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IIR 04-420 – HSR&D Study

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IIR 04-420
MST Effects on PTSD and Health Behavior: A Longitudinal Study of Marines
Jillian C. Shipherd PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: September 2006 - August 2010

BACKGROUND/RATIONALE:
This study investigated the associations among military sexual trauma (MST), posttraumatic stress disorder (PTSD) symptoms, health behaviors, and physical health problems in male and female Marine recruits.

OBJECTIVE(S):
Relationships between MST and respondents' functioning approximately 11 years after joining the Marines were evaluated utilizing a sample of 1847 Marine recruits as part of a prospective longitudinal study. The objectives were to 1) identify pre-military risk factors for MST; 2) evaluate MST impact on mental health, health risk behaviors, and functional health outcomes; 3) examine PTSD severity as a mediator of MST and health risk behaviors, and between MST and functional health outcomes; 4) identify risk and resilience factors that moderate the impact of MST on health outcomes; and 5) Identify risk factors for suicide.

METHODS:
This study is the fifth wave of data collection (T5) in a longitudinal investigation of 1847 Marines. T5 occurred approximately 10 years after recruit training. Participants were followed irrespective of whether they stayed in the military. Self-report surveys were mailed to all original participants. Of the original sample, 1265 live persons and 22 deceased were found for a location rate of 69.7%. Of the 1265 potential participants, 740 responded for a response rate of 58.5%. The participation rate (687 completed surveys of 1265 potential) was 54.3%, and the refusal rate was low at 7.2% (n = 53).

FINDINGS/RESULTS:
Being female predicted MST status during gender integrated military experiences. Women were 5.49 times more likely than men to have experienced MST during the Marine Corps and were 3.09 times more likely than men to have experienced MST during Reserve duty.

MST experiences during T2-T4 were associated with several health outcomes: in men, number of suicide attemps and social/leisure functioning, and in women, adequacy of sleep and binge/purging, were associated with MST.

A series of path analyses identified mediators and moderators of the relationships between MST and health outcomes and revealed different gender patterns.
Among women only, PTSD symptoms at T4 mediated the relationships between MST and later work/school, family, and social/leisure functioning. Effects of MST on outcomes were also moderated by T1 levels of PTSD in the predicted direction.
Among men, the impact of MST on later functioning was moderated by depression, PTSD symptoms, unwanted adult sexual experiences, and self-esteem at T1.

National Death Index search identified 22 deaths. Of those, 6 were suicides, 14 "possible suicides" (11 motor vehicle accidents, 2 overdoses, and 1 unspecified). Two deaths were homicides. One suicide and 3 of the possible suicides had previously endorsed MST; neither homicide had reported MST.

IMPACT:
These data will improve our understanding of the sequelae of MST for men and women and will be informative to the VA healthcare system. Data from deceased participants add to the growing body of literature that indicate that premature deaths are high among Veteran samples.

PUBLICATIONS:

Journal Articles

  1. Shipherd JC, Pineles SL, Gradus JL, Resick PA. Sexual harassment in the Marines, posttraumatic stress symptoms, and perceived health: evidence for sex differences. Journal of traumatic stress. 2009 Feb 1; 22(1):3-10.
  2. Vogt DS, Rizvi SL, Shipherd JC, Resick PA. Longitudinal investigation of reciprocal relationship between stress reactions and hardiness. Personality and Social Psychology Bulletin. 2008 Jan 1; 34(1):61-73.
Journal Other

  1. Gradus, Abramovitz. Prevalence of depression and suicidal behavior among Marine recruits. [Abstract]. American journal of epidemiology. 2007 Jan 1.
Conference Presentations

  1. Brogan LA, Suvak M, Iverson KM, Shipherd JC. A Prospective Examination of Sexual Revictimization in a Large Sample of Marine Recruits. Poster session presented at: Association for Psychological Science Annual Convention; 2011 May 23; Washington, DC.
  2. Vaughn RA, Smith B, Vogt DS, Shipherd JC. Sex differences across multiple domains of social support: Moderators of the impact of stress on mental health outcomes during US Marine Corps training. Poster session presented at: Association for Behavioral and Cognitive Therapies Annual Convention; 2010 Nov 21; San Francisco, CA.
  3. Shipherd JC, Suvak M. Short-term and long-term health effects of Military Sexual Trauma (MST) in women. Poster session presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 14; Arlington, VA.
  4. Giasson HL, Gradus JL, Shipherd JC. Military sexual trauma and suicide attempts in a sample of Marines. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 27; Seattle, WA.
  5. Gradus JL, Abramovitz SM, Shipherd JC. Pre-enlistment depression, suicidal ideation and plan/attempts among Marine recruits. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 5; Atlanta, GA.
  6. Harrington E, Abramovitz SM, Shipherd JC. PTSD mediates the relationship between MST and eating behavior. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 5; Atlanta, GA.
  7. Gradus JL, Abramovitz SM, Shipherd JC. Pre-Enlistment Depression, Suicidal Ideation and Plan/Attempts Among Marine Recruits. Poster session presented at: VA Boston VAMC Annual Research Week; 2009 May 6; Boston, MA.
  8. Abramovitz SM, Harrington EF, Shipherd JC. Does MST predict Healthcare Utilization for Men and Women? Poster session presented at: VA HSR&D National Meeting; 2009 Feb 6; Baltimore, MD.
  9. Gradus J L, Abramovitz S M, Shipherd J S. Prevalence of Depression and Suicidal Behavior among Marine Recruits. Presented at: Society for Epidemiologic Research Annual Meeting; 2007 Jun 19; Boston, MA.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention
Keywords: Deployment Related, Outcomes, Sexual abuse
MeSH Terms: none

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