Military Sexual Trauma Survivors Research Articles

Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations

ABSTRACT Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue. Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4). Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8). Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing. Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.

Trauma-focused therapy retention among military sexual trauma survivors: relationship with veterans’ sexual or gender minority identification

ABSTRACT Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans’ treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol [FP] or receiving minimally adequate care [MAC; defined as attending eight or more sessions]). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.

Contrasting ecological contexts among treatment-seeking military sexual assault survivors: Consideration of relationships with sexual and gender minority identification.

Survivors of military sexual trauma (MST) seeking mental health services may present with concerns extending beyond symptom relief. Attention to social, economic, and coping resource contexts is salient for care consideration. Although those identifying as sexual and gender minorities (SGM) are overrepresented among service members exposed to assaultive MST, research contrasting ecological resource variability among treatment seekers is limited. The present study delineates modifiable risk and protective factors that might be used to inform MST-related health care for Veterans, broadly, and SGM-identifying Veterans, specifically. Veterans (N = 493, 12.8% identifying as SGM) presenting for treatment secondary to military sexual assault completed a semistructured clinical interview and intake survey including demographic characteristics, diversity-related factors, and access to psychosocial resources. SGM/non-SGM-identifying groups were contrasted on individual-, interpersonal-, and community-level ecological characteristics. SGM-identifying Veterans were less likely to report access to sufficient financial resources and had double the prevalence rate of housing instability in contrast to non-SGM-identifying Veterans. No significant differences emerged in terms of past-year interpersonal violence exposure, endorsement of helpful spiritual beliefs, or availability of social support based on SGM identification. Findings underscore the importance of attending to the intersection of SGM identity and ecological factors that can influence Veterans' clinical presentation and treatment engagement. Recommendations for provision of MST services are made. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negative posttraumatic cognitions about self potentially mediate the relation between sexual revictimization and suicide risk in a sample of military sexual assault survivors.

Military sexual trauma (MST) is a risk factor for suicide among service members/veterans. Research reported that around half of MST survivors were exposed to pre-MST, making MST a revictimization experience. Unfortunately, little is known about mechanisms of the association between revictimization and suicide risk among MST survivors. One possible mechanism is posttraumatic cognitions (PTCs), which include the survivor's (a) negative cognitions about themselves, (b) negative cognitions about the world, and (c) self-blame. The current study examined each of the PTC subscales as potential mediators of the association between sexual revictimization and suicide risk. Participants were 383 service members/veterans reporting a history of MST that involved assault (50.65% female). Participants completed self-report questionnaires assessing demographics, suicide risk, history of sexual victimization (MST and premilitary sexual victimization), and PTCs. Of these, 340 (88.8%) reported a history of MST and premilitary victimization and comprised the revictimization group. Parallel mediation analysis with suicide risk regressed on each of the PTCs subscales and covariates revealed that negative cognitions about self had a significant indirect effect on the association between revictimization and higher suicide risk, above and beyond negative cognitions about the world and self-blame. Targeting negative cognitions about self among sexual revictimization survivors may be a therapeutic strategy to reduce suicide risk most effectively. Cognitive processing therapy may be particularly useful given the focus on altering PTCs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PTSD, depression, and suicidality among survivors of childhood sexual trauma (CST), military sexual trauma (MST), and sexual revictimization (CST + MST).

Research to date has not examined how childhood sexual trauma (CST) followed by sexual trauma during military service (MST) relates to posttraumatic stress disorder (PTSD), depression, and suicidality among women and men. Given the strong association between MST in particular, and these serious posttraumatic outcomes, the current study sought to address this gap. The current study compared the mental health concerns of 268 treatment-seeking veterans who were survivors of CST, MST, or both (CST + MST). We hypothesized that MST would be associated with greater severity of symptoms compared with CST and that those who experienced sexual revictimization (CST + MST) would report more severe symptoms than veterans who experienced CST or MST alone. Veteran men presented with significantly higher suicidality but not higher PTSD or depression scores than women. Controlling for gender, MST survivors had significantly higher PTSD and depression symptom severity scores, but not suicidality, than CST survivors. PTSD, depression, and suicidality scores were significantly higher for the CST + MST group than for CST only survivors, but did not significantly differ from survivors of MST alone. Findings support the more severe clinical impact of CST + MST-specific sexual revictimization compared with CST-only among military men and women, but also suggest that MST alone can have negative consequences similar to revictimization. While results point to the need to consider context and trauma history in future trauma research and clinical applications, they should be interpreted in light of our sample demographics, which were representative of the southwest U.S. veteran population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the unique and interactive associations of gender and race on PTSD symptom severity among military sexual trauma survivors.

