Rates Of Military Sexual Trauma Research Articles

Impact of Evidence-Based Quality Improvement on Tailoring VA's Patient-Centered Medical Home Model to Women Veterans' Needs.

Women Veterans' numerical minority, high rates of military sexual trauma, and gender-specific healthcare needs have complicated implementation of comprehensive primary care (PC) under VA's patient-centered medical home model, Patient Aligned Care Teams (PACT). We deployed an evidence-based quality improvement (EBQI) approach to tailor PACT to meet women Veterans' needs and studied its effects on women's health (WH) care readiness, team-based care, and burnout. We evaluated EBQI effectiveness in a cluster randomized trial with unbalanced random allocation of 12 VAMCs (8 EBQI vs. 4 control). Clinicians/staff completed web-based surveys at baseline (2014) and 24 months (2016). We adjusted for individual-level covariates (e.g., years at VA) and weighted for non-response in difference-in-difference analyses for readiness and team-based care overall and by teamlet type (mixed-gender PC-PACTs vs. women-only WH-PACTs), as well as post-only burnout comparisons. We surveyed all clinicians/staff in general PC and WH clinics. EBQI involved structured engagement of multilevel, multidisciplinary stakeholders at network, VAMC, and clinic levels toward network-specific QI roadmaps. The research team provided QI training, formative feedback, and external practice facilitation, and support for cross-site collaboration calls to VAMC-level QI teams, which developed roadmap-linked projects adapted to local contexts. WH care readiness (confidence providing WH care, self-efficacy implementing PACT for women, barriers to providing care for women, gender sensitivity); team-based care (change-readiness, communication, decision-making, PACT-related QI, functioning); burnout. Overall, EBQI had mixed effects which varied substantively by type of PACT. In PC-PACTs, EBQI increased self-efficacy implementing PACT for women and gender sensitivity, even as it lowered confidence. In contrast, in WH-PACTs, EBQI improved change-readiness, team-based communication, and functioning, and was associated with lower burnout. EBQI effectiveness varied, with WH-PACTs experiencing broader benefits and PC-PACTs improving basic WH care readiness. Lower confidence delivering WH care by PC-PACT members warrants further study. The data in this paper represent results from a cluster randomized controlled trial registered in ClinicalTrials.gov (NCT02039856).

Characteristics and Gender Differences of Headache in the Veterans Health Administration: A National Cohort Study, Fiscal Year 2008-2019.

To determine gender differences in headache types diagnosed, sociodemographic characteristics, military campaign and exposures, and health care utilization among US veterans in the Veterans Health Administration (VHA). This study used a retrospective cohort design to examine VHA electronic health record (EHR) data. This cohort includes veterans who had at least 1 visit for any headache between fiscal years 2008 and 2019. Headache diagnoses were classified into 8 categories using International Classification of Disease, Clinical Modification codes. Demographics, military-related exposures, comorbidities, and type of provider(s) consulted were extracted from the EHR and compared by gender. Age-adjusted incidence and prevalence rates of medically diagnosed headache disorders were calculated separately for each type of headache. Of the 1,524,960 veterans with headache diagnoses included in the cohort, 82.8% were men. Compared with women, men were more often White (70.4% vs 56.7%), older (52.0 ± 16.8 vs 41.9 ± 13.0 years), with higher rates of traumatic brain injury (2.9% vs 1.1%) and post-traumatic stress disorder (23.7% vs 21.7%), and lower rates of military sexual trauma (3.2% vs 33.7%; p < 0.001 for all). Age-adjusted incidence rate of headache of any type was higher among women. Migraine and trigeminal autonomic cephalalgia rates were most stable over time. Men were more likely than women to be diagnosed with headache not otherwise specified (77.4% vs 67.7%) and have higher incidence rates of headaches related to trauma (3.4% vs 1.9% [post-traumatic]; 5.5% vs 5.1% [postwhiplash]; p < 0.001 for all). Men also had fewer headache types diagnosed (mean ± SD; 1.3 ± 0.6 vs 1.5 ± 0.7), had fewer encounters for headache/year (0.8 ± 1.2 vs 1.2 ± 1.6), and fewer visits to headache specialists (20.8% vs 27.4% p < 0.001 for all), compared with women. Emergency department utilization for headache care was high for both genders and higher for women compared with men (20.3% vs 22.9%; p < 0.001). Among veterans with headache diagnoses, important gender differences exist for men and women veterans receiving headache care within VHA regarding sociodemographic characteristics, headache diagnoses, military exposure, and headache health care utilization. The findings have potential implications for providers and the health care system caring for veterans living with headache.

