Prevalence Of Military Sexual Trauma Research Articles

Military Sexual Trauma and its Association with Mental Health Among Sexual Minority and Heterosexual Veterans in the United States.

Purpose: The purpose of this study was to examine the prevalence of military sexual trauma (MST) by sexual orientation, characteristics of sexual minority (SM) and heterosexual veterans who have experienced MST, and associations between sexual orientation and mental health symptoms among veterans who have experienced MST. Methods: Data were analyzed from a nationally representative web-based survey of 4069 U.S. veterans (4.9% SM), which assessed sociodemographic (e.g., age, sexual orientation) and military (e.g., branch) characteristics, and lifetime and current mental health symptoms. Bivariate analyses compared sociodemographic and military characteristics and mental health symptoms among veterans who have experienced MST by sexual orientation. Multivariable logistic regressions examined associations between sexual orientation and mental health symptoms among veterans who have experienced MST, while controlling for differences in sociodemographic characteristics and non-MST traumatic events. Results: The prevalence of MST (7.5% of weighted sample) was higher among SM veterans compared to heterosexual veterans, with bisexual/pansexual/queer veterans endorsing the highest prevalence (22.7%), followed by gay/lesbian (17.0%) and heterosexual (6.5%) veterans. SM veterans who experienced MST were more likely than heterosexual veterans to screen positive for lifetime and current posttraumatic stress disorder (odds ratio [OR] = 3.06 and 3.38, respectively), and current drug use disorder (OR = 3.53). Conclusions: This study adds to growing evidence that mental health symptoms associated with MST disproportionately impact SM veterans relative to heterosexual veterans. Approaches to reducing barriers and tailoring MST-related care to SM veterans, including through addressing cumulative effects of minority stress, are discussed.

Moral injury in women military members and Veterans: What do we really know?

LAY SUMMARY Moral injury describes and explains the biological, psychological, sociological, and spiritual wounds service members may develop when they are betrayed by leadership or act, fail to act, or bear witness to acts that are in direct conflict with their moral code. Very little research is focused on moral injury experienced by women service members and Veterans. A woman’s experience in the military is often vastly different from a man’s because they have a higher prevalence of military sexual trauma (the threat or experience of sexual assault or harassment). To date, little research has been conducted about how betrayal, military sexual trauma, and moral injury interact. This article attempts to decipher moral injury from other psychological and combat stress injuries and highlights the unique aspects of moral injury experienced by women combat Veterans.

‘We need a culture change’: military sexual trauma through the lens of rape culture

Military sexual trauma remains a critical concern within the US military. One possible explanation for the persistence of this trauma is the presence of rape culture. This study examined perceptions of military sexual trauma within the framework of rape culture (i.e. traditional gender roles, sexism, adversarial sexual beliefs, hostility toward women, and acceptance of violence), in addition to associated factors, to address the US Department of Defense’s call to focus on the role of culture on military sexual trauma. Focusing on culture is important as subtle norms in culture shape our behaviour and impact the excusal/perpetration of military sexual trauma. Identifying these norms may provide insight into factors to target in prevention efforts to reduce/eliminate military sexual trauma. Forty-two US service members responded to a series of open-ended questions. Standard content analysis procedures were utilised to determine themes. Results paint a complex picture of military sexual trauma, with participants demonstrating concern regarding military sexual trauma, but minimal acknowledgement of behaviour change to reduce military sexual trauma. These results are consistent with the observed increase in prevalence of military sexual trauma and decrease in reporting of it since 2018. Adding to the existing literature, participants noted the continued existence of rape culture within the military and the need for cultural change to address military sexual trauma.

Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers.

Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.

Prevalence and Correlates of Military Sexual Trauma in Service Members and Veterans: Results From the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey.

Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST. Data came from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941, ages 33 years + ). Individuals endorsing sexual trauma were stratified into MST and non-MST and compared to individuals with no sexual trauma. The prevalence of lifetime MST was computed, and correlates of sexual trauma were examined using multinomial regression analyses. The overall prevalence of MST was 44.6% in females and 4.8% in males. Estimates were comparable between currently serving members and veterans. In adjusted models in both sexes, MST was more likely among younger individuals (i.e., 33-49 years), and MST and non-MST were more likely in those reporting more non-sexual traumatic events. Among females, MST and non-MST were more likely in those reporting lower household income, non-MST was less likely among Officers, and MST was more likely among those with a deployment history and serving in an air environment. Unwanted sexual touching by a Canadian military member or employee was the most prevalent type and context of MST. A high prevalence of MST was observed in a follow-up sample of Canadian Armed Forces members and veterans. Results may inform further research as well as MST prevention efforts.

