Sexual Trauma during Military Service Increases Risk of Subsequent Suicide among Veterans
Veterans are at increased risk for suicide relative to the general U.S. population, prompting a focus on the conditions and experiences that account for this excess risk. While mental health conditions (i.e., PTSD, schizophrenia, and substance use disorder) are reliably associated with suicide risk, the risks posed by deployment to Iraq or Afghanistan are less clear. Moreover, little is known about other military experiences that may increase risk for suicide, such as military sexual trauma (MST). This was the first large-scale, population-based study of sexual trauma and suicide mortality that examined risks associated with MST among both male and female Veterans receiving VA care. Using VA data, investigators identified more than 6 million male Veterans and 363,680 female Veterans who received VA outpatient services between FY2007 and FY2011, and who were screened for MST. The primary outcome was death by suicide as indicated by the National Death Index database of cause-specific mortality. Age adjusted models and fully adjusted models that included age, medical morbidity, rural residence, and mental health diagnoses also were calculated.
- Women and men who reported MST had an increased risk of suicide, and MST remained an independent risk factor even after adjusting for other known risk factors for suicide among Veterans, including mental health conditions, medical morbidity, and demographic characteristics.
- Among Veterans who reported MST, those who died by suicide were significantly more likely to be treated for mental health conditions determined by their provider to be related to MST experiences: men 50% vs. 36%, and women 67% vs. 48%.
- Overall, 2% of the Veterans in this study reported MST when screened (1% of men, and 21% of women), with 97% reporting no MST, and 0.3% declining to complete the screen.
- Of the Veterans in this study cohort, 9,017 completed suicide during the follow-up period. The increased risk associated with MST could contribute to between 10% to 20% of all suicides in women Veterans under VA care.
- Unobserved suicide mortality may have occurred following exposure but prior to screening for MST, leading study results to underestimate the true risk associated with MST.
- Data are from 2011, which may not reflect current VHA trends in MST screening or treatment.
- In FY2013, VA provided specialized MST-related mental healthcare to 59% of women Veterans and 44% of male Veterans who reported MST, representing potential opportunities for prevention interventions for those at increased risk of suicide. Sexual trauma is also an important consideration for suicide prevention among individuals without documented psychiatric morbidity. This is the first study to document that sexual trauma during military service increases subsequent risk of suicide. Findings have informed VA approaches to MST services and suicide prevention.
This study was supported by VHA Mental Health Services and Mental Health Operations, and was conducted for program planning and evaluation purposes, not for research. Dr. Kimerling is part of HSR&D's Center for Innovation to Implementation in Palo Alto, CA. Dr. McCarthy is part of HSR&D's Center for Clinical Management Research in Ann Arbor, MI.
Kimerling R, Makin-Byrd K, Louzon S, Ignacio R, McCarthy J. Military Sexual Trauma and Suicide Mortality. American Journal of Preventive Medicine. December 14, 2015;e-pub ahead of print.