Veterans who experience sexual trauma while in the military are more likely to have a substance use disorder and die at earlier ages than veterans who have not experienced sexual trauma. However, it is unclear if sexual trauma increases the risk of premature death specifically among veterans with substance use disorder. To examine this question, this study analyzed relationships between military sexual trauma and mortality across sex within the Veterans Health Administration.
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Military sexual trauma (sexual assault or harassment experienced during military service) is a persistent problem in the US military. Despite prevention efforts, evidence suggests that over 15% of military personnel report experiencing sexual trauma, with 29,061 service members reporting unwanted sexual contact in 2023 alone. This is concerning, as veterans who have experienced military sexual trauma are more likely develop substance use disorder than veterans who have not. Concurrently, veterans with substance use disorder are more likely to die due to accidental overdose or suicide than veterans without substance use disorder. These findings suggest that military sexual trauma is associated with premature death among military personnel, but research has not examined direct links between military sexual trauma and mortality.
There is also evidence that military sexual trauma impacts women more than men. An estimated 44% of female veterans are impacted by sexual trauma, compared to 3.5% of male veterans. At the same time, women who experience military sexual trauma are at a greater risk of having a substance use disorder than men who experience military sexual trauma. Further, substance use disorder may elevate female veterans’ suicide risk, despite suicide being more prevalent among male veterans. There is also evidence that female survivors of military sexual trauma are more likely to die by suicide than male survivors. Given these findings it is critically important to understand the ways in which military sexual trauma may impact overdose and suicide deaths among veterans and how these relationships may vary across sex. To this end, the current study analyzed relationships between alcohol and opioid use disorder and mortality in US veterans.
This study analyzed data from the Veteran’s Health Administration Corporate Data Warehouse and Mortality Data Repository. The Veteran’s Health Administration Corporate Data Warehouse is a national repository of clinical data from the Veterans Health Information Systems and Technology Architecture and several other Veterans Health Administration clinical and administrative systems. The Veteran’s Health Administration Mortality Data Repository is a national repository of mortality data drawn from multiple sources (including the Department of Defense and the National Center for Health Statistics).
Data for the current study were restricted to veterans with an alcohol or opioid use disorder, as indicated by having at least 1 inpatient or 2 outpatient encounters with an International Classification of Disease code for either condition in any healthcare encounters. History of military sexual trauma was determined via indication of sexual harassment or assault during military service on the Veterans Health Administration military sexual trauma screener during a primary care or mental health appointment. All data for this study were from 2016-2022.
The main outcomes of the current study were age at death and death due to suicide or opioid overdose. To calculate age at death, the authors computed means and standard deviations for age at death for all deceased. Cause of death was determined by the presence of specific International Classification of Disease codes. Deaths due to opioid overdose were determined by the presence of International Classification of Disease codes indicating opioid poisoning (e.g., X40 “accidental self-poisoning by drugs…”). Deaths due to suicide were determined by presence of International Classification of Disease codes with the “intentional self-harm” qualifier, (e.g., X60 “intentional self-poisoning by drugs…”). The authors examined the differences in average age at death, and odds of dying via suicide or opioid overdose based on history of military sexual trauma and sex.
This study had a sample of 111,222 deceased veterans, including 108,309 male and 2,913 female veterans. The majority of the sample was White (66.9%), with remainder identifying as Black (20.4%), Hispanic or Latino (5.2%), unknown (5.0%), American Indian/Alaskan Native (1.0%), Asian (0.2%), multiple race/ethnicities (0.7%), or Native Hawaiian or Pacific Islander (0.6%). Analyses controlled statistically only for race/ethnicity to further isolate the effects of sexual trauma history and gender on outcomes. Over 80% of veterans had an alcohol use disorder, 9% had an opioid use disorder, and 10.8% had co-occurring alcohol and opioid use disorders. The average age at which veterans died was 66.8 years.
Veterans who experienced military sexual trauma were more likely to die by suicide and overdose
Compared to deceased veterans with an alcohol or opioid use disorder who did not experience military sexual trauma, those who did experience such trauma were 130% more likely to have died by suicide, compared to all other causes of death. In addition, those who experienced military sexual trauma died by suicide at younger ages relative to other veterans who died by suicide (46 vs 52 years of age, respectively). This risk of military sexual trauma on suicide did not differ by sex (i.e., there was no interaction effect).
