Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service

Abstract

IMPORTANCE Adverse childhood experiences (ACEs) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments; however, to our knowledge prevalence of ACEs among persons with a history of military service has not been documented in the United States using population-based data.OBJECTIVE To compare the prevalence of ACEs among individuals with and without a history of military service. DESIGN, SETTING, AND PARTICIPANTS Data are from the 2010 Behavioral Risk Factor Surveillance System. Computer-assisted telephone interviews were conducted with population-based samples of noninstitutionalized US adults from January 1 through December 31, 2010. Analyses were limited to respondents who received the ACE module (n = 60 598). Participants were categorized by history of military service and whether a respondent was 18 years of age in 1973.MAIN OUTCOMES AND MEASURES History of military service was defined by active duty service, veteran status, or training for the Reserves or National Guard. The ACE inventory assessed 11 negative experiences before the age of 18 years. Weighted χ 2 tests and multiple logistic regression analyses were used to examine differences in ACEs by history of military service, era of service, and sex. RESULTSThose with military experience had greater odds of any difference in prevalence of ACEs. In the all-volunteer era, men with military service had a higher prevalence of ACEs in all 11 categories than men without military service. Notably, in the all-volunteer era, men with military service had twice the odds of reporting forced sex before the age of 18 years (odds ratio, 2.19; 95% CI, 1.34-3.57) compared with men without military service. In the draft era, the only difference among men was household drug use, in which men with a history of military service had a significantly lower prevalence than men without a history of military service (2.1% vs 3.3%; P = .003). Fewer differences were observed among women in the all-volunteer and draft eras. CONCLUSIONS AND RELEVANCEDifferences in ACEs by era and sex lend preliminary support that enlistment may serve as an escape from adversity for some individuals, at least among men. Further research is needed to understand how best to support service members and veterans who may have experienced ACEs.

Adverse Childhood Experiences and Adult Health Outcomes Among Veteran and Non-Veteran Women

“…One study of 2010 Behavioral Risk Factor Surveillance System (BRFSS) data from 10 states and the District of Columbia found that women with a history of military service, which included those on active duty and those in the Reserves or National Guard regardless of activation, reported higher rates of household physical abuse, emotional abuse, and exposure to domestic violence compared with women who had not served in the military (rates of other ACE factors did not differ significantly by military status). 2 This study, though, did not assess whether a higher burden of ACEs was associated with health outcomes. A study of 2010 BRFSS data from Washington state found that military service increased the association between ACEs and mental health (but not physical health) outcomes.…”

“…1 Recent evidence suggests that women with military service history report greater burdens of ACEs than women who have never served in the military; 2 however, little research has examined if ACEs may contribute to poorer health among women veterans compared with non-veterans. The scant research about childhood abuse and women veterans has relied on clinical samples, namely women veterans using Veterans Health Administration (VHA) care, [3][4][5] though a significant proportion of veterans do not use VHA services.…”

Needs of Male Sexual Assault Victims in the U.S. Armed Forces

“…Researchers have noted that many individuals, particularly men, may enlist in the military in an effort to escape adversity (Blosnich et al, 2014). Research involving active-component U.S. personnel, members of the National Guard and Reserves, and U.S. military veterans has shown that men who experienced sexual assault during military service had a greater number of instances of childhood sexual abuse, childhood physical abuse, and traumatic life events (Martin, Rosen, and Durand, 1998;Murdoch, Polusny, Street, et al, 2014;Schry et al, 2015).…”

Mental Health Consequences of Pre- and Peri-Military Violence Victimization among United States Army Soldiers: The Moderating Effect of Resilience

“…First, it is well-documented that service members report higher levels of interpersonal victimization pre-military than their civilian counterparts. In one population-based sample, a comparison of men with and without a history of military service in the all-volunteer era (post-1973) a higher prevalence of all eleven categories of adverse childhood experiences was found, with the most marked difference being for sexual abuse (Blosnich, Dichter, Cerulli, Batten, & Bossarte, 2014). Men with a history of military service were also twice as likely as men without such history to report experiencing adverse events in childhood across four or more categories (Blosnich et al, 2014).…”

“…In one population-based sample, a comparison of men with and without a history of military service in the all-volunteer era (post-1973) a higher prevalence of all eleven categories of adverse childhood experiences was found, with the most marked difference being for sexual abuse (Blosnich, Dichter, Cerulli, Batten, & Bossarte, 2014). Men with a history of military service were also twice as likely as men without such history to report experiencing adverse events in childhood across four or more categories (Blosnich et al, 2014). A subsequent study extended these findings by assessing gender differences and found that women with a history of military service were more likely to report childhood physical abuse than civilians (23.2 versus 16.2 percent), as well as childhood verbal abuse (41.5 versus 27.4 percent) and childhood sexual abuse (21.2 versus 16.3 percent) (Katon et al, 2015).…”