Adverse Childhood Experiences and Veteran Mental Health: An Epidemiological Study

Introduction The significant and well-known mental health challenges facing US veterans are compounded by the well-established dose-response relationship between early childhood trauma and poor health outcomes in adulthood. However, epidemiological studies have not examined associations between early childhood trauma and US veterans’ long-term mental health outcomes. This study is the first to investigate population-level correlations of adverse childhood experiences (ACE) on mental health outcomes among US veterans, in an attempt to close the gap among this cultural minority population.

Methods The current study was a cross-sectional analysis of secondary data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Participants included adult US veterans residing in ten states and Washington DC that administered the optional CDC module on ACE (N=3,349). The primary data analytic approach for this study was logistic regression in which the three outcome variables: (1) ever having a depressive disorder; (2) ever having an anxiety disorder; and (3) having poor mental health during the last 30 days, were regressed on the primary predictor of ACE and covariates of age, gender, ethnicity, and educational attainment.

Results These results specifically demonstrated the significant long-term disparities in veteran mental health when considered as a factor of ACE. Even after holding constant the effects of several covariates, all three statistical analyses demonstrated greater mental health burdens among US veterans with multiple-ACE than veterans who have 1 or no ACE. The odds of veterans with multiple-ACE exposures being diagnosed with an anxiety disorder are 3.75 times greater than the odds of veterans with one or no ACE exposures being diagnosed. After holding all predictor variables constant, the predicted probability of lifetime anxiety as a function of ACE is 60%.  The odds of veterans with multiple-ACE exposures being diagnosed with depression are 4.20 times greater than the odds of veterans with one or no ACE exposures. The predicted probability of lifetime depression as a function of ACE is 41%. The odds of veterans with multiple-ACE exposures reporting poor mental health are 2.41 times greater than the odds of veterans with one or no ACE exposures. The predicted probability of self-perception of having poor mental health as a function of ACE is 63%.  

Conclusion Multiple-ACE exposure emerged as the most significant predictor of having poor mental health across all three models. These associations support the hypotheses that military populations, as a cultural minority group, are particularly vulnerable to negative health outcomes associated with multiple-ACE. These findings further strengthen the construct validity and predictive power of the ACE construct on health outcomes among a military-connected community.  Implementing an ACE-based screening and brief intervention model may be a logical step in the natural evolution of efforts to best improve mental health outcomes among a uniquely vulnerable veteran population.