Compared to deceased veterans who did not experience military sexual trauma, those who did were 280% more likely to have died due to an opioid overdose compared to other causes (see graph below). In addition, veterans who experienced military sexual assault died at younger ages relative to other veterans who died by suicide (51.0 vs 52.7 years of age respectively).
Female veterans were more likely to die by suicide and overdose than male veterans
Relative to male veterans, deceased female veterans were 170% more likely to die by suicide compared to all other causes. As shown in the graph below, they were 160% more likely to die by opioid overdose than male veterans, relative to other causes. The effect of sex on suicide and overdose as causes of death did not differ by military sexual trauma history (i.e., there was no interaction effect).
Female veterans with history of military sexual trauma died earliest
Across all causes of death, the average age at death for female veterans who experienced military sexual trauma was 56.1 years. In contrast, male veterans who experienced military sexual trauma on average died at age 62.8 years. Men and women veterans who did not report past military sexual trauma on average died at the ages of 67.1 and 59.5 years respectively. Here – for all causes of death – the effect of military sexual trauma did differ by sex (i.e., there was an interaction effect). Women with a history of military sexual trauma died younger than women without a history of such trauma, as well as men, both with and without this history of trauma.
Experiencing military sexual trauma is associated with an increased risk of death due to suicide and opioid overdose among deceased veterans with alcohol or opioid use disorder, compared to all other causes of death. Veterans who experienced military sexual trauma were more likely to have died by suicide and died at younger ages than other deceased veterans. In addition, veterans who experienced military sexual trauma were more likely to have died due to an opioid overdose and died at younger ages relative to other deceased veterans. Taken together, these results demonstrate how military sexual trauma may explain increased risk of preventable causes of death like suicide and overdose. Importantly this study also highlights the increased impact of military sexual trauma on female veterans. Female veterans who experienced military sexual trauma died younger (of any cause) than all other veterans. This suggests that military sexual trauma may put female veterans at especially high risk of premature death. While these data point to risks of military sexual trauma on suicide and opioid overdose, importantly, it could also be that female deaths are more likely to result from suicide and overdose because men are at greater risk of other causes of death, like coronary disease, than women. Overall, men have higher rates of suicide and overdose than women; but these causes of death account for a larger share of female deaths, offering opportunities for prevention and intervention. Also of note, the study did not examine alcohol use-related death, which are greatest among men, but on the rise in women.
It is unclear from this study why military sexual trauma was associated with increased mortality among veterans (particularly among female veterans). However, it is likely that military sexual trauma impacts mortality in multiple ways, including negatively impacting mental health, increasing the severity of one’s substance use disorder, and reducing help seeking at Veteran’s Affair facilities. Female veterans may be especially deterred from seeking treatment since up to 42% of female veterans report experiencing sexual and gender-based harassment when seeking healthcare, which could cue a recurrence of trauma symptoms. This is speculative as the limitations of the data make it is impossible to determine how military sexual trauma impacted veterans’ mortality. Nevertheless, these results suggest veterans with substance use disorder who experienced military sexual trauma were at increased risk of premature death. Multi-pronged strategies are needed to ensure veterans receive the support and care they need. These may include, for example, female-specific treatment groups that offer empirically supported treatments for individuals who experienced sexual trauma (e.g., Seeking Safety).
This study shows that deceased veterans with substance use disorder who experienced military sexual trauma were more likely to die by suicide and opioid overdose, relative to other causes of death, than their peers without such a trauma history. The study also shows that, among deceased veterans, female veterans who experienced military sexual trauma died significantly younger than all other veterans. It also found that female veterans overall were more likely to die from an opioid overdose compared to other causes of death than their male peers. Taken together, these results underscore the impact of military sexual trauma on the wellbeing of veterans and the need for improved prevention and intervention efforts.
