CINCINNATI -- Before military women were allowed to serve on the front lines of the United States' wars, they were already fighting and dying in private battles with post-traumatic stress disorder.
From the 1950s to the new millennium, the rate of suicide among woman veterans has remained between four and eight times higher than the suicide rate among women who never served -- a statistic one professional epidemiologist called "staggering."
"(PTSD) is a physical pain," Army combat veteran Nikkie Holliday, who served in Iraq and Afghanistan before her suicide attempt, said. "Like you're hurting so bad you can't think past it. … I didn't report for many years what I was going through."
According to a 2015 study by the Department of Veterans Affairs, women in the general population take their own lives at one-fourth the rate men do. Woman veterans such as Holliday match their male counterparts nearly death for death, and they can struggle to find effective help even when they seek it out.
A veteran who has made it all the way to therapy might clam up if she is the only woman in her group or if she fears her peers might interpret her experience with sexual assault as a negative reflection of her character, Veterans Crisis Line worker Letrice Titus told NPR. Like male veterans, women can also chafe as they attempt to transition from military roles to civilian ones, including those in which they are expected to nurture and care for a family.
The sum total of all those barriers led John Preston, a Marine veteran and country singer who focuses on veterans' issues, to cast a female veteran in the music video for his latest song.
Preston wrote "Before I Am Gone" about his own battle with PTSD and suicidal ideation, but decided to put a female face on the story to honor his sisters-in-arms.
"There's not a video out right now that showcases a female veteran, (but) they fought along our side," he said. "There are amazing female veterans that are home without limbs and dealing with a lot of the same problems that the men are."
If you or someone you know is a veteran dealing with PTSD or suicidal feelings, programs such as Stop Soldier Suicide and the Veterans Crisis Line offer 24/7 support via phone call, text and online chat.