It's no secret that women face unique challenges in the United States military. What's less known is how deep and wide those challenges can be, and how they affect service members while on active duty and well after leaving the service.

With Women's Health Week (May 9 to May 15) falling within Mental Health Awareness Month, we asked experts about the most pressing issues facing women in the military today. They range from the predictable, sexual harassment, to some that are much less talked about, such as female veterans' inability to land jobs compared to their male counterparts.

Some trends are well documented but no less alarming during the time of COVID-19, when even more stressors have piled up. That includes the fact that women veterans are more than two times more likely to die by suicide as the general population, as reported by the Department of Veterans Affairs clinical psychologist Jennifer Strauss to attendees of a Defense Health Agency (DHA) event in February. Strauss also said that in 2019, 43% of female users of the VA had diagnosed mental health issues, compared to 26% of male VA users.

Many said that these statistics underscore the need for the Department of Defense and the VA to coordinate and prioritize women's mental health needs.

One place for women to start is the VA's Center for Women Veterans. It includes information on individual and whole-family services, for post-traumatic stress disorder, military sexual trauma, depression, readjustment, and substance use disorders. The Psychological Health Center of Excellence has a page on women's mental health in the military, too.

"Resilience is a little bit different with women," said Air Force Lt. Col. Regina Owen, a psychiatric mental health nurse practitioner and a professor at the Uniformed Services University in Bethesda, Maryland. "A lot of women decide to leave the military because they are not treated equal to their male counterparts. So now (with COVID-19) we have this additional stressor.

"With mental health, more people are reaching out, including women. But it depends on what kind of position, what kind of environment these women are in, what kind of leader (they have), how open they are to getting help with the additional stressors that COVID has brought on," she added. "If a woman does not feel supported and her cohort is largely male, she is less likely to seek out help."

Mental health for women in the military cannot be discussed fully without acknowledging that their bodies are much different from men's, noted Air Force Col. (Dr.) Jennifer Chow, deputy director of psychological health for the Air Force Medical Readiness Agency in Falls Church, Virginia.

"Menstruation management and pregnancy are decisions women must consider for deployment, combat zones, and overseas duties," Chow said. "Access to more specialized care such as with an OB-GYN may be more limited," and active-duty pregnant women are not allowed to PCS (permanent change of station) to some locations, or they must PCS or re-deploy prior to a certain point in their pregnancy.

Bathrooms and hygiene are also special considerations for women, Owen said. Uniforms and equipment pose problems, too, though strides have been made in recent years to accommodate females.

"Body armor in the past were not specifically built for female bodies," she said. "One sign of progress is that the Air Force now allows women to wear ponytails to a certain length. This makes the donning of gas masks safer and faster."

Pregnancy is stressful in even the most ideal conditions. For women in the military, there are a host of other concerns aside from the normal chemical and hormonal changes that take over an expecting mother's body.

A PCS, for example, "puts stress on that pregnancy and leads to challenges with it," said Owen. "Whether or not to have the COVID-19 vaccine while pregnant or nursing is yet another stressor."

On top of that, having a child not only marks a big change in a woman's family life, but possible changes in her career and professional future as well, Owen noted.

"A lot of times we try to talk about the here-and-now.," she said. "But one of my specialties is military family medical health, and that's probably why I see so much long-term impact of pregnancy of women in the military."

Owen said she sees a much higher rate of adjustment disorder in females, "whether it is to a combat deployment or transitioning from military to civilian life. Depending on why they get out, they may not have a feeling of hope. If you look at some of these female veterans, they feel like they have been let down. They feel like they maybe aren't getting the equal opportunities as their male counterparts have been given, and they handle trauma in a different way.

"Women have higher rates of (post-traumatic stress disorder) on active duty. That translates on the civilian side as sometimes (going) unnoticed, or they don't believe women. Women are almost twice as likely to have adjustment disorder, and that's very telling."

Chow explained that women have higher rates of a history of sexual harassment or assault even before they deploy, which can predispose them to developing a mental health disorder. Further, rates of military sexual trauma (both harassment and assault) in deployed areas are generally higher for women and contribute to that developmental risk, she noted.

"Being a minority in close quarters and/or small units can make one feel like they are in a fishbowl," Chow said. "They feel especially scrutinized and overly observed. This makes all of their actions, personal and professional, feel like they are being judged and/or criticized."

Owen suggested meditation and mindfulness as positive coping mechanisms that military women can use deal with their stress and overall mental health, especially when deployed.

"Women have to be grounded," she said. "They have to pay attention to being in the moment, realizing what is going on right now, and how best to handle it. Reach out to the right people and confide in the right people."

Army Maj. Darlene Lazard, a clinical social worker and the deputy director for behavioral health at Walter Reed National Military Medical Center in Bethesda, Maryland, sees things a little more straightforward.

"Some of these things that others view as being stressors, I just view as being par for the course of being in the Army," said Lazard, who has been in the military since the 1980s. "I say that based on my experience of being in the military for a lengthy period of time and seeing how it’s evolved from certain responsibilities that women were not allowed to take on, to where we are now, when we pretty much have the capability of taking on whatever we elect to, if the opportunity is presented."

Still, Lazard noted there’s a definite challenge and balancing act between being, say, a wife and a mother in addition to being a soldier. That women in the military are almost always a significant minority at any given command, compared the number of men, is also a hurdle.

"It can be quite stressful because you always feel like you have to prove yourself that you are worthy - are you the best candidate to be in the room amongst other gentlemen - and be able to hold your own in terms of your area of responsibility as well as being the best soldier you can be," she said. "So, there is a real sense of pressure, of proving yourself."

But overall, Lazard said, "I really don't think there's that much of a difference between how women and men deal with certain things in the military. I think the numbers are different because women are more receptive to receiving care."

Owen repeated that she takes the long view, too, but that nonetheless, adjustment disorder, which she describes as "a broad assortment of anxieties," is "hands down" the most common mental health diagnosis that she finds in military women.

"Women aren't given the same opportunities as men are," she said. "When they leave the military, they're leaving with an idea of men being in a better position. We're not giving them much hope. We prepare girls in general to say, 'What's wrong with me? Why can't I do this?' "We prepare men in society to say, 'What's wrong with this problem? It has to be wrong. I'm doing everything right.'"

"Participants of a April 2020 study by the DOD's Office of People Analytics (OPA), pointed out that the delivery of the trainings is often more important than the content itself; younger service members often take their lead from how their leadership delivers trainings, discusses difficult or uncomfortable topic matter, and how inappropriate behavior is enforced. Younger service members are most influenced by their mid-level leadership, NCOs and supervisors, and their peers, making discussions and trainings with these groups integral to shaping appropriate behaviors at the start of their careers."

This undergirds the need for women early in their career - in all jobs - to have mentorships and sponsorships.

"Even though there are more formal mentorships and networks for women in military medicine, the best are the informal networks and opportunities to share stories, share feelings and reactions and help plan the way forward," said Army Col. (Dr.) Dana Nguyen, at an event in March.

Nguyen, chair of the Department of Family Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, noted that it shouldn't happen just in military medicine, but within their local communities as well, where "there is more emphasis on whole-person well-being."