Military sexual trauma in the United States: Results from a population-based study

BackgroundThe reported prevalence of military sexual trauma (MST) has increased over the past decades in the United States, yet scarce population-based studies have examined the prevalence, correlates, and health burden of MST in the general veteran population. MethodsData were from the 2019–2020 National Health and Resilience in Veterans Study, a population-based survey of veterans (n = 4069). Analyses: (1) estimated the prevalence of MST; (2) identified sex-stratified sociodemographic, military, and trauma characteristics associated with MST; and (3) examined sex-stratified associations between MST and psychiatric comorbidities, functioning, disability, and treatment utilization. ResultsFemale veterans reported substantially higher rates of MST (44.2%) than male veterans (3.5%). Relative to male veterans without MST histories, male veterans with MST histories had nearly 3-fold increased odds of reporting future suicidal intent, 2-to-3-fold greater odds of screening positive for current posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder; and nearly 2-fold increased odds of being disabled. Male veterans with MST histories also scored lower on mental, physical, cognitive, and psychosocial functioning (d's = 0.16–0.29). Relative to female veterans without MST histories, female veterans with MST histories had 5-fold greater odds of current PTSD, 2-fold greater odds of engaging in mental health treatment, and scored lower on psychosocial functioning and higher on somatic symptoms (both d's = 0.25). LimitationsCross-sectional design precludes causal inference. ConclusionsA substantial proportion of veterans in the U.S. experience sexual trauma during their military service, and these experiences are associated with an elevated health burden.

The Identification and Management of Military Sexual Trauma in Veterans: Ask the Question!

Military sexual trauma (MST) is a serious and pervasive problem in the US military and results in the occurrence of physical, psychological, and psychosocial negative health consequences in female and male veterans. The prevalence of MST is increasing, and more veterans are seeking health care outside of the Veteran Affairs Medical Centers (VHA). Consequently, nurse practitioners as non-VHA health care providers may treat this population in the community. Insufficient knowledge precludes the ability to identify and manage MST. This article provides NPs with information for accurately identifying and managing military sexual trauma in the military and veteran population.

Military Sexual Trauma and Sexual Health in Women Veterans: A Systematic Review.

Sexual trauma during military service is prevalent among women veterans and is associated with multiple negative physical and mental health sequelae. The high prevalence of military sexual trauma (MST), sexual harassment and assault during military service, has prompted the Veterans Health Administration to enact several policies to address the detrimental health impacts of this experience. MST also negatively impacts veterans' sexual health, yet the field lacks a systematic review of the relationship between MST and sexual health among women veterans. To systematically review the existing research on the impact of MST on sexual health in women veterans. The published literature examining MST and sexual health in women veterans prior to July 19, 2018, was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Articles were abstracted and evaluated for risk of bias. 6 articles were identified that met inclusion criteria; they generally evidenced a low risk of bias and thus a high quality of evidence. Results indicated that MST is associated with sexual dysfunction and low sexual satisfaction among women veterans. Other mental health concerns were also commonly comorbid with female sexual dysfunction in this population. This body of literature is small and methodologically limited by over-reliance on observational study design, use of non-validated and single-item measures of sexual health, and failure to comprehensively assess trauma history, including sexual and non-sexual trauma. Sexual dysfunction is a salient health issue for women veterans who experienced MST. Additional research is needed with improved designs, validated measures of sexual function, and comprehensive assessment of trauma to learn about the specific impact of MST on women veterans' sexual health. We present recommendations for future directions in terms of research, clinical practice, education, and policy. Pulverman CS, Christy AY, Kelly UA. Military Sexual Trauma and Sexual Health in Women Veterans: A Systematic Review. Sex Med Rev 2019;7:393-407.

Abstract P6-15-01: Military sexual trauma is associated with an increased prevalence of mastectomy versus breast conserving surgery in a population of female veterans with early stage breast cancer