Characterizing women veterans receiving seizure care in the veterans affairs healthcare system

ObjectiveThe number and proportion of women served by the Veterans Health Administration (VHA) is rapidly expanding, necessitating better characterization of factors unique to this population. While nascent literature has begun to better characterize women within the broader seizure population, women Veterans remain an understudied sample. To expand our clinical understanding of women with seizures, we assessed demographic and clinical characteristics, as well as psychiatric/military histories in women receiving care from an Epilepsy Center of Excellence within the VA Healthcare System. MethodsThe sample included 90 women with psychogenic nonepileptic seizures (PNES) and 28 women with epileptic seizures (ES) as the final diagnosis after epilepsy monitoring at a large VA medical center between 2010 and 2020. Retrospective chart review gathered demographics, including age, marital status, and work status; clinical characteristics, including history of traumatic brain injury (TBI) or migraines, gynecological history, and use of anti-seizure medications (ASM); psychiatric information, including trauma history, psychiatric diagnoses, and treatment; and military history related to service or service connection. Group differences were assessed between women with PNES and ES. ResultsThe ES group was significantly older than the PNES group (47.8 v. 41.9 years, p = 0.02) and had a non-significantly longer diagnosis duration (12.3 vs. 8.6 years, p = 0.17). Clinically, the PNES group had a significantly higher rate of migraines (76.7% v. 57.1%, p = 0.04) and hysterectomy (40% v. 17.9%, p = 0.03). Many psychiatric factors differentiated the two groups, with significantly higher rates of psychotropic medication use (86.7% v. 60.7%, p = 0.002), psychiatric hospitalization (42.2% v. 21.4%, p = 0.047), and suicide attempts (42.2% v. 14.3%, p = 0.005), alongside trends toward higher rates of military sexual trauma (47.8% vs. 28.6%, p = 0.07) and childhood sexual trauma (37.8% vs. 17.9%, p = 0.05) among those with PNES. SignificanceThis is the largest study to date characterizing women veterans with seizures seeking comprehensive seizure care and provides an update to previously published information on Veteran samples with seizures. Several characteristics differ between women Veterans with PNES and ES, spanning demographic, clinical, and psychiatric factors. Understanding the unique profile of women Veterans with epilepsy seeking care through the VA system is a crucial step in providing optimal care, including making informed diagnosis and providing appropriate treatment.

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).

Resiliency and Posttraumatic Growth Following Sexual Trauma in Women Veterans of Iraq and Afghan Wars

Women veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience a myriad of traumatic stressors, including high rates of Military Sexual Trauma (MST). Furthermore, there is an upsurge in combat exposure, length and number of deployments, and/or perceived personal danger in these eras compared to women veterans of previous eras. These stressors can increase the risk of developing posttraumatic stress disorder (PTSD). Women veterans with combat exposure and/or MST experience PTSD differently than civilian women or military men, and therefore may require tailored and integrative treatments. Interventions that focus on resiliency and posttraumatic growth (PTG) may help decrease symptom presentation, increase quality of life, and reduce the utilization/cost of care. Moreover, resiliency-based interventions could offer a recovery-oriented framework that reinforces positive psychology constructs that may promote growth following trauma. To investigate these concepts, we interviewed four women from the OEF/OIF/OND eras who have experienced MST and/or received a diagnosis of PTSD. We explored four major areas: experiences of life after military, impact of trauma on factors that influence resiliency, helpful and unhelpful interventions for trauma recovery, and the concepts of resiliency and posttraumatic growth. These women generally felt a sense of lost identity following trauma and in post-military life, and they expressed a desire for therapy groups to support and foster connections to women with similar experiences. We also observed that they had a general understanding of resilience but lacked in-depth knowledge as it could apply to trauma recovery and welcomed opportunities to learn these skills in group settings.

Intimate Partner Violence Among Pregnant Veterans: Prevalence, Associated Mental Health Conditions, and Health Care Utilization.

