Sexual Trauma, Suicide, and Overdose in a National Cohort of Older Veterans

Little is known about the association between military sexual trauma (MST) and risk for suicide-related outcomes later in life.

To determine the association between MST and risk for suicide, overdose, and related mortality among older men and women at specific age landmarks and to investigate whether posttraumatic stress disorder (PTSD) modifies risk.

Longitudinal cohort study; baseline in 2012 to 2013, with follow-up through 31 December 2020.

All U.S. Department of Veterans Affairs (VA) medical centers in the United States.

5 059 526 veterans aged 50 years or older.

Positive MST screening result, nonfatal suicide attempt, death by suicide, or overdose death.

MST was documented for 15.7% of older women and 1.3% of older men. The adjusted cumulative incidence of any suicide attempt was higher for those with MST (men, 18.67%; women, 8.66%) than for those without MST (men, 6.25%; women, 2.92%) at age 90 years. The adjusted risk differences among men and women were 12.41% (95% CI, 11.72% to 13.10%) and 5.74% (CI, 5.22% to 6.26%) for any late-life suicide attempt, 11.92% (CI, 11.27% to 12.57%) and 5.58% (CI, 5.08% to 6.08%) for nonfatal suicide attempt, 0.27% (CI, 0.00% to 0.54%) and 0.15% (CI, 0.00% to 0.30%) for fatal suicide attempt, and 1.05% (CI, 0.79% to 1.31%) and 0.48% (CI, 0.28% to 0.68%) for any drug overdose at age 90 years. MST remained a significant risk factor for any suicide attempt among people with and without PTSD.

Selection bias, generalizability to non-VA veterans, possible unmeasured confounding, and missingness.

Late-life suicide attempt and death by suicide or overdose are associated with prior MST. These findings advance our understanding of the lasting effect of sexual trauma on suicide risk and mortality and suggest that monitoring and treatment of MST-related conditions are vital over the long term.

VA Office of Research and Development.