Abstract Background: The National Accreditation Program for Breast Centers (NAPBC), in a 2014 statement of standards, endorsed breast conservation surgery (BCS) for women with AJCC stage 0,I, or II breast cancer, with a target of 50% BCS. Women comprise the fastest growing segment of Veteran's Health Administration (VA) enrollees, and have high rates of trauma exposure including military sexual trauma (MST). The VA conducts universal screening of all Veterans for MST. Implications for medical care, e.g. an increased rate of hysterectomy among survivors of MST, have been reported. While the numbers of breast cancers treated in VA are relatively small compared to non-VA centers, a trend toward decreasing rates of BCS in VA from 2000-2006 has been reported. Reasons for declining rates of BCS within VA, and the lower rates of BCS in the VA compared to the private sector remain unclear. The objective of this study was to identify determinants of mastectomy versus BCS in women Veterans with early stage breast cancer and to examine whether history of MST was associated with choice of mastectomy versus BCS. Methods: As a quality improvement study, we conducted a retrospective review of all early-stage (0,I,II) female breast cancer patients identified in the tumor registry between 2006-2015 at one Northeastern VA to determine rates of mastectomy and BCS. Through chart review, we examined potential determinants of BCS including age, stage, distance from treating VA facility, genetic testing, contralateral prophylactic mastectomy, and reconstructive surgery. History of MST was documented through chart review. Analyses were performed using unpaired t-test for age and distance from treatment facility and Fisher's exact test for significance comparing history of MST between surgical groups. Results: 70 women with early stage breast cancer were eligible for BCS. Of these, 39 underwent BCS and 31 underwent mastectomy (55% rate of BCS). Age and distance to treating VA were not significant. Women who underwent mastectomy were on average younger (p=0.21) and lived farther away (p =0.42) and were more likely to undergo genetic testing. Of the women who underwent genetic testing (10/70), none had mutations. The biggest difference seen between surgical groups was in history of MST, with women in the mastectomy group having more than twice the prevalence of MST, 58%, vs 31% in the BCS group (p = 0.0154 ). Patient characteristics by type of surgery performed BCS N=39Mastectomy n=31Age (mean)63.559.3Distance from VA56.7 miles67.7 milesGenetic testing (no mutations found)4 (10%)6 (19%)Reconstructive surgery05Prophylactic contralateral mastectomy011MST11(28%)18(58%) Conclusion: These data suggest that MST is associated with choice of mastectomy over BCS. MST results in poor body image which may impact decisions about breast surgery. Trauma-informed strategies for counseling women about options for surgical management of early stage breast cancer may be needed to ensure that women with MST and other forms of trauma pursue evidence-based cancer treatment. Further work with a larger cohort is needed to better understand these findings. Citation Format: Oshry LJ, Naomi K, Megan GR. Military sexual trauma is associated with an increased prevalence of mastectomy versus breast conserving surgery in a population of female veterans with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-15-01.

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans.

Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.

Prevalence of Military Sexual Trauma and Sexual Orientation Discrimination Among Lesbian, Gay, Bisexual, and Transgender Military Personnel: a Descriptive Study.

Despite the repeal of Don't Ask, Don't Tell, Don't Pursue (DADT) and the update to the Transgender Policy, there remain concerns about the persistence of military sexual trauma (MST) and sexual orientation discrimination against lesbian, gay, bisexual, and transgender (LGBT) service members. A sample of 253 participants (89 women, 164 men) completed an Internet-based survey that assessed the prevalence of sexual orientation discrimination (e.g., offensive speech, physical or discriminatory behaviors) and MST (e.g., sexual harassment and sexual assault). The survey was conducted between April 2012 and October 2013. Women and men reported similar levels of sexual orientation discrimination in the military. Participants reported experiencing more threats and intimation, vandalism, and physical assault outside of the military than inside the military (p < 0.05). Although the prevalence of MST (both sexual harassment and sexual assault) in the military was high among both genders, women were more likely to report experiences of sexual harassment compared to men (p < 0.05). Our findings demonstrate the prevalence of MST and sexual orientation discrimination among LGBT service members in the military and point to the need for strong accountability and oversight to protect sexual minority persons while they are serving their country.

Association of Military Sexual Trauma, Post-Tramautic Stress Disorder With Obesity in Female Veterans