Banducci, A. N., Mandavia, A. D., Bovin, M. J., Adams, R. S., Maloney, M. A., Roth, C. E., McClain, L., & Livingston, N. A. (2025). Opioid overdose, suicide mortality, and premature death among veterans with alcohol or opioid use disorders: The impact of military sexual trauma. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108330.
l
Military sexual trauma (sexual assault or harassment experienced during military service) is a persistent problem in the US military. Despite prevention efforts, evidence suggests that over 15% of military personnel report experiencing sexual trauma, with 29,061 service members reporting unwanted sexual contact in 2023 alone. This is concerning, as veterans who have experienced military sexual trauma are more likely develop substance use disorder than veterans who have not. Concurrently, veterans with substance use disorder are more likely to die due to accidental overdose or suicide than veterans without substance use disorder. These findings suggest that military sexual trauma is associated with premature death among military personnel, but research has not examined direct links between military sexual trauma and mortality.
There is also evidence that military sexual trauma impacts women more than men. An estimated 44% of female veterans are impacted by sexual trauma, compared to 3.5% of male veterans. At the same time, women who experience military sexual trauma are at a greater risk of having a substance use disorder than men who experience military sexual trauma. Further, substance use disorder may elevate female veterans’ suicide risk, despite suicide being more prevalent among male veterans. There is also evidence that female survivors of military sexual trauma are more likely to die by suicide than male survivors. Given these findings it is critically important to understand the ways in which military sexual trauma may impact overdose and suicide deaths among veterans and how these relationships may vary across sex. To this end, the current study analyzed relationships between alcohol and opioid use disorder and mortality in US veterans.
This study analyzed data from the Veteran’s Health Administration Corporate Data Warehouse and Mortality Data Repository. The Veteran’s Health Administration Corporate Data Warehouse is a national repository of clinical data from the Veterans Health Information Systems and Technology Architecture and several other Veterans Health Administration clinical and administrative systems. The Veteran’s Health Administration Mortality Data Repository is a national repository of mortality data drawn from multiple sources (including the Department of Defense and the National Center for Health Statistics).
Data for the current study were restricted to veterans with an alcohol or opioid use disorder, as indicated by having at least 1 inpatient or 2 outpatient encounters with an International Classification of Disease code for either condition in any healthcare encounters. History of military sexual trauma was determined via indication of sexual harassment or assault during military service on the Veterans Health Administration military sexual trauma screener during a primary care or mental health appointment. All data for this study were from 2016-2022.
The main outcomes of the current study were age at death and death due to suicide or opioid overdose. To calculate age at death, the authors computed means and standard deviations for age at death for all deceased. Cause of death was determined by the presence of specific International Classification of Disease codes. Deaths due to opioid overdose were determined by the presence of International Classification of Disease codes indicating opioid poisoning (e.g., X40 “accidental self-poisoning by drugs…”). Deaths due to suicide were determined by presence of International Classification of Disease codes with the “intentional self-harm” qualifier, (e.g., X60 “intentional self-poisoning by drugs…”). The authors examined the differences in average age at death, and odds of dying via suicide or opioid overdose based on history of military sexual trauma and sex.
This study had a sample of 111,222 deceased veterans, including 108,309 male and 2,913 female veterans. The majority of the sample was White (66.9%), with remainder identifying as Black (20.4%), Hispanic or Latino (5.2%), unknown (5.0%), American Indian/Alaskan Native (1.0%), Asian (0.2%), multiple race/ethnicities (0.7%), or Native Hawaiian or Pacific Islander (0.6%). Analyses controlled statistically only for race/ethnicity to further isolate the effects of sexual trauma history and gender on outcomes. Over 80% of veterans had an alcohol use disorder, 9% had an opioid use disorder, and 10.8% had co-occurring alcohol and opioid use disorders. The average age at which veterans died was 66.8 years.
Veterans who experienced military sexual trauma were more likely to die by suicide and overdose
Compared to deceased veterans with an alcohol or opioid use disorder who did not experience military sexual trauma, those who did experience such trauma were 130% more likely to have died by suicide, compared to all other causes of death. In addition, those who experienced military sexual trauma died by suicide at younger ages relative to other veterans who died by suicide (46 vs 52 years of age, respectively). This risk of military sexual trauma on suicide did not differ by sex (i.e., there was no interaction effect).
