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Trauma Exposure and Mental Health in Ex-Servicewomen Compared with Civilian Women in the UK

Smith, A. S.; Ayer, L.; Stevelink, S.

2026-03-19 epidemiology
10.64898/2026.03.18.26348680 medRxiv
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BackgroundExposure to trauma is associated with poor mental health, but little is known about how trauma profiles differ between ex-servicewomen and civilian women. Differences in trauma exposure may arise before, during, and after military service. ObjectiveTo characterise trauma profiles in ex-servicewomen and civilian women in the UK using separate latent class analyses, and to examine associations between trauma class membership and mental health outcomes within each group. MethodsData were drawn from the UK Biobank and stratified by serving status. Ex-servicewomen (n = 446) were compared with civilian women (n = 54,068). Within each group, sixteen lifetime traumatic experiences were assessed, and latent class analysis was applied to identify trauma profiles. Multinomial logistic regression examined associations between class membership and sociodemographic characteristics, and logistic regression assessed associations between trauma classes and mental health difficulties. ResultsFive trauma classes were identified for both ex-servicewomen and civilian women. Ex-servicewomen were less likely than civilians to belong to the low-trauma class (33.0% vs 62.8%) and reported higher exposure to childhood trauma and intimate partner violence. Among civilians, all trauma classes were associated with elevated odds of depression, anxiety, self-injurious thoughts and behaviours (SITB), as well as reduced meaning in life. Among ex-servicewomen, associations were less consistent; only severe cumulative trauma was linked to all adverse mental health outcomes, while other classes showed no differences in anxiety compared to ex-servicewomen with low trauma exposures. ConclusionTrauma profiles and their mental health correlates differ between ex-servicewomen and civilian women. These differences may reflect early life vulnerabilities, military experiences, and post-service exposures. Although ex-servicewomen reported higher levels of trauma, the associations between trauma classes and mental health were less pronounced than among civilians. HighlightsO_LIEx-servicewomen showed substantially higher prevalence of trauma exposure compared to civilian women, with the greatest differences in childhood adverse events and intimate partner violence C_LIO_LISeparate latent class analyses identified five distinct trauma profiles in both groups, with ex-servicewomen considerably less likely to belong to the low-trauma class than civilian women (33.0% vs 62.8%). C_LIO_LIThe association between trauma exposure and mental health outcomes was less consistent among ex-servicewomen than civilian women, suggesting that military service may involve resilience factors that moderate the trauma-mental health relationship. C_LI

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