Sex Differences in Military Sexual Trauma and Severe Self-Directed Violence

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Domestic and Intimate Partner Violence | Epidemiology | Gender and Sexuality | Health Services Research | Mental and Social Health | Military and Veterans Studies | Preventive Medicine | Psychiatry and Psychology | Psychological Phenomena and Processes


INTRODUCTION: Previous research has demonstrated an association between military sexual trauma and risk for suicide; however, risk for self-directed violence such as suicide attempt or nonsuicidal self-injury following military sexual trauma is understudied. This study examines the relationship between military sexual trauma and serious self-directed violence resulting in hospitalization, as well as whether this relationship differs by sex.

METHODS: Participants were 750,176 Operations Enduring Freedom/Iraqi Freedom/New Dawn veterans who were enrolled in Veterans Health Administration care during the period of October 1, 2001-September 30, 2014 and who were screened for military sexual trauma. Data were analyzed in 2019. Bivariate analyses and Cox proportional hazards regression models were employed.

RESULTS: Women veterans were more likely to screen positive for military sexual trauma (21.33% vs 1.63%), and women and men were equally likely to experience serious self-directed violence (1.19% women vs 1.18% men). Controlling for demographic variables and psychiatric morbidity, military sexual trauma predicted serious self-directed violence for both men and women. Further, men with military sexual trauma were 15% less likely to experience self-directed violence compared with women with military sexual trauma (hazard ratio=0.85, 95% CI=0.74, 0.98).

CONCLUSIONS: Military sexual trauma is associated with risk for serious self-directed violence for both men and women veterans, and the relationship may be pronounced among women. Results underscore the importance of incorporating military sexual trauma into treatment and preventative efforts for self-directed violence.


military, sexual trauma, violence, suicide, gender

DOI of Published Version



Gross GM, Ronzitti S, Combellick JL, Decker SE, Mattocks KM, Hoff RA, Haskell SG, Brandt CA, Goulet JL. Sex Differences in Military Sexual Trauma and Severe Self-Directed Violence. Am J Prev Med. 2020 Feb 6:S0749-3797(20)30017-9. doi: 10.1016/j.amepre.2019.12.006. Epub ahead of print. PMID: 32037020. Link to article on publisher's site

Journal/Book/Conference Title

American journal of preventive medicine

PubMed ID


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Link to Article in PubMed