PTSD Linked to Military Sexual Trauma, Childhood Experiences Among Females

Gen Shinozaki, MD, University of Iowa Health Care

Gen Shinozaki, MD

According to newly presented research at the American Psychiatric Association’s Annual Meeting, service members who experience trauma, including sexual trauma during service, are at increased risk of major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and chronic medical conditions.

Female military personnel are at a heightened risk for exposure to military sexual trauma during service, and more than 30% report being sexually assaulted during service—around 10% reportedly resulting in PTSD.

“Clinicians taking care of veterans, especially female veterans, with symptoms of PTSD and/or depression, should pay attention if they are a victim of MST. That puts tremendous impacts on patients’ health both mentally and physically,” Gen Shinozaki, MD, University of Iowa Health Care, told MD Magazine. “Without knowing the root cause of symptoms presented by the patients, it would be hard to reach best outcomes for treatment.”

Researchers at the University of Iowa studied the associations of military sexual trauma, adverse childhood events and military deployment/combat experience with MDD, PTSD and various medical conditions like diabetes, fibromyalgia, fatigue or chronic pain in 388 military personnel.

The study explored whether epigenetic marks on DNA obtained from servicewomen are correlated with exposure to sexual trauma and investigated if such biomarkers are associated with risk of PTSD.

The participants, 201 male and 187 female, were recruited through a study conducted at the Iowa City Veteran’s Affairs Medical Center, and computer-assisted telephone interviews were conducted.

The interview included the PTSD checklist for DSM-5 (PCL-5), the Center for Epidemiologic Studies-Depression (CES-D), Adverse Childhood experience questionnaire (ACE), military deployment and combat experience and histories of military sexual trauma, among other types of military and civilian trauma.

In addition to the interviews, buccal and saliva samples were collected, and DNA was extracted to be analyzed for DNA methylation levels in the Illumina Infinium HumanMethylationEPIC BeadChip array.

A total of 63 participants experienced either attempted or completed sexual assault during military service—58 were female (31% of the interviewed population) and 5 were male (2.5% of the interviewed population).

Among the female population, military sexual trauma showed significant associations with medical comorbidities including diabetes, fibromyalgia, fatigue and pain (Chi-square = 8.46; P = 0.0036). Military sexual trauma was also significantly associated with MDD (Chi-square = 4.52; P = 0.03).

Findings also showed that among the 58 female military sexual trauma victims, 19 (32.8%) reported PTSD versus 9 (7%) who did not experience military sexual trauma (Chi-square = 18.914; P = 1.368e-05).

“It is very high among female, and this confirmed the report in the past, indicating that things are not improving,” Shinozaki added. “Also, prevalence is low among male, but they tend not to disclose such experience, thus actual prevalence is known to be higher, and also the number of male service members are much higher than female, actual number of victims from MST among male could be pretty high.”

Depression was significantly associated with history of military trauma and adverse childhood experiences for both genders. While the study found great association between PTSD and a history of military sexual trauma, military trauma and adverse childhood experiences among females, among males however, PTSD was only associated with military trauma.

Based on a limited medical status assessment, the researchers found a great increase in chronic health conditions among men with a history of military trauma.

Data shows that among female service women, military sexual trauma is extremely prevalent, and the consequences are significant. Findings propose that veterans can have sex-dependent different response to different trauma types.

“This is obviously a potentially preventable cause of suffering among our service members, so more rigorous actions are needed among military service,” Shinozaki concluded. “#MeToo is true in military.”

Methylation analysis is currently in-progress, and researchers are aiming to identify epigenetic biomarkers modulating the relationship between traumatic experience and subsequent consequences like PTSD, MDD and medical comorbidities.

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