Burden of mental illness associated with military sexual trauma among veterans deployed to Iraq and Afghanistan

Background: A significant burden of illness associated with the mental health effects of Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq is now a key focus of the Veteran Health Administration (VHA). The issue of sexual trauma has received scant attention in the discussion of deployment-related stressors and subsequent mental health conditions, but it has been hypothesized to be a significant mental health issue for this newest generation of veterans. To date, no research has examined the contribution of experiences of sexual assault or harassment during service, referred to as Military Sexual Trauma (MST), to mental health conditions among OEF/OIF veterans.

Purpose: To examine the mental health conditions associated with MST among OEF/OIF veterans treated in VHA.

Methods: This cross-sectional analysis utilized administrative data obtained from the VA/DoD OEF/OIF Roster and VHA inpatient and outpatient event files. Analyses include 89,960 OEF/OIF veteran patients who utilized medical care at any VHA facility during the time period October 1, 2001 to October 1, 2006 and for whom MST screening data were available. Diagnoses were quantified by grouping ICD-9 codes into non-overlapping categories using the Mental Health and Substance Abuse Clinical Classification System. We assessed bivariate associations between demographic characteristics and MST status, and calculated the adjusted odds of mental health conditions in relation to MST status. Results were stratified by gender.

Results: MST was reported by 14.5% (1,849) of women and 0.6% (471) of men. Both women and men with a positive MST screen were three times more likely to be diagnosed with a mental health condition than patients who did not report MST. The most frequently reported mental health conditions among OEF/OIF veterans were depression, PTSD, anxiety disorders, adjustment disorders, and substance abuse disorders, all of which were significantly more likely among women and men who experienced MST. The relationship between MST and specific mental health conditions did not differ by gender with the exception of PTSD, where women who had experienced MST were significantly more likely to have PTSD than men who experienced MST.

Conclusions: A substantial proportion of OEF/OIF veterans treated at VHA reported MST and these experiences are associated with a wide range of mental health conditions. VHA should ensure access to appropriate services for newly returned veterans and clinician training regarding sexual trauma in men and women. MST appears to be a particularly salient issue for the treatment of PTSD among women.