Mental Health Burden in Enlisted and Commissioned U.S. Military Veterans: Importance of Indirect Trauma Exposure in Commissioned Veterans

Abstract: The objective of the study is to 1) identify sociodemographic and military differences between enlisted and commissioned U.S. military veterans; (2) examine sociodemographic, military, trauma, and mental health histories of enlisted and commissioned veterans; and (3) evaluate interactions between enlistment status and trauma exposures in relation to mental health. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative sample of U.S. military veterans. Screening instruments were used to assess posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol and drug use disorders (AUD, DUD), and suicidal ideation (SI). Post-stratification weights were applied to analyses to permit generalizability to the U.S. veteran population. Enlisted veterans (7.5%–13.1%) were more likely than commissioned veterans (3.5%–11.1%) to screen positive for most mental health outcomes. Multivariable analyses revealed enlisted veterans were more likely than commissioned veterans to report past-year SI (odds ratio [OR] = 2.48). Enlistment status interacted with exposure to potentially traumatic events (PTEs), such that greater exposure to indirect PTEs was associated with a greater likelihood of screening positive for PTSD (OR = 1.12) and GAD (OR = 1.10) among commissioned relative to enlisted veterans. Commissioned veterans with higher exposures to adverse childhood experiences had increased odds (OR = 1.36) of endorsing SI relative to enlisted veterans. The study found that while enlisted veterans had higher rates of SI relative to commissioned veterans, commissioned veterans with higher exposure to indirect PTEs may have an increased risk of screening positive for PTSD and GAD.