Military Sexual Assault As a Mediator of Post-Traumatic Stress Disorder and Depression Among Lesbian, Gay, and Bisexual Veterans

Background:  In the general population, lesbian, gay, and bisexual (LGB) individuals report significantly higher rates of PTSD and depression compared to their heterosexual counterparts.  Similar trends exist within military veteran populations.  Minority stress theory suggests the higher prevalence of mental health disorders among LGB individuals are explained through interactions between distal and proximal factors.  A distal factor of particular interest is sexual assault.  While PTSD, depression, and military sexual assault (MSA) have been identified among LGB veterans, the literature has yet to explore the relationship between these factors.  This study examined the rates of PTSD and depression among LGB veterans as compared to their non-LGB peers with consideration for MSA. 

Methods: A sample of 2,583 veterans was obtained through two cross-sectional, needs assessment surveys conducted in 2013. An extensive recruitment strategy was employed, including utilizing collaboration with national, state, county, and local organizations to obtain a nonprobability sample.  The surveys assessed veterans’ needs across various aspects of life.  Participants from the two larger parent studies were selected for inclusion (n=440) if they identified as LGB (n=110) and were matched one to three on gender and age with non-LGB veterans (n=330) using PROC SORT.  MSA was assessed by asking about the presence of sexual assault during military service.  Probable PTSD was measured utilizing the PCL-C.  Probable depression was measured utilizing the PHQ-9.  Logistic regressions with mediation were used to examine associations between LGB, MSA, PTSD, and depression, adjusting for the presence of deployment.

Results: All analyses were completed in SAS 9.4. Chi-square analyses showed statistically significant differences for LGB veterans when compared to non-LGB veterans for experiencing MSA (33% vs. 14%, respectively, p<.001) and meeting clinical levels for PTSD (41% vs. 30%, respectively, p <.05) and depression (48% vs. 36%, respectively, p<.05). Logistic regression analyses showed LGB veterans have more than twice the odds of experiencing MSA when compared to non-LGB veterans (p<.001). Individuals who experienced MSA had five times the odds of PTSD (p<.001) and three times the odds of depression (p<.001).  Utilizing the Sobel test for mediation, MSA was found to fully mediate the relationship of LGB identity with PTSD (z’=2.85, p<.01) and depression (z’=2.66, p<.01).

Discussion: To our knowledge, no previous study has 1) explored the relationship of LGB identity, MSA during military service, and current PTSD and depression and 2) utilized matching to evaluate LGB and non-LGB veterans.  Our study found LGB veterans are experiencing MSA, probable PTSD, and probable depression at significantly higher levels than their non-LGB peers. These findings alone should raise concerns for the need of potential treatment programs and policies for LGB military populations. As MSA fully explains the presence of PTSD and depression, it is vital for mental health providers to assess whether LGB veterans have or have not experienced MSA and to have cultural competence in treating LGB individuals. Continuing to identify how MSA explains outcomes among LGB veterans, as well as active duty, is critical. It is possible that MSA is explaining other outcomes among LGB military populations.