Despite a robust association between military sexual trauma (MST) and posttraumatic stress disorder (PTSD), few studies have examined factors that are associated with increased symptom severity. To this end, the current study was designed to examine the unique and interactive effects of gender and race on PTSD symptoms using a sample of MST survivors. The sample included 126 veterans (71% Women, 29% Men; 70% Black/African American and 30% White/Caucasian) presenting for psychological services to a MST specialty clinic at a large Southeastern Veterans Affairs (VA) hospital. As part of their intake evaluation, veterans completed a diagnostic interview and battery of self-report questionnaires. Results revealed a main effect of gender and race such that veteran men and Black/African American veterans were found to have increased PTSD symptom severity. However, there was not a significant gender by race interaction. Findings are discussed with regard to previous research and treatment implications. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Military sexual trauma among Veterans using and not using VA justice-related programing: A national examination

Veterans accessing Department of Veterans Affairs (VA) Veterans Justice Program (VJP) services have high rates of depression, substance misuse, and posttraumatic stress disorder. Although factors that may confer risk for mental health sequelae among these Veterans have been identified (e.g., childhood abuse, combat exposure), limited research has examined report of military sexual trauma (MST) among Veterans accessing VJP services. As survivors of MST experience myriad chronic health conditions which necessitate identification and referral to evidence-based care, identifying MST survivors among those accessing VJP services may facilitate referral to appropriate services. We examined whether MST prevalence differed between Veterans with and without a history of VJP service use. Sex-stratified analyses were conducted with 1,300,252 male (13.34% accessing VJP) and 106,680 female (10.14% accessing VJP) Veterans. In crude models, male and female Veterans accessing VJP services were significantly more likely to screen positive for MST (PR = 3.35 and 1.82 respectively). Significance was maintained in models that adjusted for age, race/ethnicity, VA service use, and VA mental health use. VJP service settings may serve as a critical intercept for identifying male and female survivors of MST. Using a trauma-informed approach to screen for MST in VJP settings is likely warranted. Moreover, integration of MST programing into VJP settings may be beneficial.

Military Sexual Trauma Among Women Veterans Using Veterans Health Administration Reproductive Health Care: Screening Challenges and Associations with Post-Military Suicidal Ideation and Suicide Attempts.

Military sexual trauma (MST) is highly prevalent among women veterans. Research among MST survivors has focused on individuals receiving care in specific settings, such as mental health services. There is a dearth of knowledge regarding MST prevalence and associations in other settings commonly accessed by women veterans, including reproductive healthcare settings. We examined MST prevalence (overall, by MST type and extent of underreporting) and associations with suicidal ideation and suicide attempts, among women veterans accessing Veterans Health Administration (VHA) reproductive health care. Our sample included 352 post-9/11 women veterans who used VHA reproductive health care in Fiscal Year (FY) 2018 and participated in a cross-sectional survey. Approximately 68.7% screened positive for MST, including 44.9% who reported experiencing military sexual assault. Notably, 30.8% reported MST on the survey, but had a negative MST screen for their most recent MST screen in their VHA medical record. Both military sexual harassment and assault were associated with increased prevalence of experiencing suicidal ideation following military service; however, a significant association among military sexual harassment, past-month suicidal ideation, and post-military suicide attempts was not detected. Military sexual assault was uniquely associated with past-month suicidal ideation and post-military suicide attempts. As MST and underreporting are highly prevalent among women veterans using VHA reproductive health care, rescreening for MST within this population is essential. A trauma-informed approach is recommended irrespective of prior MST screening results and may facilitate suicide prevention in this population. Addressing barriers to MST disclosure and preventing MST and its sequelae remain critical.

Influence of Comorbid Social Anxiety Disorder on Symptomatology and Social Functioning in Female Military Sexual Trauma Survivors with PTSD

Military sexual trauma (MST) is a common experience in veterans and associated with numerous negative outcomes, such as posttraumatic stress disorder (PTSD), diagnostic comorbidity, and impairments in multiple domains, including social functioning. Comorbid social anxiety disorder (SOC) may represent a particularly challenging presentation due to added difficulties with social functioning and treatment response. The present study investigated severity, emotion regulation, and perceived support and functioning of comorbid SOC in female MST survivors with PTSD. Participants were recruited for a randomized clinical trial that compared telehealth and in-person delivery of evidence-based psychotherapy for PTSD. Of the 112 participants with PTSD, 30 participants (27%) also met criteria for comorbid SOC on a diagnostic interview. Participants with comorbid PTSD-SOC endorsed poorer emotion regulation, less positive affect, and greater negative affect compared to participants with PTSD without SOC comorbidity. Participants with comorbid PTSD-SOC also were less likely to be involved in a romantic relationship and evidenced increased difficulties in sharing thoughts and feelings with family members and friends. Together, these findings suggest that SOC comorbidity in patients with MST-related PTSD is associated with increased impairments in emotion regulation and social functioning.