Compared to deceased veterans who did not experience military sexual trauma, those who did were 280% more likely to have died due to an opioid overdose compared to other causes (see graph below). In addition, veterans who experienced military sexual assault died at younger ages relative to other veterans who died by suicide (51.0 vs 52.7 years of age respectively).
Female veterans were more likely to die by suicide and overdose than male veterans
Relative to male veterans, deceased female veterans were 170% more likely to die by suicide compared to all other causes. As shown in the graph below, they were 160% more likely to die by opioid overdose than male veterans, relative to other causes. The effect of sex on suicide and overdose as causes of death did not differ by military sexual trauma history (i.e., there was no interaction effect).
Female veterans with history of military sexual trauma died earliest
Across all causes of death, the average age at death for female veterans who experienced military sexual trauma was 56.1 years. In contrast, male veterans who experienced military sexual trauma on average died at age 62.8 years. Men and women veterans who did not report past military sexual trauma on average died at the ages of 67.1 and 59.5 years respectively. Here – for all causes of death – the effect of military sexual trauma did differ by sex (i.e., there was an interaction effect). Women with a history of military sexual trauma died younger than women without a history of such trauma, as well as men, both with and without this history of trauma.
Experiencing military sexual trauma is associated with an increased risk of death due to suicide and opioid overdose among deceased veterans with alcohol or opioid use disorder, compared to all other causes of death. Veterans who experienced military sexual trauma were more likely to have died by suicide and died at younger ages than other deceased veterans. In addition, veterans who experienced military sexual trauma were more likely to have died due to an opioid overdose and died at younger ages relative to other deceased veterans. Taken together, these results demonstrate how military sexual trauma may explain increased risk of preventable causes of death like suicide and overdose. Importantly this study also highlights the increased impact of military sexual trauma on female veterans. Female veterans who experienced military sexual trauma died younger (of any cause) than all other veterans. This suggests that military sexual trauma may put female veterans at especially high risk of premature death. While these data point to risks of military sexual trauma on suicide and opioid overdose, importantly, it could also be that female deaths are more likely to result from suicide and overdose because men are at greater risk of other causes of death, like coronary disease, than women. Overall, men have higher rates of suicide and overdose than women; but these causes of death account for a larger share of female deaths, offering opportunities for prevention and intervention. Also of note, the study did not examine alcohol use-related death, which are greatest among men, but on the rise in women.
It is unclear from this study why military sexual trauma was associated with increased mortality among veterans (particularly among female veterans). However, it is likely that military sexual trauma impacts mortality in multiple ways, including negatively impacting mental health, increasing the severity of one’s substance use disorder, and reducing help seeking at Veteran’s Affair facilities. Female veterans may be especially deterred from seeking treatment since up to 42% of female veterans report experiencing sexual and gender-based harassment when seeking healthcare, which could cue a recurrence of trauma symptoms. This is speculative as the limitations of the data make it is impossible to determine how military sexual trauma impacted veterans’ mortality. Nevertheless, these results suggest veterans with substance use disorder who experienced military sexual trauma were at increased risk of premature death. Multi-pronged strategies are needed to ensure veterans receive the support and care they need. These may include, for example, female-specific treatment groups that offer empirically supported treatments for individuals who experienced sexual trauma (e.g., Seeking Safety).
This study shows that deceased veterans with substance use disorder who experienced military sexual trauma were more likely to die by suicide and opioid overdose, relative to other causes of death, than their peers without such a trauma history. The study also shows that, among deceased veterans, female veterans who experienced military sexual trauma died significantly younger than all other veterans. It also found that female veterans overall were more likely to die from an opioid overdose compared to other causes of death than their male peers. Taken together, these results underscore the impact of military sexual trauma on the wellbeing of veterans and the need for improved prevention and intervention efforts.
