Sexual trauma during military service linked to higher risk of suicide and overdose death later in life

Embargoed for release until 5:00 p.m. ET on Monday 28 April 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Sexual trauma during military service linked to higher risk of suicide and overdose death later in life

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01145

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A longitudinal cohort study of older veterans found that a history of military sexual trauma (MST) is associated with increased risk for any suicide attempt and death by drug overdose in both women and men, especially those who also have post-traumatic stress disorder (PTSD). According to the authors, these findings are a call to action for policies and practices that reduce sexual trauma in the military. The study is published in Annals of Internal Medicine. 

In the first study of its kind, researchers from the University of California, San Francisco studied a national longitudinal cohort of 5,059,526 veterans aged 50 or older to determine the association between MST and risk for suicide, overdose, and related mortality later in life. The researchers stratified the study cohort by gender and MST exposure and examined whether PTSD modified the effect of MST on suicide and drug overdose death risk. The researchers found that MST was associated with an increased risk for any suicide attempt and death by suicide in both genders. The risk of suicide attempt was three times higher among men and women who had experienced MST compared to those who did not experience MST. The cumulative incidence of any late-life suicide attempts by women and men with MST were six and twelve percentage points higher than those who did not experience MST. Although MST similarly increased the risk of suicide and overdose death for both genders, MST was more than 10 times more common among women than men. MST was associated with over 60% increased risk of death by drug overdose in both genders. The findings also showed that for both men and women veterans with PTSD, MST was associated with a higher risk for suicide attempt and nonfatal attempt compared to those who only had PTSD. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Anita S. Hargrave, MD, MAS, please email the SFVAHCS Public Affairs Office at V21SFCPublicAffairs@va.gov.  

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2. Unexpected urticarial reactions (hives) seen in trial of HIV mRNA vaccines

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02701

Editorials: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01102

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A safety analysis of mRNA vaccination in a phase 1, randomized, open-label clinical trial evaluated the safety and tolerability of three investigational HIV-1 trimer mRNA vaccines. The study vaccines were found to be generally safe and tolerable. However, the researchers observed unexpected, delayed onset urticaria, or hives, in 7% of participants, highlighting the importance of promoting awareness and reporting of chronic urticaria after mRNA vaccination, adopting risk mitigation strategies in future mRNA vaccine trials, and encouraging further evaluation to determine the cause of these reactions. Urticarial reactions, mostly transient, have been reported with both licensed mRNA COVID-19 vaccines. The study is published in Annals of Internal Medicine.

A team of researchers funded by the National Institutes of Health analyzed the safety and tolerability of three investigational HIV-1 trimer mRNA vaccines: BG505 MD39.3 gp140 (soluble trimer gp140); BG505 MD39.3 gp151 (membrane-bound trimer gp151); and BG505 MD39.3 gp151 CD4 knockout (membrane-bound gp151 CD4KO). 108 participants without HIV aged 18 to 55 years were enrolled at 10 US clinical research sites between February and August 2022 and were randomly assigned to receive one of the three vaccines. Vaccines were administered intramuscularly at weeks 0, 8, and 24. Participants were observed for at least 30 minutes after vaccination and completed a daily symptom diary for a week after. Participants reported frequent but mild to moderate side effects including pain at the injection site, fatigue and muscle aches that were like those seen previously with licensed mRNA COVID-19 vaccines.  80 participants reported 180 adverse events (AEs), with 30 AEs related to the study vaccinations. These AEs included lymphadenopathy, axillary pain, and angioedema. Urticaria was observed in seven participants, four of which had unresolved, intermittent urticaria at 12 months. All seven participants with urticaria had prior receipt of mRNA COVID-19 vaccines, and urticaria occurred with each of the three study vaccines. The study details the first two cases of participants with delayed onset, generalized urticaria with dermographism related to study products. The mRNA platform is under investigation in many vaccines, including HIV-1 vaccines. While the mechanism behind urticarial reactions with these investigational HIV-1 mRNA vaccines is currently unknown, the researchers note that mRNA technology continues to hold great promise for vaccines and therapeutics. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Sharon A. Riddler, MD, please email riddler@pitt.edu.

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3. Prior antibiotic exposure linked to increased hospital-onset antimicrobial resistant infections during pandemic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03078

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A retrospective cohort study found that antimicrobial resistant (AMR) infections increased in hospitals during the pandemic due to non-hospital factors, including increased illness severity and antibiotic exposure in the 3 months prior to hospitalization. The findings are consistent with a recent Centers for Disease Control and Prevention fact sheet on AMR. The researchers say their study could inform ongoing control interventions and improve responses to future crises. The study is published in Annals of Internal Medicine.

Researchers from the National Institutes of Health Clinical Center and colleagues queried PINC AI to sort data from 243 U.S. hospitals between January 2018 and December 2022 to determine incidence of AMR infection and contributing factors among adult patients. They analyzed infections during three time periods: prepandemic (January 2018 to December 2019), peak pandemic (March 2020 to February 2022), and waning pandemic (March to December 2022). Encounters were screened for cultures from any source with growth of Staphylococcus aureus, Enterococcus species, Acinetobacter species, Pseudomonas aeruginosa, or Enterobacterales. The AMR phenotypes analyzed included: methicillin-resistant S aureus (MRSA), vancomycin resistant Enterococci (VRE), extended-spectrum cephalosporin-resistant (carbapenem-susceptible) Enterobacterales (ECR-E), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant P aeruginosa (CR-PA), and carbapenem-resistant Acinetobacter (CRAB).  The researchers also conducted a competing risks analysis to investigate the effects of patient- and hospital-level characteristics on the risk of hospital-onset AMR infection.

