Post-9/11 veterans in the BRAVO cohort showed heavy behavioral-health burden with concentrated disparities, including elevated PTSD among several women's groups and Black men, lower AUD among women, and pronounced sex differences in sexual harm, with mental-health visit volume not scaling with need for women after adjustment.
Key Findings
Methods
The BRAVO cohort achieved a large, diverse baseline sample deliberately oversampling women and racial/ethnic minority post-9/11 veterans.
Final baseline N = 2,083 participants
37.3% were female
Mean age was 38.5 years
Race/ethnicity composition: Non-Hispanic White 34.4%, Hispanic 35.1%, Non-Hispanic Black 19.0%, with smaller proportions of Asian, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and multiracial veterans
Recruitment proceeded in two parallel streams with rigorous identity verification
Results
Probable depression, anxiety, and PTSD were each prevalent in approximately half of the sample at baseline.
Probable depression prevalence: 48.9%
Anxiety prevalence: 44.6%
PTSD prevalence: 44.4%
Elevated suicide risk prevalence: 40.7%
Alcohol use disorder (AUD) prevalence: 11.5%
Results
Military sexual violence and harassment were highly prevalent, with substantially higher risk among all female groups compared to men.
Military sexual violence prevalence: 35.7% whole-sample
Military sexual harassment prevalence: 50.0% whole-sample
Adjusted contrasts showed all female groups had substantially higher risk of military sexual violence and harassment
Inferential models used modified Poisson regression for binary outcomes and negative binomial for counts
Models were cross-classified by sex by race/ethnicity
Results
Elevated PTSD risk was found among several women's groups and among Non-Hispanic Black men compared to Non-Hispanic White men.
Adjusted contrasts showed higher PTSD risk among several women's groups
Non-Hispanic Black men also showed higher PTSD risk in adjusted models
Models used modified Poisson regression for binary outcomes
Analyses were cross-classified by sex and race/ethnicity to enable subgroup contrasts
Results
Women had lower risk of alcohol use disorder compared to Non-Hispanic White men after adjustment.
Whole-sample AUD prevalence was 11.5%
Adjusted contrasts showed women had lower AUD risk than Non-Hispanic White men
This pattern held across female groups in adjusted models
Modified Poisson regression was used for this binary outcome
Results
Hispanic men had lower suicide-risk prevalence compared to Non-Hispanic White men in adjusted models.
Whole-sample elevated suicide risk prevalence was 40.7%
Adjusted contrasts showed Hispanic men had lower suicide-risk prevalence
Models were cross-classified by sex by race/ethnicity
Modified Poisson regression was used for this binary outcome
Results
Women had higher counts of healthcare problems treated compared to men.
Adjusted contrasts showed women had higher counts of health care problems treated
Negative binomial regression was used for count outcomes
Models were cross-classified by sex and race/ethnicity
Results
Mental health visit volume did not scale with need for women after adjustment, suggesting potential under-intensity of care relative to burden.
Women had higher counts of healthcare problems treated and elevated rates of PTSD, depression, and sexual harm
After adjustment, mental-health visit volume did not scale with this elevated burden for women
The authors describe this as suggesting 'potential under-intensity of care relative to burden'
This pattern was identified through adjusted inferential models cross-classified by sex and race/ethnicity
Background
The BRAVO cohort was specifically designed to be adequately powered for sex-by-race/ethnicity contrasts, addressing a gap in prior veteran research.
Prior studies of behavioral health and healthcare engagement among post-9/11 veterans were described as 'underpowered for sex-by-race/ethnicity contrasts'
The cohort deliberately oversampled women and racial/ethnic minority veterans
The study used rigorous identity verification during recruitment
Two parallel recruitment streams were employed
What This Means
This research studied the mental health and healthcare experiences of over 2,000 post-9/11 veterans enrolled in the BRAVO Cohort Study, a study specifically designed to include enough women and racial/ethnic minority veterans to make meaningful comparisons between groups. The researchers found extremely high rates of mental health challenges: nearly half of all participants showed signs of probable depression (48.9%), anxiety (44.6%), or PTSD (44.4%), and over 40% showed elevated suicide risk. Military sexual violence was reported by more than one-third of all participants, and military sexual harassment by half, with women at substantially higher risk than men across all racial/ethnic groups. The study also found important differences between demographic groups, with elevated PTSD risk among several groups of women and among Black men, lower rates of alcohol use disorder among women compared to white men, and lower suicide risk among Hispanic men.
One of the most significant findings was that even though women in this sample had higher counts of healthcare problems and greater mental health burden, their mental health visit volume did not increase proportionally after statistical adjustment — suggesting that women veterans may be receiving less intensive mental healthcare than their level of need would warrant. This research suggests that post-9/11 veterans as a whole carry a very heavy behavioral health burden, and that this burden is not evenly distributed, with women, Black veterans, and survivors of military sexual trauma facing particularly elevated risks.
The practical implications of these findings point to the need for healthcare systems serving veterans — including the VA and other providers — to be aware of these concentrated disparities and to consider whether current care delivery is adequately meeting the needs of women veterans in particular. The study's deliberate design to oversample underrepresented groups means it provides more reliable estimates for these populations than most prior research, filling an important gap in understanding who post-9/11 veterans are and what they need.
Jordan P. Davis, Eric R. Pedersen, John J. Prindle, C. Castro, Kathryn Bouskill, Whitney S. Livingston, et al.. (2026). Military service, healthcare needs, and healthcare engagement among post-9/11 veterans from the BRAVO Cohort Study.. Military Psychology. https://doi.org/10.1080/08995605.2026.2719097