The article attempts to find a relationship between military sexual trauma (MST) and suicide. The study is observational in nature, and over 6 million veterans who received Veterans Health Administration services between 2007- 2011 were screened for MST. With the larger sample size involved in the study, an observational approach was the right option because it does not involve assigning treatment of the subjects. The researchers only observed the subjects, analyzed data and drew conclusions.
The study involved a large sample size. More than 6 million veterans who visited VHA between 2007- 2011 were screened for sexual trauma. 5,991,080 men and 360,774 women were observed. The participants had different ages, medical morbidity, psychiatric conditions and they came from different places. The sample size was large enough to represent the entire veteran population of 21.8 million. The researchers used the clinical reminder in an Electronic Medical Record to screen for MST; the clinical reminder is made up of two items that inquired from the participants whether they experienced unwanted sexual attention or assault during the service. Affirmative responses were entered into the system as positive screens, while those who declined to answer were questioned again in the next year.
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The study was guided by two research questions. The first research question was to determine the rate of suicide among women and male veterans who reported MST. Secondly, the study aimed at evaluating whether MST is related to suicide risk in veterans. To answer the above research questions, the researchers used the MST clinical reminder to screen the participants. The MST clinical test was not enough to answer the questions because other preexisting psychological conditions could be responsible for suicide among the veterans. Hence, the researchers obtained more data from the Veteran Affairs (VA) National Patient Care Database, and MST support Team to provide more information on veteran suicide.
The researchers used proportional hazards regression models to evaluate the relationship between MST and suicide. The hazard regression model analyzed the data from male and female participants differently. Age adjusted models were also included to cater for the different age groups involved in the study. Mental health diagnoses, particularly substance abuse disorder, bipolar disorder, depression, anxiety, PTSD and schizophrenia were also calculated. In the end, the following factors influenced the data analysis: age, sex, medical morbidity, rurality and mental health diagnoses. Suicide was the dependent variable in the study, and it was analyzed against MST and other variables. MST was the independent risk factor, while other factors such as age, sex and the presence of mental health diagnoses were manipulated during the study. Fully adjusted models were applied to cater for the differences. The number of suicides was multiplied by the population-attributable fraction during the observation period.
The results were presented in two tables and a chart. The first table focused on the demographic characteristics of the sample, and the overall number of veterans who reported MST. 2.2% of veterans screened reported MST (1.1% of men and 21.2% of women). 97.4% of the total participants reported no MST, and 0.3% refused to complete the screen. The results showed that veterans likely to report MST were female, younger and with lower Charlson scores. The methods of analysis used to analyze the data appear insufficient, with a sample size of over 6 million participants, the researchers were incapable of analyzing each case individually and they generalized by classifying participants into groups. The data gathered was too much to be analyzed well with the statistical methods in the article.
In conclusion, the study has a number of statistical limitations that stem from the large sample size. In the end, the others cannot conclusively determine the relationship between MST and suicide because of the many other factors to consider. The researchers conclude that women and men with a history of MST have increased risk for suicide, but they fail to evaluate the extent of the risk. A smaller sample size coupled with thorough analysis would have answered the research questions.
Reference
Kimerling, R., Makin-Byrd, K., Louzon, S., Ignacio, R. V., & McCarthy, J. F. (2016). Military sexual trauma and suicide mortality. American journal of preventive medicine , 50 (6), 684-691.
