Opioid overdose, suicide mortality, and premature death among veterans with alcohol or opioid use disorders: The impact of military sexual trauma

Veterans with a history of military sexual trauma (MST+) are more likely to have substance use disorders (SUD) and may be at an elevated risk of premature death, driven in part by acute causes of death associated with SUD, such as suicide and overdose, as well as those associated with MST (e.g., suicide). However, the risks of veteran status, SUD, and MST+ have generally been examined independently. The current study analyzed data from 111,222 veteran decedents (2,913 women, 108,309 men) identified via Veterans Health Administration (VHA) electronic medical record data, who had both a documented opioid and/or alcohol use disorder between 2016-2021 and a VHA MST screen (4,546 veterans screened positive) in their medical record. We evaluated MST status, sex, and their interaction as predictors of suicide and opioid overdose death and age at death. Of veteran decedents, MST+ veterans died six years younger than MST- veterans, overall. Although MST more substantially reduced life expectancy in men than women, MST+ women died significantly younger than both MST- women and MST+/- men, overall. MST+ veterans were 1.3x more likely to die by suicide and 2.8x more likely to die by opioid overdose, relative to other causes of death, than MST- veterans and died 1.5-6 years younger than MSTveterans of these causes. Women were also more likely to die by suicide and opioid overdose and died younger of these causes than men. Taken together, additional work is needed to develop interventions designed to reduce the risk of premature death among MST survivors and women with SUD.