PTSD, depression, and suicidality among survivors of childhood sexual trauma (CST), military sexual trauma (MST), and sexual revictimization (CST + MST).

Abstract

Objective: Research to date has not examined how childhood sexual trauma (CST) followed by sexual trauma during military service (MST) relates to posttraumatic stress disorder (PTSD), depression, and suicidality among women and men. Given the strong association between MST in particular, and these serious posttraumatic outcomes, the current study sought to address this gap. Method: The current study compared the mental health concerns of 268 treatment-seeking veterans who were survivors of CST, MST, or both (CST þ MST). We hypothesized that MST would be associated with greater severity of symptoms compared with CST and that those who experienced sexual revictimization (CST þ MST) would report more severe symptoms than veterans who experienced CST or MST alone. Results: Veteran men presented with significantly higher suicidality but not higher PTSD or depression scores than women. Controlling for gender, MST survivors had significantly higher PTSD and depression symptom severity scores, but not suicidality, than CST survivors. PTSD, depression, and suicidality scores were significantly higher for the CST þ MST group than for CST only survivors, but did not significantly differ from survivors of MST alone. Conclusion: Findings support the more severe clinical impact of CST þ MST-specific sexual revictimization compared with CST-only among military men and women, but also suggest that MST alone can have negative consequences similar to revictimization. While results point to the need to consider context and trauma history in future trauma research and clinical applications, they should be interpreted in light of our sample demographics, which were representative of the southwest U. S. veteran population. Clinical Impact StatementOur study found that male and female veteran survivors of both childhood sexual trauma (CST) and military sexual trauma (MST; i.e., sexual revictimization) experience more severe posttraumatic stress, depression, and suicidality than individuals who have experienced CST alone. Regardless of the type of sexual trauma, men reported more suicidality than women. Additionally, MST survivors who did not report CST reported mental health concerns similar to the revictimized group, suggesting the powerful impact of MST on mental health. The context of a veteran's trauma history should inform assessment of current mental health symptoms (i.e., suicidality) and treatment planning.

The role of shame and trauma type on posttraumatic stress disorder and depression severity in a treatment-seeking veteran population.

“…These results suggest that exposure to multiple trauma types does not necessarily summate to greater reported PTSD and depression symptoms. Although some literature supports the cumulative effects of multiple trauma types on psychological symptoms (Baca et al, 2021;Scott et al, 2014), our findings corroborate past studies that have also been unable to find these differences (Walter et al, 2014;Wolfe-Clark et al, 2017). It is possible that sex differences in study samples may partly explain these discrepant findings.…”

“…It is possible that sex differences in study samples may partly explain these discrepant findings. Among study samples that have found cumulative effects of trauma type, they have been found in primarily or entirely female samples (Baca et al, 2021; Scott et al, 2014), although this is not always the case (Walter et al, 2014). Conversely, studies that have not found this effect have typically had primarily male samples (such as the present study; Wolfe-Clark et al, 2017).…”

“…Interestingly, few studies have explored the interaction of childhood abuse, MST, or combat exposure on PTSD and depression symptoms in veterans. Some research indicates that exposure to multiple types of trauma worsens PTSD and depression symptoms in an additive, cumulative manner for veterans (Baca et al, 2021; Scott et al, 2014). However, other findings have challenged this idea.…”

Childhood Sexual Abuse and Military Sexual Trauma Interact to Increase Suicide Risk: Results from a Nationally Representative Veteran Sample

“…To our knowledge, this study is the first to examine both the independent and interactive associations of CSA and MST with different types of suicidal thoughts and behaviors, including past and self-reported likelihood of future behaviors, in a nationally representative sample of US military veterans. Consistent with some past findings (Baca et al, 2021;Holliday et al, 2021;Kelly et al, 2011), veterans who experienced both CSA and MST, relative to those who experienced neither, were at greater risk for reporting experiences of suicidal ideation in the past year, lifetime suicide attempt, and likelihood of making a future suicide attempt. This finding persisted above and beyond a variety of correlates of suicide risk previously documented in the literature (e.g., non-CSA ACEs, combat exposure, psychiatric comorbidity, gender), as well as CSA and MST individually.…”

“…To date, examination of sexual violence revictimization across the lifespan in relation to suicidal self-directed violence risk among veterans remains limited. The few available studies suggest that veterans who have experienced sexual revictimization (i.e., CSA and MST) are at greater risk for psychiatric symptoms and suicidal self-directed violence (Baca et al, 2021; Holliday et al, 2021; Kelly et al, 2011). However, prior research has largely focused on small convenience samples and discrete timepoints of exposure (e.g., childhood or during military service).…”