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Research Questions

  1. Are minority-group service members more likely to experience behavioral health problems relative to their majority counterparts in the military? If so, are these differences still apparent after accounting for sociocultural environmental factors at the individual (e.g., age and education) and interpersonal (e.g., social support and sexual harassment) levels?
  2. Do minority groups in the military experience similar or different behavioral health disparities compared with sociodemographically matched minority groups in the civilian population?

Behavioral health disparities, in which socially disadvantaged groups—such as racial/ethnic minorities, women, and sexual-orientation minorities—experience greater risk for certain mental health and substance use problems, are well documented in the general population. Less is known about whether similar behavioral health disparities exist among military service members. The U.S. Department of Defense (DoD) desires to understand whether the behavioral health disparities seen in the civilian population also exist in the military, as this knowledge is important to helping DoD target its efforts to address the needs of service members and improve force readiness.

To investigate this issue, the authors examined (1) whether minority-group service members are more likely to experience mental health and substance use problems relative to their majority counterparts in the military and (2) whether minority–majority group differences in behavioral health in the military are similar to or different from those in the civilian population.

The authors used data from the 2015 Health Related Behaviors Survey, the 2015 National Survey on Drug Use and Health, the 2015 and 2016 Behavioral Risk Factor Surveillance System, and the 2015 National Health and Nutrition Examination Survey. Behavioral health outcomes include mental health (e.g., depression, suicide behaviors, posttraumatic stress disorder) and substance use (e.g., problematic alcohol use, tobacco use) conditions.

Key Findings

Minority service members experience behavioral health disparities, but patterns vary

  • Racial/ethnic minority service members report mostly lower rates of behavioral health problems relative to white service members, although non-Hispanic black and Asian service members are more likely than non-Hispanic whites to report a suicide attempt.
  • Military women exhibit greater prevalence of mental health conditions but lower prevalence of substance use problems relative to military men.
  • Sexual-minority service members report the greatest number of disparities; these are largely accounted for by sociocultural stressors.
  • Different patterns of behavioral health disparities are observed for gay/lesbian service members compared with bisexual service members.

Minority–majority group differences in behavioral health in the military are similar to those in the civilian world, but there are a small number of differences

  • Non-Hispanic black and Hispanic service members have higher rates of suicide attempts than their white peers, whereas an opposite pattern was found among racial/ethnic minority civilians relative to their white peers.
  • For some outcomes, both military and civilian racial/ethnic minority groups have lower rates than their white peers.
  • Gender disparities in the civilian world are mirrored in the military, with both civilian and military women being more likely than men to report mental health problems and less likely to abuse alcohol and use tobacco products.
  • Sexual-minority groups in both the military and civilian worlds have higher rates of heavy drinking relative to their heterosexual peers, but this disparity is even greater in the military.

Recommendations

  • Although there do not appear to be widespread behavioral health disparities among racial/ethnic minority service members, DoD should consider focusing attention on suicide attempts, particularly among non-Hispanic black, Hispanic, and non-Hispanic Asian military personnel.
  • To support the behavioral health of female service members, DoD should consider addressing gender disparities in mental health outcomes.
  • Because disparities observed among sexual-minority service members were no longer significant when sociocultural environmental risk factors were accounted for, DoD should consider focusing on these areas to reduce disparities.
  • DoD should ensure that prevention programs and behavioral health treatments address the specific needs and stressors experienced by minority service members to ensure optimal readiness in the military.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Literature Review: Minority Group Differences in Behavioral Health Outcomes

  • Chapter Three

    Factors Related to Military Minority Group Differences in Behavioral Health Outcomes

  • Chapter Four

    Military Versus Civilian Comparisons in Behavioral Health Outcomes

  • Chapter Five

    Key Findings and Policy Implications

  • Appendix A

    Methodology

  • Appendix B

    Mental Health Care Service Utilization Among Minority Active Duty Service Members

This research was sponsored by the Psychological Health Center of Excellence and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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