A Longitudinal Investigation of Military Sexual Trauma and Perinatal Depression

Military sexual trauma (MST), which includes sexual harassment or assault while in the military, is prevalent among women Veterans and associated with depression and suicide. Little is known about women Veterans' perinatal mental health, including the potential role of MST. This is the first study to investigate the impact of MST on risk of depression and suicidal ideation (SI) during and after pregnancy. Bivariate statistical tests between MST harassment and assault, measured by the two standard Veterans Health Administration screening questions, and pre- and postnatal depression and SI, measured by the Edinburgh Postnatal Depression Scale, were examined using longitudinal data from the ongoing Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study. COMFORT includes 620 Veterans interviewed during pregnancy; 452 have been reinterviewed after delivery. Hayes mediation models were employed to examine whether prenatal depression mediated the association between MST and postnatal depression. MST was associated with higher pre- and postnatal symptoms of depression and SI. Further, prenatal depression mediated the association between MST and postnatal depression (indirect effect [standard error] of harassment on postnatal depression through prenatal depression: 1.11 [0.26], p < 0.001; indirect effect [standard error] of assault on postnatal depression through prenatal depression: 1.50 [0.35] p < 0.001), even after controlling for demographic variables and prenatal stress. Women Veterans who have experienced MST may be at higher risk of perinatal depression and SI. Findings highlight the importance of access to mental health care and trauma-informed obstetrical care for these Veterans.