Introduction: Post-traumatic stress disorder (PTSD), military sexual trauma (MST), and obesity are among the many medical issues that plague our growing population of new veterans. Our aim is to focus on MST and PTSD and their association with obesity in the female veteran population. Methods: We extracted data from the Veterans Health Administration (VA) from fiscal year FY2009 (Oct 2008-Sep 2009) on women using outpatient care or VA hospitals after excluding patients with schizophrenia. The sample included 285,848 women. We defined obesity and other weight categories from ICD9 diagnosis codes and body-mass index (BMI). PTSD was defined by outpatient visits with ICD9 diagnosis, Military Sexual Trauma (MST) was defined by use of a MST clinic. Covariates included age, race (black, white, Asian/Native Peoples, unknown), married, VA Priority as well as prescribed antipsychotics and Selim count of chronic conditions. Chi-square and logistic regression assessed correlates of obesity. Results: The unadjusted chi-square analysis of MST by obesity diagnosis or BMI >30 found a strong association: 32% non-MST vs 45% MST-affected women were obese. The effect of PTSD was similar: 32% of non-PTSD women vs 42% of women with PTSD were obese. We repeated the analyses adjusting for clinical and demographic covariates, and found a modest level of support for our hypothesis: adjusted odds ratio (OR) 1.14, 95% CI 1.06-1.24 for MST, OR: 1.1, 95% CI 1.06-1.13 for PTSD;. Age, race, depression or bipolar disorder, and chronic disease burden correlated with obesity. Within the subgroup with PTSD, MST was not associated with obesity. Conclusion: This is a pilot study showing the association of MST with obesity in female Veterans. An overlooked phenomenon of weight-gain associated with trauma reactions may be adding cardiovascular and other risk to the burden of disease shouldered by female veterans with MST and/or PTSD. Our study showed increased rates of obesity in women diagnosed with MST and/or PTSD, covarying with additional medical and mental disorders. This is of particular concern due to the growing female veteran population from recent military conflicts and increased incidence and prevalence of MST and PTSD amongst this new wave of veterans. This study highlights the need for paying particular attention to female patients with these complex patterns of physical and mental disorders. Providers should consider interventions such as early referral to dieticians or weight management programs (MOVE).

Military sexual trauma in US veterans: results from the National Health and Resilience in Veterans Study.

To evaluate the prevalence of military sexual trauma (MST) among US veterans, identify sociodemographic and military characteristics of MST, and examine the relationships between MST and psychiatric comorbidities, functioning/quality of life, and mental health treatment utilization. Data were analyzed from the National Health and Resilience in Veterans Study, a contemporary, nationally representative survey of 1,484 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured include history of MST, trauma histories, lifetime and current DSM-IV mental disorders, functioning and quality of life, and utilization of mental health treatment. The overall prevalence of MST was 7.6% and was higher among female than male veterans (32.4% vs 4.8%) and younger than older veterans (22.8% among veterans aged 18-29 years vs 4.5% among veterans aged 60+ years). After adjustment for sociodemographic and military characteristics, MST was associated with elevated rates of current major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder (adjusted odds ratio [aOR] range, 2.19-3.12); past history of suicide attempt (aOR = 2.78) and current suicidal ideation (aOR = 2.19); and decreased mental and cognitive functioning and quality of life (Cohen d, 0.23-0.38). MST was also associated with increased current utilization of psychotropic medication (aOR = 3.70) and psychotherapy or counseling (aOR = 2.41), independent of psychiatric morbidities. 7.6% of US veterans screen positive for MST, with substantially higher rates among female and younger veterans. MST is associated with elevated rates of several psychiatric morbidities and suicidality, reduced functioning and quality of life, and increased mental health treatment utilization, independent of other sociodemographic, military, and mental health factors. These results suggest that MST is prevalent among US veterans and associated with elevated health burden. Findings can help inform efforts to identify at-risk veterans and characterize the concomitant health burden and needs associated with MST in this population.

Revealing the importance of military sexual trauma and its consequences.

Revealing the importance of military sexual trauma and its consequences.

Military Sexual Trauma

This article reviews the literature documenting the prevalence of military sexual trauma (MST) and its associated mental and physical health consequences. Existing research indicates that prevalence rates of MST vary depending on method of assessment, definition of MST used, and type of sample. Risk factors for MST have been identified as including age, enlisted rank, negative home life, and previous assault history. MST has been associated with increased screening rates of depression and alcohol abuse, in addition to significantly increased odds of meeting criteria for post-traumatic stress disorder. In addition, MST has been associated with reporting increased number of current physical symptoms, impaired health status, and more chronic health problems in veterans. Available research on health care utilization and MST is also discussed. Researchers are encouraged to utilize standardized definitions of MST, employ standardized assessment methodology, and utilize more male veterans in future research. Policy and practice implications are discussed.

Posttraumatic stress disorder in female veterans with military and civilian sexual trauma

This study examines relationships among military sexual trauma (MST), nonmilitary sexual trauma, and posttraumatic stress disorder (PTSD). A sample of 196 female veterans was assessed for trauma occurring before, during, and after military service, and for current PTSD. The prevalence of MST was higher than that of premilitary and postmilitary sexual trauma. Premilitary trauma did not significantly increase the odds of experiencing MST, but did increase the odds of experiencing postmilitary sexual trauma. Logistic regression analyses revealed MST was more strongly associated with PTSD than was premilitary or postmilitary trauma. Women with MST had the greatest increased odds of developing PTSD. Understanding risk factors for and taking steps to prevent MST may reduce cases of PTSD in female veterans.