Behavioral Health and Service Use Among Civilian Wives of Service Members and Veterans

In recent years, policymakers and members of the media have raised concerns regarding access to behavioral health care for service members and veterans of the U.S. military and their families. Particular concern has been raised regarding the availability and accessibility of care to individuals covered by the DoD's Military Health System (MHS) and the Veterans Health Administration (VHA). To date, research on access to behavioral health care among eligible family of service members and veterans has been limited. In this study, we examine utilization of behavioral health care among one important segment of this population: current or former wives of service members and veterans (whom we refer to as military wives) who are covered by either TRICARE or CHAMP-VA (corresponding to eligibility for care in the MHS or VHA, respectively).

Data for this study are drawn from the National Survey of Drug Use and Health (NSDUH), a large annual cross-sectional survey of behavioral health status and service use in the general U.S. population. By pooling across four consecutive years of the NSDUH, from 2008 to 2011, we are able to compile a large enough sample of current and former wives of service members and veterans to allow meaningful statistical analysis. The sample of military wives was identified in the sample by three criteria:

1. They had never been in the U.S. armed services.
2. They had been married at some point in their lives (presumably to a service member who established their eligibility for either DoD or VA health benefits).
3. They currently receive health care coverage from either TRICARE or the CHAMP-VA.

The comparison group was also drawn from the four-year pooled NSDUH sample according to the following criteria:

1. They had never been in the U.S. armed services.
2. They had been married at some point in their lives.
3. They were covered by a nonmilitary form of health insurance.

Comparisons were made with respect to use of any behavioral health service and of three specific types of service: specialty behavioral health treatment, use of prescription psychiatric medications, and substance use treatment.

Three findings of interest emerged from the analysis. First, relative to the comparison group, military wives who were covered for either TRICARE or CHAMP-VA were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. That is, women who lived small towns or rural areas were less likely to use care, regardless of whether they were military spouses or not. Third, contrary to expectations, we found that military wives who live more than 30 minutes from a military treatment facility (MTF) were more likely than military wives living close to an MTF to receive prescription psychiatric mediations but not other types of behavioral health services.

This study, the first to directly examine behavioral health service use among a representative sample of TRICARE- or CHAMP-VA-covered military wives, did not find evidence that the group experiences disparities in care compared with the general population. The study does have some limitations, which could be addressed in future studies, notably the indirect method of identifying the population of interest. The unexpected finding that military spouses who are more than a 30-minute drive from an MTF are more likely to use prescription psychiatric medications, might indicate a problem in the quality of behavioral health care they are receiving and should be followed up in future studies.

Key Findings

• The military wives and the comparison group were fairly similar in past-year behavioral health status. However, there is evidence that military wives are more likely to have had major depression in their lifetimes.
• Military wives were more likely to have received behavioral health service in the past year, but this difference was not consistent across the types of services; it was due to higher use of prescription psychiatric medications.
• Military wives in more rural areas are less likely to use any type of behavioral health services, significantly so for substance use disorder treatment.
• The likelihood of receiving specialty behavioral health treatment is similar in metropolitan noncore and metropolitan core areas, but lower among residents of micropolitan and small towns and rural areas.
• Military wives living close to an MTF showed lower use of behavioral health services than those living farther away. For the comparison group, proximity to an MTF is associated with higher likelihood of using services.
• Military wives who live near an MTF are less likely to use prescription medication than those who live farther away.

This research was conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.