Military Sexual Assault as a Mediator of the Association Between Posttraumatic Stress Disorder and Depression Among Lesbian, Gay, and Bisexual Veterans

Abstract

Lesbian, gay, and bisexual (LGB) civilians report higher rates of sexual assault, posttraumatic stress disorder (PTSD), and depression compared to their heterosexual counterparts. In this study, we compared military sexual assault (MSA), PTSD, and depression in LGB individuals and their non-LGB peers in two community samples of veterans (N = 2,583). Participants were selected for inclusion if they identified as LGB (n = 110) and were matched 1 to 3 on gender and age with non-LGB veterans (n = 330). Chi-square analyses showed significant differences for LGB veterans compared to non-LGB veterans for experiencing MSA (32.7% vs. 16.4%, respectively), p < .001; probable PTSD (41.2% vs. 29.8%, respectively), p = .039; and probable depression (47.9% vs. 36.0%, respectively), p = .039. Multivariable logistic regression analyses showed LGB veterans were 1.93 times more likely to have experienced MSA compared to non-LGB veterans, 95% CI [1.30, 2.88], p = .001. The experience of MSA significantly mediated associations with probable PTSD, odds ratio (OR) = 1.43, 95% CI [1.13, 1.80], p = .003, and probable depression, OR = 1.32, 95% CI [1.07, 1.64], p = .009. As the experience of MSA fully mediates the presence of PTSD and depression among LGB veterans, we highly recommend health providers assess for MSA among LGB veterans, especially those who meet clinical thresholds for PTSD and depression.

Improving affirming care for sexual and gender minority veterans.

“…For example, among 365 women using VHA care, LGB veterans were more likely to have experienced sexual trauma in the military (31%) than non-LGBT (13%) women (Mattocks et al, 2013). Similar results were shown in two large community samples of veterans: LGB veterans were nearly twice as likely to have experienced sexual assault while in the military compared with non-LGB veterans (Lucas, Goldbach, Mamey, Kintzle, & Castro, 2018) and among transgender veterans, high rates of military sexual assault were found among both transgender women (15%) and especially transgender men (30%; Beckman, Shipherd, Simpson, & Lehavot, 2018). LGBT veterans are at greater risk for depression, posttraumatic stress disorder, and alcohol abuse relative to nonminority veterans (Cochran, Balsam, Flentje, Malte, & Simpson, 2013).…”

Experiences of Sexual Harassment, Stalking, and Sexual Assault During Military Service Among LGBT and Non‐LGBT Service Members

“…In the current study, service members who identified as LGB demonstrated an elevated risk of sexual harassment, stalking, and sexual assault during military service, suggesting that disparities in sexual victimization experiences reported among veteran samples are also present among active duty personnel (Brown & Jones, 2016; Lucas et al., 2018; Mattocks et al., 2013). Our findings also align with military research among active duty service members (DoD, 2017a, 2019), suggesting that those who identify as LGB remain at an elevated risk of sexual and stalking victimization in the years following the repeal of a restrictive military policy believed to have fostered victimization risk (i.e., Don't Ask, Don't Tell; Burks, 2011).…”

“…Indeed, research among veteran samples has suggested that LGBT military personnel experience higher rates of sexual harassment and assault than their non‐LGBT peers (Beckman, Shipherd, Simpson, & Lehavot, 2018; Brown & Jones, 2016; Lehavot & Simpson, 2014; Lucas, Goldbach, Mamey, Kintzle, & Castro, 2018; Mattocks et al., 2013); however, data from active duty samples are lacking. An exception is the U.S. military's biennial anonymous survey of service members, which assesses past‐year sexual victimization experiences and has included measures of sexual and gender identity since 2016.…”

Mind the gap: Sex, gender, and intersectionality in military-to-civilian transitions

“…68,69 The health literature also addresses the unique needs of LGBT+ service members and Veterans. For example, compared with heterosexual and cisgender service members and Veterans, they tend to experience poorer physical health, 70 are at increased risk of experiencing MST, 71 and have poorer mental health outcomes, such as higher rates of PTSD and suicidal ideation resulting from minority stress. 72 LGBT+ service members and Veterans also face insensitivity and even discrimination and harassment from service providers.…”