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with mental health disorders and suicide, and analyzing histor- of suicide in post-deployment veterans. According to the
ical policies that contribute to stigma and discrimination based National Veteran Suicide Prevention Annual Report, 58.7%
upon sexual orientation and gender identity, are essential to the of veterans utilizing VHA services to die by suicide had a men-
reduction of suicide in MSMV who identify as LGBT. tal health diagnosis or substance use disorder, with the highest
suicide rates amongst veterans diagnosed with bipolar disor-
der and opioid use disorder. 5
Military Sexual Trauma
Military sexual trauma (MST) is defined as: “psychological Deployed Servicemembers are returning to the US with alarm-
trauma, which in the judgment of a mental health professional ing rates of mental health disorders. However, less than half
47
employed by the VA, resulted from a physical assault of a sex- receive VA mental health services. The authors observe that
ual nature, battery of a sexual nature, or sexual harassment to increase the number of Servicemembers and veterans who
which occurred while the veteran was serving on active duty, receive life-saving mental health treatment, it will be necessary
active duty for training, or inactive duty training.” 30 to remove both personal and organizational barriers. Personal
barriers to treatment may include personal embarrassment
In the most recent biennial report of MST, the DoD reports about service-related mental disabilities, fear of being seen as
a sharp rise in active duty Servicemembers who have expe- weak, and concerns related to the privacy of mental health
rienced a sexual assault. It is estimated that 20,500 Service- records and the impact of mental health records on contin-
members experience a sexual assault, with active duty women ued military service and future promotions. 49,50 Organizational
50
accounting for 6.2% (13,000) and active duty men accounting barriers include interagency information sharing obstacles,
for 0.7% (7,500) of the reported unwanted sexual contact or as well as ineffective Veterans Affairs’ policies regarding the
penetrative assault in 2018. 31 availability of services to the veteran population. 50–51 Addi-
tional organizational barriers include long wait times to re-
MST has consistently been a strong predictor of mental health ceive mental health treatment, logistical problems such as
conditions such as posttraumatic stress disorder (PTSD), de- travel distances, and a lack of an accessibility standard for
pression, anxiety, and substance abuse. 32, 33 In a study con- mental health follow-up. 49,50 Finally, evaluative research sug-
ducted with 213,803 Iraq and Afghanistan veterans with a gests that MSMV experiencing mental health concerns will be
diagnosis of PTSD, it was found that 31% of the women and better served with the use of evidence-based practice guide-
1% of the men screened positive for MST. Servicemembers lines and screening assessments that are normed and validated
34
with a PTSD diagnosis were also more likely to receive a co- specifically for the experiences and mental health disparities of
morbid diagnosis of substance use disorder, depression, or Servicemembers and veterans. 41,51
34
anxiety. However, when controlling for the aforementioned
comorbid mental health conditions, MST also continues to be
strongly associated with elevated risks of suicide. 33,35 The DoD Military Connectedness
has implemented several policies aimed at eliminating MST. Loneliness and social isolation are typically a concern for
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Continued accountability and oversight with regard to expo- older adults. However, military-related loneliness is increas-
sure to incidents of MST, as well as support for MSMV who ingly recognized as having a negative impact on both mental
report exposure to MST, could potentially decrease rates of and physical health in veterans who are no longer service-
53
suicide attempts and completions. connected. Many veterans report difficulty with reintegra-
tion into civilian society. Studies have found that veterans
report feelings of disconnection, uniqueness of experience in
Mental Health Concerns
comparison to the civilian population, lack of structure in ci-
MSMV do not live and work in isolation, therefore it is rea- vilian life, loss of purpose, disruption of the military family,
sonable to assume they are faced with the same mental health and unsupportive institutions as they navigate the reintegra-
54
risks as the general population. However, military-specific tion process. However, research suggests that one of the most
occupational stressors such as training, combat/operational significant barriers to successful reintegration into civilian so-
stress (COS), family separation, relationship discord, residen- ciety is the social isolation many experience upon returning
tial mobility, risk of injury, exposure to human suffering and home. According to a Pew Research Center survey, approxi-
55
trauma, as well as reintegration 36–39 potentially exposes Ser- mately 21% of those who have served have a “somewhat dif-
vicemembers to dual occurrences of mental health risks. Since ficult” time adjusting, and 6% have a “very difficult” time
38
2001, 2.6 million US troops have deployed in support of Oper- going back to a normal way of life. When evaluating the fac-
ation Enduring Freedom (OEF) and Operation Iraqi Freedom tors of social connectedness, researchers found that loneliness
(OIF). 40,41 Based on the literature, psychological and cognitive was associated with higher levels of depression and suicide
health disorders are prevalent and impact at least one-third ideation in military veterans. 53,56
of returning Servicemembers. 42,43 In particular, 24.4% of re-
turning Servicemembers met the Diagnostic and Statistical While there is very limited research regarding the impact of
Manual of Mental Disorders (DSM) diagnostic criteria for loneliness and social isolation on veterans’ health, veteran sup-
PTSD. 44–43 Veterans who met DSM criteria for PTSD are four port programs such as “Vet to Vet” and national, nonpartisan,
times more likely to report suicidal ideations. Additionally, non-profit organizations such as “The Mission Continues”
45
it is estimated that 19.55% meet the criteria for depression, seek to help veterans make the connection to civilian life. The
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and 19.5–22.8% of postdeployment Servicemembers meet the Mission Continues made the following suggestions for main-
criteria for traumatic brain injury (TBI). 41–43 Other common taining connections:
comorbid psychological health disorders noted include depres-
sion, bipolar disorder, anxiety, and substance abuse. 41,46 These “Connect veterans with other veterans by creating a team
mental health disorders are associated with a greater likelihood of veterans dedicated to service, create experiences for

136 | JSOM Volume 22, Edition 1 / Sping 2022