Banducci, A. N., Mandavia, A. D., Bovin, M. J., Adams, R. S., Maloney, M. A., Roth, C. E., McClain, L., & Livingston, N. A. (2025). Opioid overdose, suicide mortality, and premature death among veterans with alcohol or opioid use disorders: The impact of military sexual trauma. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108330.
l
Military sexual trauma (sexual assault or harassment experienced during military service) is a persistent problem in the US military. Despite prevention efforts, evidence suggests that over 15% of military personnel report experiencing sexual trauma, with 29,061 service members reporting unwanted sexual contact in 2023 alone. This is concerning, as veterans who have experienced military sexual trauma are more likely develop substance use disorder than veterans who have not. Concurrently, veterans with substance use disorder are more likely to die due to accidental overdose or suicide than veterans without substance use disorder. These findings suggest that military sexual trauma is associated with premature death among military personnel, but research has not examined direct links between military sexual trauma and mortality.
There is also evidence that military sexual trauma impacts women more than men. An estimated 44% of female veterans are impacted by sexual trauma, compared to 3.5% of male veterans. At the same time, women who experience military sexual trauma are at a greater risk of having a substance use disorder than men who experience military sexual trauma. Further, substance use disorder may elevate female veterans’ suicide risk, despite suicide being more prevalent among male veterans. There is also evidence that female survivors of military sexual trauma are more likely to die by suicide than male survivors. Given these findings it is critically important to understand the ways in which military sexual trauma may impact overdose and suicide deaths among veterans and how these relationships may vary across sex. To this end, the current study analyzed relationships between alcohol and opioid use disorder and mortality in US veterans.
This study analyzed data from the Veteran’s Health Administration Corporate Data Warehouse and Mortality Data Repository. The Veteran’s Health Administration Corporate Data Warehouse is a national repository of clinical data from the Veterans Health Information Systems and Technology Architecture and several other Veterans Health Administration clinical and administrative systems. The Veteran’s Health Administration Mortality Data Repository is a national repository of mortality data drawn from multiple sources (including the Department of Defense and the National Center for Health Statistics).
Data for the current study were restricted to veterans with an alcohol or opioid use disorder, as indicated by having at least 1 inpatient or 2 outpatient encounters with an International Classification of Disease code for either condition in any healthcare encounters. History of military sexual trauma was determined via indication of sexual harassment or assault during military service on the Veterans Health Administration military sexual trauma screener during a primary care or mental health appointment. All data for this study were from 2016-2022.
The main outcomes of the current study were age at death and death due to suicide or opioid overdose. To calculate age at death, the authors computed means and standard deviations for age at death for all deceased. Cause of death was determined by the presence of specific International Classification of Disease codes. Deaths due to opioid overdose were determined by the presence of International Classification of Disease codes indicating opioid poisoning (e.g., X40 “accidental self-poisoning by drugs…”). Deaths due to suicide were determined by presence of International Classification of Disease codes with the “intentional self-harm” qualifier, (e.g., X60 “intentional self-poisoning by drugs…”). The authors examined the differences in average age at death, and odds of dying via suicide or opioid overdose based on history of military sexual trauma and sex.
This study had a sample of 111,222 deceased veterans, including 108,309 male and 2,913 female veterans. The majority of the sample was White (66.9%), with remainder identifying as Black (20.4%), Hispanic or Latino (5.2%), unknown (5.0%), American Indian/Alaskan Native (1.0%), Asian (0.2%), multiple race/ethnicities (0.7%), or Native Hawaiian or Pacific Islander (0.6%). Analyses controlled statistically only for race/ethnicity to further isolate the effects of sexual trauma history and gender on outcomes. Over 80% of veterans had an alcohol use disorder, 9% had an opioid use disorder, and 10.8% had co-occurring alcohol and opioid use disorders. The average age at which veterans died was 66.8 years.
Veterans who experienced military sexual trauma were more likely to die by suicide and overdose
Compared to deceased veterans with an alcohol or opioid use disorder who did not experience military sexual trauma, those who did experience such trauma were 130% more likely to have died by suicide, compared to all other causes of death. In addition, those who experienced military sexual trauma died by suicide at younger ages relative to other veterans who died by suicide (46 vs 52 years of age, respectively). This risk of military sexual trauma on suicide did not differ by sex (i.e., there was no interaction effect).
