptom load and physical functioning among employed service members who perceive poor work performance and have low work satisfaction. Further research is needed on causal links between these predictors and employment outcomes.

Effectiveness of a multimedia outreach kit for families of wounded veterans.

BACKGROUND: Young children in military families with a member who has a life changing injury can experience emotional difficulties and behavior changes. OBJECTIVE: This study evaluated a Sesame Workshop multimedia kit called: Talk, Listen, Connect: Changes (TLC-II(C); 2008). The kit, which included video and print materials, aimed to help caregivers (i.e., at-home partner, at-home relative or family member of a current or discharged military member) assist young children as they adjusted to their parent's injury. We expected that the materials would be used and their quality evaluated. We hypothesized that use of the materials would produce improvements in caregiver and child outcomes as well as reductions in perceptions of disruption in the home. We also predicted that kit-use would have a positive impact on the family. METHODS: One-hundred and fifty three families with children aged 2-8 years were randomly assigned to receive the kit being evaluated (TLC-II(C)) or a control kit (Healthy Habits for Life (HHL)), also developed by Sesame Workshop. Group outcomes were compared four weeks following receipt of the kits using multivariate analysis of variance. RESULTS: All materials were well used and highly rated. All caregivers reported less social isolation, less child aggression, and significantly less disruptive home environments after kit use. Test group caregivers reported significantly greater reductions in depressive symptoms and significant increases in children's social competence over time in comparison to the control group. CONCLUSIONS: These results signal important improvements among families as a consequence of using either test or control materials. As a preventative intervention designed for families with an injured member, TLC-II(C) was particularly effective at improving coping.

The development and implications of peer emotional support for student service members/veterans and civilian college students.

Student service members/veterans represent a growing population on college campuses. Despite this growth, scholarly investigations into their health- and adjustment-related issues are almost nonexistent. The limited research that is available suggests that student service members/veterans may have trouble connecting with their civilian counterparts and be at risk for social isolation. The present study compared the development and implications of emotional support from peers among 199 student service members/veterans and 181 civilian students through 3 distinct occasions over the course of 1 calendar year. Data were collected via electronic survey. Measured constructs included perceived emotional support from university friends, mental health, alcohol use, and academic functioning. A series of multilevel models revealed that student service members/veterans reported less emotional support from their peers compared with their civilian counterparts; yet, emotional support from peers increased similarly for both groups over time. Although, increasing peer emotional support was generally related to better academic and mental health outcomes for both groups, the links between emotional support and mental health were stronger for civilian students. Results suggest that mental health practitioners, particularly those on college campuses, should be prepared to deal with veteran-specific experiences that occur before and during college.

Implications of posttraumatic stress among military-affiliated and civilian students.

OBJECTIVES: To determine whether posttraumatic stress (PTS) symptoms are associated with problem drinking and alcohol-related consequences, as well as academic correlates among military-affiliated and civilian students. PARTICIPANTS: The final sample (n = 248) included 78 combat-exposed student service members/veterans, 53 non-combat-exposed student service members/ veterans, 38 ROTC (Reserve Officers' Training Corps) students, and 79 civilian students. METHODS: Self-report data were collected spring 2011 via a Web-based survey measuring PTS, problem drinking, alcohol-related consequences, grade point average, educational self-efficacy, academic amotivation, and persistence. RESULTS: Military students exposed to combat-related trauma reported significantly greater PTS symptoms than other military and civilian groups. PTS symptoms were associated with problem drinking and alcohol-related consequences for all groups, yet unrelated to academic correlates among those exposed to combat-related trauma. CONCLUSION: This study adds to the scant literature base exploring the unique characteristics of student service members/veterans in higher education.

Prospective evaluation of mental health and deployment experience among women in the US military.

Previous research has shown that military women often experience potentially severe health outcomes following deployment. Data from the Millennium Cohort Study, a 21-year longitudinal study examining the health effects of military service, were used to examine this issue. In longitudinal analyses (2001-2008) carried out among US military women (n = 17,481), the authors examined positive screens for depression, anxiety, panic, and posttraumatic stress disorder in relation to deployment in support of the operations in Iraq and Afghanistan, while adjusting for relevant baseline and time-varying covariates. Women who were deployed and reported combat-related exposures had greater odds than nondeployed women of reporting symptoms of a mental health condition (odds ratio = 1.91, 95% confidence interval: 1.65, 2.20), after adjustment for demographic, military, and behavioral covariates. In addition, higher stress, problem drinking, and a history of mental illness were significantly associated with increased risk of later mental health conditions. In contrast, women in the Reserves or National Guard and those with higher education were at decreased risk of mental health conditions (all P 's < 0.01). As the roles and responsibilities of women in the military expand and deployments continue, designing better prevention and recovery strategies specifically for women are critical for overall force health protection and readiness.