Patterns of Adverse Experiences and Health Outcomes Among Women Veterans.

INTRODUCTION: Adverse childhood experiences are associated with poor health outcomes in adulthood, such as depression, suicidal behavior, and post-traumatic stress disorder. Subsequent military service may continue trajectories of childhood adversity and contribute to cumulative disadvantage over the life span. This study examines distinct patterns of adversity from childhood through military service and their relationships with adult health and mental health outcomes.

METHODS: The study used data from a nationally representative survey (conducted in 2012, analysis in 2016) with >6,000 women primary care users in the Veterans Health Administration, and linked to data from electronic medical records. Latent class analysis was used to derive qualitatively distinct patterns of adverse experiences and logistic regression to model odds of past-year health conditions, comparing effect sizes across classes.

RESULTS: Prevalence of both childhood and military adverse events was high. Five meaningful classes of adversity were observed, characterized by low adversity across all events, high adversity across all events, extreme high adversity across all events, adverse family context, and a class characterized primarily by adverse military experiences. Odds of past-year diagnoses of depression, anxiety, post-traumatic stress disorder, substance use disorder, and comorbid mental health and chronic health conditions significantly differed across classes.

CONCLUSIONS: Among women Veterans Health Administration users, examination of qualitatively distinct patterns of adversity yielded more meaningful results than counting the number of adverse events. Given the high incidence of adverse experiences, Veterans Health Administration is positioned to respond with secondary prevention and a universal trauma precautions approach to all care for women Veterans.