I think that's one of the interesting things in our study. We used a complicated statistical modelling to show what the pathways are between different things. We showed that there was a pathway from experiencing sexual discrimination or assault and distress and there was a pathway between experiencing psychological distress and having severe chronic pain. It means that for the people who had those experiences, there was a linkage. One thing led to the next thing that led to the next thing.
It really told us that there is a psychological impact in the physical impact. We can't separate that. We see this so often, especially with chronic musculoskeletal pain. Often, for people who present with chronic musculoskeletal pain, underneath that it's like an onion skin. Psychological injuries occurred that led to that. Sometimes because of the stigma around mental health, it's easier for people to present with chronic pain than to reflect on the chronic psychological distress and injuries they've had. If they don't acknowledge these problems, they manifest as chronic pain. People may talk about their physical symptoms more than they talk about their mental health symptoms because of chronic pain, but if you treat one and ignore the other, you don't get anywhere.
It's a very western philosophy to separate physical health and mental health, but we know that's not really good in any aspect of health. They really are integrated everywhere, but perhaps nowhere is this more important than with veterans.