Compared to deceased veterans who did not experience military sexual trauma, those who did were 280% more likely to have died due to an opioid overdose compared to other causes (see graph below). In addition, veterans who experienced military sexual assault died at younger ages relative to other veterans who died by suicide (51.0 vs 52.7 years of age respectively).
Female veterans were more likely to die by suicide and overdose than male veterans
Relative to male veterans, deceased female veterans were 170% more likely to die by suicide compared to all other causes. As shown in the graph below, they were 160% more likely to die by opioid overdose than male veterans, relative to other causes. The effect of sex on suicide and overdose as causes of death did not differ by military sexual trauma history (i.e., there was no interaction effect).
Female veterans with history of military sexual trauma died earliest
Across all causes of death, the average age at death for female veterans who experienced military sexual trauma was 56.1 years. In contrast, male veterans who experienced military sexual trauma on average died at age 62.8 years. Men and women veterans who did not report past military sexual trauma on average died at the ages of 67.1 and 59.5 years respectively. Here – for all causes of death – the effect of military sexual trauma did differ by sex (i.e., there was an interaction effect). Women with a history of military sexual trauma died younger than women without a history of such trauma, as well as men, both with and without this history of trauma.
Experiencing military sexual trauma is associated with an increased risk of death due to suicide and opioid overdose among deceased veterans with alcohol or opioid use disorder, compared to all other causes of death. Veterans who experienced military sexual trauma were more likely to have died by suicide and died at younger ages than other deceased veterans. In addition, veterans who experienced military sexual trauma were more likely to have died due to an opioid overdose and died at younger ages relative to other deceased veterans. Taken together, these results demonstrate how military sexual trauma may explain increased risk of preventable causes of death like suicide and overdose. Importantly this study also highlights the increased impact of military sexual trauma on female veterans. Female veterans who experienced military sexual trauma died younger (of any cause) than all other veterans. This suggests that military sexual trauma may put female veterans at especially high risk of premature death. While these data point to risks of military sexual trauma on suicide and opioid overdose, importantly, it could also be that female deaths are more likely to result from suicide and overdose because men are at greater risk of other causes of death, like coronary disease, than women. Overall, men have higher rates of suicide and overdose than women; but these causes of death account for a larger share of female deaths, offering opportunities for prevention and intervention. Also of note, the study did not examine alcohol use-related death, which are greatest among men, but on the rise in women.
It is unclear from this study why military sexual trauma was associated with increased mortality among veterans (particularly among female veterans). However, it is likely that military sexual trauma impacts mortality in multiple ways, including negatively impacting mental health, increasing the severity of one’s substance use disorder, and reducing help seeking at Veteran’s Affair facilities. Female veterans may be especially deterred from seeking treatment since up to 42% of female veterans report experiencing sexual and gender-based harassment when seeking healthcare, which could cue a recurrence of trauma symptoms. This is speculative as the limitations of the data make it is impossible to determine how military sexual trauma impacted veterans’ mortality. Nevertheless, these results suggest veterans with substance use disorder who experienced military sexual trauma were at increased risk of premature death. Multi-pronged strategies are needed to ensure veterans receive the support and care they need. These may include, for example, female-specific treatment groups that offer empirically supported treatments for individuals who experienced sexual trauma (e.g., Seeking Safety).
This study shows that deceased veterans with substance use disorder who experienced military sexual trauma were more likely to die by suicide and opioid overdose, relative to other causes of death, than their peers without such a trauma history. The study also shows that, among deceased veterans, female veterans who experienced military sexual trauma died significantly younger than all other veterans. It also found that female veterans overall were more likely to die from an opioid overdose compared to other causes of death than their male peers. Taken together, these results underscore the impact of military sexual trauma on the wellbeing of veterans and the need for improved prevention and intervention efforts.
Banducci, A. N., Mandavia, A. D., Bovin, M. J., Adams, R. S., Maloney, M. A., Roth, C. E., McClain, L., & Livingston, N. A. (2025). Opioid overdose, suicide mortality, and premature death among veterans with alcohol or opioid use disorders: The impact of military sexual trauma. Addictive Behaviors, 167. doi: 10.1016/j.addbeh.2025.108330.
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