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2015 HSR&D/QUERI National Conference Abstract

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3013 — Military Sexual Trauma and Co-Occurring Posttraumatic Stress Disorder, Depressive Disorders, and Substance Use Disorders among OEF/OIF Veterans

Gilmore AK, VA Puget Sound Health Care System, Seattle Division; University of Washington, Department of Psychology; Brignone E, Utah State University, Department of Psychology; Painter JM, VA Puget Sound Health Care System, Seattle Division; Lehavot K, VA Puget Sound Health Care System, Seattle Division, HSR&D; University of Washington; Fargo J, Utah State University, Department of Psychology; Suo Y, University of Utah, Department of Internal Medicine; Simpson T, VA Puget Sound Health Care System, Seattle Division; University of Washington; Carter ME, University of Utah, Department of Internal Medicine; Blais R, Utah State University, Department of Psychology; Gundlapalli AV, Veterans Affairs Salt Lake City Health Care System; University of Utah, Department of Internal Medicine

Objectives:
Posttraumatic stress disorder (PTSD), depressive disorders (DD), and substance use disorders (SUD) are prevalent among OEF/OIF Veterans. A military sexual trauma (MST)-positive screen is associated with increased likelihood of PTSD, DD, and SUD. However, the association between MST screen status and co-occurrence of these diagnoses is unknown. The current study evaluated the association between MST-positive screen status and co-co-occurring disorders (PTSD/DD; PTSD/SUD; DD/SUD; PTSD/DD/SUD). Differential risk by gender was examined.

Methods:
MST screen results, gender, and ICD-9 diagnoses (PTSD, DD, and SUD) within one year of entering the VA were compiled for a sample of 499,609 Veterans from the OEF/OIF Roster. Four logistic regressions evaluated the association between MST-status and presence or absence of the following diagnostic combinations: PTSD/DD; PTSD/SUD; DD/SUD; PTSD/DD/SUD. Independent variables included MST, gender, and their interaction, as well as associated covariates.

Results:
Overall, 2.7% of the sample screened positive for MST (16.4% women; 0.7% men). MST-status was positively associated with PTSD/DD (adjusted odds ratio [AOR] = 3.31, 95% CI = 3.10, 3.53), PTSD/SUD (AOR = 2.38, 95% CI = 1.90, 2.99), SUD/DD (AOR = 1.90, 95% CI = 1.47, 1.88), and PTSD/SUD/DD (AOR = 4.22, 95% CI = 3.47, 5.15). Further, gender interacted with MST-status such that the association between MST-positive screen and disorder combination was stronger among women than men for PTSD/SUD (AOR = 0.70; 95% CI = 0.52, 0.95), PTSD/DD (AOR = 0.72, 95% CI = 0.64, 0.82) and PTSD/SUD/DD (AOR = 0.49, 95% CI = 0.37, 0.66), but not for SUD/DD.

Implications:
Findings indicate that MST-positive screen was associated with all possible co-occurring pairs among PTSD, DD, and SUD as well as the presence of all three and this was stronger among women than men for PTSD/SUD, PTSD/DD, and PTSD/SUD/DD.

Impacts:
Among OIF/OEF Veterans who recently entered the VA system, those who endorsed MST are at elevated risk of having one of several diagnostic profiles that are associated with poor long-term mental health outcomes relative to their peers who did not report MST. These findings suggest that VA has an opportunity and obligation to identify and treat these Veterans before these issues become chronically debilitating.