Differences in substance use and mental health symptoms among female and male active duty personnel

Purpose: This study examines female and male service members' alcohol use, tobacco use, and prescription drug misuse, and co-occurrence with symptoms of posttraumatic stress (PTS), depression, anxiety, and suicide ideation/attempts. Methods: We utilize data from the 2011 Health Related Behaviors (HRB) Survey of Active Duty Military Personnel, the Department of Defense and Coast Guard's largest anonymous, representative survey administered for the first time via the internet. It was completed by approximately 40,000 respondents (85% male, 15% female) on indicators of binge drinking, heavy cigarette smoking, prescription drug misuse, and mental health symptoms experienced within the past year. Results: Females reported higher symptoms of PTS (6% vs. 5%), depression (12% vs. 9%), anxiety (23% vs. 16%), and suicide ideation/attempts (5% vs. 4%) than males. However, males reported higher rates of binge drinking (35% vs. 25%) and heavy smoking (4% vs. 2%); prescription drug misuse rates were identical across gender (1%). Logistic regressions revealed that for males only, heavy smoking increased odds of suicide ideation/attempts (OR=1.8, CI=1.2-2.5). Overall, prescription drug misuse had the strongest relationship to mental health symptoms, with males who misused prescription drugs 6 times more likely than non-misusers to report suicide ideation/attempts and females who misused prescription drugs 5 times more likely than non-misusers to report PTS symptoms. Conclusion: For both females and males, prescription drug misuse exhibited a strong relationship to suicide ideation/attempts and PTS symptoms, reinforcing a public health approach that tailors prevention and treatment programs to the co-morbidity of substance abuse and mental health symptoms.