The researchers found that of the 9,955,696 hospitalizations, there were 178,579 infection episodes associated with 1 of the 6 AMR phenotypes, equivalent to an overall incidence of 179.4 per 10,000 hospitalizations. MRSA infections were the most common overall, but CRAB infections increased the most during the pandemic. MRSA infections decreased during the pandemic and continued declining throughout 2022. VRE, CR-PA, CRE, and CRAB represented relatively greater proportions of hospital-onset infections. Overall AMR infections increased by 6.5% during the pandemic and returned to baseline levels after March 2022. Hospital-based infections had larger increases than community-based infections during the pandemic, and as the pandemic waned, community-onset AMR returned to baseline levels whereas hospital-onset AMR remained 11.6% above the baseline. Patient factors were most associated with higher hospital-onset AMR infections during the pandemic including acute illness severity. Additionally, antibiotic exposure in the prior 3 months was incrementally associated with an increased risk for hospital-onset AMR infections.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Sameer S. Kadri, MD, MS, please email Yvonne Hylton at yvonne.hylton@nih.gov.

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4. ACP recommends ways physicians can be more effectives advocates for patients and profession

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03973

URL goes live when the embargo lifts            

In a new policy paper published in Annals of Internal Medicine, Empowering Physicians Through Collective Action: A Position Paper from the American College of Physicians, ACP is offering recommendations about how physicians can become effective advocates for their patients and their profession through collective action.

ACP’s new policy paper details what the goals of collective action should be and how physicians and health systems should approach action. The recommendations start by stating that the primary objective of collective empowerment actions by physicians should be to ensure that patients have access to safe, affordable, high-quality care. The paper goes on to say that practicing physicians must be included in executive positions and on the boards of hospitals and health systems, and that they must have means to collaborate with hospital and health systems leaders.

ACP supports the rights of physicians to engage in protected concerted activity to amplify concerns about health and safety, working conditions, and other issues without retaliation or penalties from their employer. ACP also supports the right of physicians to engage in responsible collective bargaining, including joining a union or bargaining unit. Actions like a refusal to perform administrative requirements, billing duties, or concerted refusals to work should only be considered once all other negotiating tactics have been exhausted, and efforts have been made by all involved parties to ensure safe patient care. Finally, ACP reaffirms that independently practicing physicians should have the right to negotiate jointly with health insurance plans over terms that affect the quality of, and access to, patient care, including payment and administrative policies that adversely affect access and quality.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.   

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5. Medicaid ‘unwinding’ left many younger adults uninsured

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03261

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A brief research report examined the changes in uninsured rates among working-age adults 1 year after the pandemic-era Medicaid continuous enrollment provision ended. The study found that this “unwinding” led to an increase in the uninsured rate, mostly affecting younger adults, those with lower educational attainment, and combined-race groups. According to the authors, the findings highlight the critical need to mitigate further insurance loss among working-age adults, especially as policymakers consider whether to extend or terminate additional pandemic-era protections. The findings are published in Annals of Internal Medicine.  

Researchers from Beth Israel Deaconess Medical Center analyzed data from The Current Population Survey Annual Social and Economic Supplement (ASEC), a nationally representative survey conducted each March. The researchers used the March 2023 (before unwinding) and March 2024 (after unwinding) ASEC which included 164,778 participants aged 19 to 64 years who self-reported their insurance status and type (uninsured, Medicaid, Medicare, employer-sponsored, Marketplace or non-Marketplace). The researchers found that the uninsured rate increased from 11.1% to 11.5% from March 2023 to March 2024. This decline was driven by declines in employer-sponsored and Medicaid coverage, despite an increase in Marketplace coverage. Medicaid unwinding was associated with an increase in uninsured rates among adults aged 19 to 44 years, White and combined race adults and adults with a high school education or less. Surprisingly, there was also an association between Medicaid unwinding and an increase in uninsurance rates for those above the poverty line, but not for those below the poverty line. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Rishi K. Wadhera, MD, MPP, MPhil, please email rwadhera@bidmc.harvard.edu.

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6. Report details pandemic-related trends in chronic liver disease mortality  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03218

URL goes live when the embargo lifts            

A brief research report analyzed trends in mortality for chronic liver disease (CLD) in the United States before, during and after the COVID-19 pandemic. The findings revealed disparate trends among alcohol-related liver disease (ALD), metabolic dysfunction-associated steatotic liver disease (MASLD)and hepatitis C virus (HCV)-related mortality, emphasizing the importance of establishing clinical pathways that provide uninterrupted care to persons with CLD in future public health crises. The findings are published in Annals of Internal Medicine.

Researchers from Stanford University and colleagues used the national mortality data set released by the National Vital Statistics System to analyze CLD deaths in persons aged 25 years and older and describe trends in mortality between 2015 and 2023. The researchers found that ALD-related mortality increased before the pandemic, sharply increased during the early pandemic and declined after the pandemic. Similar patterns were observed for MASLD-related mortality, however, the increasing trend in MASLD-related mortality was steeper than that of ALD-related mortality. HCV-related mortality steadily declined before the pandemic, remained stable during the early pandemic and decreased in the late pandemic. The findings suggest that after the early pandemic, improved health care access, universal vaccination rates and reduced social isolation likely mitigated the surge in ALD-related mortality and contributed to the decline in HCV-related mortality.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Donghee Kim, MD, PhD, please email dhkimmd@stanford.edu.

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Also new this issue:

Sins of Omission: Model-based Estimates of the Health Effects of Excluding Pregnant Participants from Randomized Controlled Trials

Alyssa Bilinski, PhD; Natalia Emanuel, PhD; and Andrea Ciaranello, MD

Medicine and Public Issues

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00689