Intimate partner violence (IPV) is a prevalent and serious health concern for women veterans, associated with mental and physical health symptoms. The adverse impacts of IPV are exacerbated during pregnancy, with added risks for pregnancy and postpartum outcomes. Identify the scope of IPV among pregnant veterans and associations with health outcomes. Data were obtained from a national retrospective cohort study. Study participants were 442 pregnant veterans using VHA maternity care benefits. Mental health history was assessed via self-report measure and chart review; history of IPV and perinatal depression were assessed via brief validated self-report measures. Fourteen percent of the sample reported past-year IPV. Report of past-year IPV was associated with higher self-reported rates of lifetime mental health disorders including depression (p = 0.01), posttraumatic stress disorder (p = 0.02), anxiety disorders (p = 0.05), mood disorders (p = 0.01), bipolar disorder (p = 0.001), and eating disorders (p = 0.003); past-year IPV was also associated with the diagnosis of posttraumatic stress disorder during pregnancy (p = 0.002). Additionally, past-year IPV was associated with higher rates of military sexual trauma (MST; p = 0.03), pregnancy health risk behaviors (i.e., smoking, alcohol, and drug use; p = 0.004), greater number of VHA mental health visits during pregnancy (p = 0.04), and a lower likelihood of seeking social support from a spouse or partner (p < 0.0001). Results indicate substantial rates of IPV among pregnant veterans, and high rates of mental health conditions which may be exacerbated by MST experience and lower likelihood of seeking social support. Clinicians treating pregnant veterans should screen for and address IPV and mental health treatment needs, and risks should be assessed among pregnant veterans experiencing IPV.

Context Matters: Posttraumatic Stress Disorder Symptom Associations With Military Sexual Trauma Event Characteristics and Dual Histories of Interpersonal Trauma.

Despite the high rates of military sexual trauma (MST) experienced by service members and veterans, little is known about how contextual features of the MST event or concurrent histories of other interpersonal traumas are associated with diverse clinical presentations. This study examined contextual factors of MST events (number of perpetrators, location of MST, relationship to perpetrator, location of MST) and dual history of interpersonal traumas (including sexual abuse or assault throughout the lifespan, repeated MST, and intimate partner violence) in relation to total symptoms and symptom clusters of Posttraumatic Stress Disorder (PTSD). MST involving multiple perpetrators was related to higher avoidance and hyperarousal. MST while combat-deployed was associated with higher hyperarousal. Veterans endorsing a history of partner violence presented with higher reexperiencing and avoidance. Recognition of phenotypic differences may assist providers in treatment planning and optimizing outcomes.

Context Matters: Posttraumatic Stress Disorder Symptom Associations With Military Sexual Trauma Event Characteristics and Dual Histories of Interpersonal Trauma

Despite the high rates of military sexual trauma (MST) experienced by service members and veterans, little is known about how contextual features of the MST event or concurrent histories of other interpersonal traumas are associated with diverse clinical presentations. This study examined contextual factors of MST events (number of perpetrators, location of MST, relationship to perpetrator, location of MST) and dual history of interpersonal traumas (including sexual abuse or assault throughout the lifespan, repeated MST, and intimate partner violence) in relation to total symptoms and symptom clusters of Posttraumatic Stress Disorder (PTSD). MST involving multiple perpetrators was related to higher avoidance and hyperarousal. MST while combat-deployed was associated with higher hyperarousal. Veterans endorsing a history of partner violence presented with higher reexperiencing and avoidance. Recognition of phenotypic differences may assist providers in treatment planning and optimizing outcomes.

Military sexual trauma is associated with eating disorders, while combat exposure is not.

There are strong associations among trauma and eating disorders. However, while trauma and eating disorders are more common among veterans than other populations, there is little information on how military-specific stressors affect eating disorder risk. This study's objective was to determine whether military sexual trauma and combat exposure were independent predictors of eating disorders among women veterans, a high-risk group. Participants were women age 18-70, using VA medical center services, without psychotic disorders or suicidal ideation (N = 407). We estimated a cross-sectional logistic regression model to predict eating disorders (anorexia, bulimia, binge eating disorder) as a function of military sexual trauma and combat exposure, adjusting for demographic variables. Sixty-six percent of participants reported military sexual trauma, 32% reported combat exposure, and 15% met eating disorder criteria. Mean age was 49 years (SD = 13); 40% were veterans of color. Women reporting military sexual trauma had twice the odds of an eating disorder compared to women who did not (odds ratio [OR]: 2.03; 95% CI [1.03-3.98]). Combat exposure was not associated with eating disorders. Asian race (OR: 3.36; 95% CI [1.26-8.97]) and age (OR: 1.03; 95% CI [1.01-1.06]) were associated with eating disorders. The high rates of military sexual trauma and eating disorders highlight a need for continued work. Results suggest that it may be useful to focus on women reporting military sexual trauma when implementing eating disorder screening and treatment programs. Given associations among trauma, eating disorders, obesity, and mortality, such efforts could greatly improve veteran health. (PsycINFO Database Record