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.

Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms

ABSTRACT Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.

Comparing Veterans with Posttraumatic Stress Disorder Related to Military Sexual Trauma or Other Trauma Types: Baseline Characteristics and Residential Cognitive Processing Therapy Outcomes.

The Veterans Health Administration (VHA) has called for improved assessment and intervention for survivors of military sexual trauma (MST) to mitigate deleterious sequalae, including posttraumatic stress disorder (PTSD). Research on the impact of MST-related PTSD (MST-IT) on men is limited, and few studies have examined the differential effects of treatment across genders and MST-IT. Additionally, studies have utilized varying definitions of MST (e.g., sexual assault only vs. including sexual harassment), contributing to disparate outcomes across studies. Utilizing data from 343 veterans seeking residential cognitive processing therapy (CPT) for PTSD in VHA, this study examined the impact of MST-IT and gender on differences in demographic characteristics; pre-treatment severity of PTSD (overall and clusters), depression, and negative posttraumatic cognitions (NPCs); and post-treatment severity of these variables after accounting for pre-treatment severity. Results from 2x2 factorial ANOVAs found no differences in pre-treatment depression or overall PTSD by MST-IT, gender, or their interaction; however, MST-IT survivors presented with greater pre-treatment avoidance, global NPCs, and self-blame. Results from hierarchical linear regression models found only pre-treatment symptom severity significantly predicted post-treatment severity for overall PTSD and all NPCs. These findings suggest veteran survivors of MST-IT appear to benefit similarly from CPT delivered in a VHA residential PTSD program compared to veterans with other index traumas, regardless of gender. Although there were minimal post-treatment differences in PTSD and NPCs by MST-IT status and gender, residual symptoms related to negative cognitions and mood appear to differ across gender and MST-IT status. Specifically, in individuals without MST-IT, post-treatment PTSD symptoms of negative alterations in cognition and mood were higher in men than women. Moreover, women with MST-IT reported more symptoms of depression than both men with MST-IT and women without MST-IT. These findings suggest depressive symptoms decrease through residential PTSD treatment differentially by MST-IT status and gender and warrant further examination.

Institutional betrayal and help-seeking among women survivors of military sexual trauma.

The current study examined if IB was associated with women veterans' willingness to seek VHA and non-VHA mental health and medical care, prior use of VHA care, past year use of VHA care, and use of VHA and non-VHA MST-related care. Participants were 242 women veterans who screened positive for MST and completed self-report measures of IB and willingness to seek VHA and non-VHA mental health and medical care. Use of VHA care was assessed through VA Corporate Data Warehouse data. IB was associated with lower willingness to use VHA medical care and higher willingness to use non-VHA mental health care. Although IB was not significantly associated with prior use of VHA care, participants who reported more IB were more likely to have used VHA care in the past year and to have used both VHA and non-VHA MST-related care. These findings illuminate the relationship between the institutional response to MST with women's help-seeking willingness and use. Addressing IB may be important for increasing women MST survivors' willingness to use VHA medical care. Additionally, as IB was associated with greater willingness to use non-VHA mental health care, non-VHA institutions and providers should be prepared to serve women veterans who have experienced MST-related IB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A randomized clinical trial of in-person vs. home-based telemedicine delivery of Prolonged Exposure for PTSD in military sexual trauma survivors

Posttraumatic stress disorder (PTSD) is common in women who experienced Military Sexual Trauma (MST). Despite Veterans Affairs Medical Center-wide screening and tailored MST services, substantial barriers to care exist, and about 50 % of those who start evidence-based treatment for PTSD drop out prematurely. Home-based telemedicine (HBT) may reduce logistical and stigma related barriers to mental health care, thereby reducing dropout. The current randomized clinical trial (NCT02417025) for women veterans with MST-related PTSD (N = 136) compared the efficacy of HBT delivery of Prolonged Exposure (PE) to in-person delivery of PE on measures of PTSD and depression, as well as on “PE dose” received. Hypotheses predicted that women in the HBT PE group would complete more sessions, and evince greater PTSD and depression symptom reduction compared to in-person PE. Results revealed that there were no differences in dose received or PTSD symptom reduction between in-person and HBT conditions; however, dose (i.e., more sessions) was related to reduced PTSD symptom severity. Future research should examine other factors associated with high PTSD treatment dropout among MST patients.

