Military sexual trauma may increase risk of suicide attempts and drug overdoses in veterans

1. In this longitudinal cohort study, military sexual trauma (MST) was associated with higher risk of suicide attempts among male and female veterans aged 50 years or older.

2. Victims of MST had also had higher risk of death by drug overdose.

Evidence Rating Level: 2 (Good)

Study Rundown: More than 1 million veterans are victims of military sexual trauma (MST), with downstream effects on physical and mental health including increased risk for cardiovascular disease and post-traumatic stress disorder (PTSD). Although the connection between PTSD and increased late-life suicide risk has been established, no literature has been published that examines how PTSD may affect the relationship between MST and suicidal behavior, nor has the link between MST and apparent accidental death by overdose been fully elucidated. This study aimed to explore the links between MST and suicide attempt, overdose, and associated mortality in male and female veterans aged 50 years or older. In a cohort of more than 5 million veterans, MST was associated with greater risk of suicide attempts in general as well as non-fatal attempts among both men and women. Victims of MST had slightly higher cumulative incidence of death by suicide at 90 years. Risk and cumulative incidence of death by drug overdose were higher among male and female victims of MST, while MST was associated with higher risk of suicide death by hanging among male veterans; however, the risk of suicide death by firearm was similar among victims of MST and no-MST participants. Subgroup analyses showed that MST was linked to higher suicide risk regardless of whether participants had PTSD, but the magnitude of the association was twice as high among participants without PTSD. The generalizability of this study was limited by potential underreporting, unmeasured confounding, and a lack of power to analyze non-binary and transgender veterans separately. Nonetheless, this study suggested that MST may increase the risk of late-life suicide attempts and overdose death, emphasizing a need to address the long-term effects of sexual trauma.

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Relevant Reading: Sexual Trauma and Combat During Deployment: Associations With Suicidal Ideation Among OEF/OIF/OND Veterans

In-Depth [retrospective cohort]: This longitudinal cohort study aimed to examine the links between MST and suicidal behavior, overdose, and associated mortality in veterans aged 50 or older. Patients were identified from a study of veterans from 2012 and 2013 with follow-up lasting until December 31, 2020. Data on outcomes were obtained through the VA’s National Consolidated Suicide Behavior and Overdose Report/Suicide Prevention Applications Network (SBOR/SPAN) as well as the Mortality Data Repository. The study identified 5,059,026 veterans aged 50 years or older. Women made up 6.1% of the cohort, and the mean cohort age was 68.0 years (standard deviation [SD], 10.8). Three-quarters of participants were non-Hispanic White, 13.7% were non-Hispanic Black, and 4.5% were Hispanic. Median follow-up was 7.3 years. Victims of MST comprised 15.3% of women and 1.3% of men. In adjusted models, the MST group had higher risk of suicide attempt among men (risk difference [RD], 12.41% [95% CI, 11.72% to 13.10%]) and women (RD, 5.74% [95% CI, 5.22% to 6.26%]), as well as risk of non-fatal attempt among men (RD, 11.92% [95% CI, 11.27% to 12.57%]) and women (RD, 5.58% [95% CI, 5.08% to 6.08%]). The MST group had a slightly higher cumulative incidence of death by suicide at age 90 years compared with the no-MST group for both genders (RDs: men, 0.27% [95% CI, 0.00% to 0.54%]; women, 0.15% [95% CI, 0.00% to 0.30%]). Victims of MST had a higher risk of suicide death by drug overdose among both men (RD at age 90 years, 1.05% [CI, 0.79% to 1.31%]) and women (RD at age 90 years, 0.48% [CI, 0.28% to 0.68%]), but the risk of suicide death by firearm was similar between the MST and no-MST groups. In fully adjusted models, PTSD was an effect modifier of the correlation between MST and any suicide attempt or non-fatal suicide attempt for men and women, with association magnitudes being almost twice as high among patients without PTSD compared with the PTSD subgroup.

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