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Background This study aims to assess whether there were changes in the burden of mental disorder diagnosis in active-duty service women (ADSW) during the COVID-19 pandemic and whether disparities in mental health services persist. Methods We conducted a retrospective open cohort study on ADSW across the Military Health System (MHS) using data from the Military Health System Data Repository to analyze the changes in burden of mental disorder diagnosis in ADSW during the COVID-19 pandemic to provide insight into the need for behavioral health providers. Results We identified a total of 325,147 ADSW from October 2016 to February 2020 and a total of 305,626 ADSW from March 2020 to September 2022. During the pre-COVID-19 period, 19.1% of ADSW had at least one mental disorder diagnosis compared to only 16.3% of ADSW during the COVID-19 period. Adjusted regression analyses revealed that non-Hispanic Black, Hispanic, and Asian/Pacific Islander ADSW are less likely to have a mental disorder diagnosis compared to non-Hispanic White ADSW; however, interaction testing revealed a significant interaction between race/ethnicity and rank, resulting in higher odds of a mental disorder diagnosis across all ranks, excluding 'other' rank, among non-Hispanic Black and Hispanic ADSW, and higher odds in Asian/Pacific Islander and American Indian/Alaska Native ADSW in enlisted ranks. Conclusions Our analysis indicates an increased burden of mental disorder diagnoses during the COVID-19 period; however, there was no disparity between mental health services received by Black ADSW and White ADSW overall during either the COVID-19 period or the pre-COVID-19 period, despite some variation by rank.

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