In the first large-scale study of its kind, researchers report that sexual trauma is indeed a risk factor for suicide among military veterans and are calling on veteran health providers to continue including such trauma in suicide prevention strategies.

Published in June in the American Journal of Preventive Medicine, the study is the first large-scale, population-based investigation into whether military sexual trauma is a risk factor in suicide-related mortality. To conduct the study, researchers with the Veterans Affairs system analyzed data on millions of veterans who received outpatient services and were screened for military sexual trauma via the Veterans Health Administration (VHA) between October 2007 and September 2011. Within the VHA, military sexual trauma is defined as sexual assault or repeated, threatening sexual harassment during military service.

In fiscal year 2013 alone, the study reported, the VHA provided sexual trauma-related mental health services to more than 71,000 patients. Study co-authors Rachel Kimerling, Kerry Makin-Byrd, Samantha Louzon, Rosalinda Ignacio and John McCarthy write:

Veterans are at increased risk of suicide relative to the general adult U.S. population, prompting a focus on the conditions and experiences that account for this excess risk among veterans. Mental health conditions, including substance use disorders, mood and anxiety disorders, post-traumatic stress disorder, and schizophrenia are reliably associated with suicide risk among veterans and recent-era service members. … Little is known about other military experiences that may increase risk for suicide mortality, such as military sexual trauma.

Overall, 2.2 percent of the nearly 6 million male veterans and about 350,000 female veterans included in the study reported military sexual trauma when screened — or about 1 percent of men and more than 21 percent of women. Veterans who reported such trauma were more likely to be female, younger, more likely to live in rural communities and more likely to receive a mental health diagnosis such as depression, substance abuse or post-traumatic stress disorder. Suicide rates were higher among both men and women who screened positive for military sexual trauma, and the study found such sexual trauma to be a risk factor for suicide even after adjusting for variables such as age and mental health illness.

Researchers found that among men, suicides attributable to military sexual assault during the study period ranged from 0.29 percent to 0.69 percent; for women, it ranged from about 10 percent to 19 percent. Among those veterans who reported sexual trauma, those who died by suicide were much more likely to have been treated for mental health issues related to such trauma. Researchers also wrote that military sexual trauma may “negate the protective effect of female gender on suicide risk, where women who experienced (such trauma) showed similar risk of suicide over time as the average male VA user.”

The study noted that the VHA has launched a number of efforts to create linkages between suicide prevention and mental health services and those military members who’ve reported sexual trauma. However, researchers wrote that these new results underscore the importance of continuing and strengthening such collaborations.

“Further assessment regarding suicide ideation and attempts among veterans who have experienced (military sexual trauma) will help to inform optimal points of intervention, such as primary care, to address suicide risk in these veterans,” the study stated.

To download a full copy of the new study, visit the American Journal of Preventive Medicine.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.