Differential impact of combat on postdeployment symptoms in female and male veterans of iraq and afghanistan.

We aimed to describe differences in combat experience for male and female veterans and characterize differential effects on postdeployment physical and mental health symptoms, including aggression. Retrospective cross-sectional health screening data from 554 Operation Enduring Freedom and Operation Iraqi Freedom veterans who enrolled for Veterans Affairs health care in San Diego were examined including measures of combat experience, pain intensity, traumatic brain injury symptoms, military sexual trauma, post-traumatic stress disorder, depression, alcohol use, and aggression. Although male veterans (n = 458) experienced significantly higher rates of combat than female veterans (n = 96), both experienced similar levels of postdeployment post-traumatic stress disorder and depression symptoms as well self-reported aggressive behavior compared to male veterans. Female veterans had higher rates of military sexual trauma and lower alcohol consumption than male veterans. All Operation Enduring Freedom and Operation Iraqi Freedom veterans returning from deployment may benefit from broad-based screening of physical and mental health symptoms, beyond those currently mandated by Veterans Affairs, including anger and aggression.

Do child abuse and maternal care interact to predict military sexual trauma?

The present research tested the hypothesis that maternal care moderates the relationship between childhood sexual abuse and subsequent military sexual trauma (MST). Measures of childhood sexual abuse, maternal care, and MST were administered to 197 Iraq and Afghanistan war veterans. After accounting for gender, age, and the main effects of maternal care and childhood sexual abuse, the maternal care x childhood sexual abuse interaction was a significant predictor of MST (odds ratio = .28, β = -1.26, 95% confidence intervals of .10, .80). As hypothesized, rates of MST were higher among veterans who reported childhood sexual abuse and low levels of maternal care (43%) compared with veterans who reported childhood sexual abuse and high levels of maternal care (11%). These findings suggest that high levels of maternal care may act as a protective factor against future revictimization among military service members. These findings have the potential to inform both prevention and intervention efforts.

Military Sexual Assault: An Ongoing and Prevalent Problem

Despite the fact that military sexual trauma (MST) is an ongoing and prevalent problem, it is a crime that is often under-reported because of biases inherent to the military machine, as well as being difficult to treat due to ineffective or inaccessible services. This article discusses the history and current prevalence rates of MST as well as possible factors contributing to the issue. Current legislation is discussed that, if passed, would help to identify current needs and bring education, prevention, treatment, and access to care to effective levels within the military.

Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

ABSTRACTBackgroundMany lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA.ObjectiveThe purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving.DesignProspective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities.ParticipantsThree hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %).Main MeasuresMeasures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction.Key ResultsLB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001).ConclusionsMany LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

A Systematic Literature Review of PTSD Among Female Veterans From 1990 to 2010

This article reviews literature over the past twenty years concerning female veterans and posttraumatic stress disorder (PTSD). The literature identified sexual trauma, pre-military sexual trauma, combat exposure, substance misuse, and gender difference in the development of PTSD among female veterans from the Gulf War to the current conflicts. Also incorporated in the review are evidence-based and other promising treatment options for female veterans suffering from PTSD. Based on the review, female veterans experience higher rates of military sexual trauma and much of the current research on female veteran related PTSD is focused on sexual trauma that occurs while in the military. As the number of females serving in the military grows, there needs to be a continued effort in understanding the multiple issues they experience before, during, and after their time in the military. Researchers need to continue to address sexual traumas, the disparity in the diagnosis of PTSD, effective treatment options, and further understand the dynamics of comorbidity of other mental health disorders with PTSD. In addition, more research needs to be conducted on how trauma and PTSD impacts family and occupational functioning for female veterans after both their return from operational deployment and completion of military service.