Military sexual trauma and suicidal ideation in VHA-care-seeking OEF/OIF/OND veterans without mental health diagnosis or treatment

Sexual trauma is a suicide risk factor. While military sexual trauma (MST) is frequently associated with suicidal ideation (SI) in women and men veterans who served in recent conflicts, less is known about MST's relationship to SI in veterans who have no documented mental health concerns. Of the 1.1 million post-9/11 veterans enrolled in the Veterans Healthcare Administration (VHA) we examined 41,658 (12.3% women, 87.7% men) without evidence of mental health diagnosis or treatment and who were screened for MST and SI using the standard VHA clinical reminders between 2008 and 2013. Relative risk estimates were generated using separate models for women and men. MST was reported by 27.9% of women and 2.9% of men; SI by 14.7% and 16.5%, respectively. The adjusted relative risk of MST on SI was 1.65 (95% CI 1.35, 2.00) in women, and 1.49 (95% CI 1.26, 1.75) in men. In this sample of veterans without evidence of mental health diagnosis or treatment, MST was associated with a high risk of SI in both genders. Positive MST screening should prompt SI screening and risk management if indicated, and further study of barriers to mental healthcare among MST survivors at risk for suicide is warranted.

“We really need this”: Trauma-informed yoga for Veteran women with a history of military sexual trauma

ObjectivesUp to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY’s feasibility, acceptability, and perceived effects in the context of MST. DesignCollective case series (N = 7). SettingNew England Vet Center. InterventionsExtant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. Main outcome measuresAttrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). ResultsFeasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. ConclusionsTIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.

The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior

Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.

Supplemental Material for Institutional Betrayal and Help-Seeking Among Women Survivors of Military Sexual Trauma

Supplemental Material for Institutional Betrayal and Help-Seeking Among Women Survivors of Military Sexual Trauma

The association of assault military sexual trauma and sexual function among partnered female service members and veterans: the mediating roles of depression and sexual self-schemas

ABSTRACT Background: Military sexual trauma (MST) that involves assault is associated with poorer sexual function in U. S. women service members/veterans (SM/Vs). Theory of sexual function suggests that the presence of higher depression severity and more negative sexual self-schemas may contribute to sexual dysfunction. This has yet to be examined in partnered women SM/Vs who are survivors of MST. Objective: Using path analysis, the current study examined the associations of MST type, depression, sexual self-schemas, and sexual function in 818 partnered women SM/Vs. Method: Three separate mediation models were tested, all testing indirect effects of depression and sexual self-schemas on the association of MST type and sexual function. In Model 1, the mediation model assumed that exposure to MST predicted more severe depression, which then predicted more negative sexual self-schemas. More negative sexual self-schemas, in turn, predicted poorer sexual function. In Model 2, the mediation model assumed that exposure to MST predicted more negative sexual self-schemas, which then predicted more severe depression. More severe depression, in turn, predicted poorer sexual function. In Model 3, the mediation model assumed a parallel mediation in that exposure to MST predicted more severe depression and more negative sexual self-schemas, which in turn, predicted poorer sexual function. Results: The best fitting model suggested a parallel mediation of higher depression severity (estimate: −1.30, confidence interval: −1.91,-.69) and more negative sexual self-schemas (estimate: −2.09, confidence interval: −2.94,-1.24) on the association of assault MST and poorer sexual function (Model 3). Harassment-only MST was unrelated to sexual function through mediated pathways. Conclusions: Interventions to improve sexual function among MST survivors who experienced assault should address negative sexual self-schemas related to sexual performance and depressive symptoms. Cognitive behavioural interventions that include challenging maladaptive cognitions may be well suited to address this clinical need.

Military Sexual Trauma: An Update for Nurse Practitioners

Military sexual trauma (MST) is a pervasive and insidious problem among military personnel. MST is defined as sexual harassment or sexual assault that occurs during ones’ time in military service. Due to the physical, mental, and psychosocial consequences of MST, all nurse practitioners (NPs) must be able to effectively identify survivors of MST, recognize and address health consequences of MST, and provide appropriate interventions and referrals for MST survivors. The purpose of this report is to provide an overview so that NPs are equipped to effectively care for MST survivors in both Veterans Health Administration (VHA) and non-VHA settings.