The effects of interpersonal violence and traumatic brain injuries on mental health diagnoses in female and male Veterans

Abstract: OBJECTIVE: To examine sex differences in exposure to military sexual trauma (MST), intimate partner violence (IPV), and traumatic brain injury (TBI) and their associations with new-onset mental health conditions in United States (U.S.) veterans. SETTING: Retrospective analysis using Defense Health Agency (DHA) and Veterans Health Administration (VHA) data. PARTICIPANTS: U.S. service members and veterans (SMVs) who 1) served after September 1, 2001, (2) received DHA health care in ≥3 years between 1999 and 2019, (3) received VHA health care in ≥2 years between 2000 and 2019, and (4) completed MST screening. Participants were excluded if (1) TBI status was unclear, (2) had penetrating head injury, (3) age ≤17 years at the simulated TBI index date, or (4) TBI index date occurred before medical record availability. DESIGN: Retrospective cohort study. MAIN MEASURES: Exposure to MST, IPV, TBI, and mental health conditions (eg, post-traumatic stress disorder) were obtained from health records. Index date was TBI diagnosis date or simulated based on age. Sex differences in MST, IPV, and TBI, and their associations with mental health diagnoses after index date were examined. RESULTS: Of 2 530 847 SMVs in the Long-term Impact of Military-relevant Brain Injury Consortium Phenotype study, 1 249 848 (18.2% female) were included. TBI was more prevalent among men (P < .0001), while MST and IPV were more prevalent among women (P < .0001). Veterans with TBI, MST, or IPV had higher risk of developing a new-onset mental health condition after the index TBI, with highest risk among veterans with cumulative trauma exposures (eg, TBI + MST + IPV). CONCLUSIONS: Female veterans demonstrated the highest prevalence of MST/IPV exposures, but veterans with cumulative trauma exposures had higher risk of developing a mental health condition following index TBI. Thus, screening for both TBI and interpersonal trauma history would help identify veterans who may benefit from additional services and are at greatest risk for deleterious long-term mental health consequences.