The Veterans’ Health Administration and Military Sexual Trauma

Citation:

Kimerling, Rachel, Kristian Gima, Mark W. Smith, Amy Street and Susan Frayne. 2007. "The Veterans’ Health Administration and Military Sexual Trauma." American Journal of Public Health 97 (12): 2160-66.

Authors: Rachel Kimerling, Kristian Gima, Mark W. Smith, Amy Street, Susan Frayne

Abstract:

We examined the utility of the Veterans Health Administration (VHA) universal screening program for military sexual violence.

Methods. We analyzed VHA administrative data for 185880 women and 4139888 men who were veteran outpatients and were treated in VHA health care settings nationwide during 2003. Results. Screening was completed for 70% of patients. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including posttraumatic stress disorder (adjusted odds ratio [AOR] = 8.83; 99% confidence interval [CI] = 8.34, 9.35 for women; AOR = 3.00; 99% CI = 2.89, 3.12 for men). Associations with medical comorbidities (e.g., chronic pulmonary disease, liver disease, and for women, weight conditions) were also observed. Significant gender differences emerged.

Conclusions. The VHA policies regarding military sexual trauma represent a uniquely comprehensive health care response to sexual trauma. Results attest to the feasibility of universal screening, which yields clinically significant information with particular relevance to mental health and behavioral health treatment. Women's health literature regarding sexual trauma will be particularly important to inform health care services for both male and female veterans.

Keywords: sexual violence, military, health

Annotation:

Quotes:

"The risk of exposure to sexual violence within the military is high. The annual incidence of experiencing sexual assault is 3% among active duty women and 1% among active duty men. Sexual coercion (e.g., quid pro quo promises of job benefits or threats of job loss) and unwanted sexual attention (e.g., touching, fondling, or threatening attempts to initiate a sexual relationship) occur at an annual rate of 8% and 27%, respectively, among women and 1 % and 5% among men." (Kimerling et al., 2160)

"To our knowledge, we are the first to study the VHA's MST program, which  provides an unparalleled opportunity to investigate the feasibility and clinical utility of screening for sexual violence and provides unique data to characterize the burden of illness associated with MST." (Kimerling et al., 2160)

"The approach to MST should therefore attend to both women and men and examine gender associated with MST as an initial step in the development of gender-specific interventions. Ours is the first examination of nationwide screening data for MST in the VHA and directly informs continued efforts to develop a gender-specific response to the health-related costs of military service and war. Specifically, we examined 3 issues: (1) whether universal screening detects a substantial population of VHA patients who report MST, (2) whether a greater burden of medical and mental illness is found among patients who screen positive for MST compared with patients who screen negative, and (3) whether the burden of illness associated with MST varies by patient gender." (Kimerling et al., 2161)

"The VHA universal screening program for MST screened over 70% of all patients, a rate commensurate with other screening-related performance measures collected by VHA in the same fiscal year: 80% for alcohol screening, 75% for tobacco counseling, and 90% for cervical cancer screening. Screening data indicate that MST is prevalent among veterans who seek VA health care, and as such, represents an important issue for VHA facilities." (Kimerling et al., 2163)

"Approximately 22% of screened veteran women reported MST, which represents 29418 patients. Sexual trauma, including MST, is often viewed as primarily a women's health issue and the proportion of positive screens among male patients is significantly lower than among women, only slightly over 1 %. However, because the majority of VHA patients are men, this prevalence results in a detected clinical population of 31 797 patients, comparable in size to the MST population of female patients." (Kimerling et al., 2163)

"The diagnosis of PTSD, however, is more common among women veterans with a military sexual trauma than among those who report other traumatic events or other sexual assaults. Furthermore, the effects of previous trauma or civilian sexual assault do not account for the strong relation observed between MST and PTSD.'" (Kimerling et al., 2164)

Topics: Combatants, Female Combatants, Male Combatants, Gender, Women, Men, Health, Mental Health, PTSD, Military Forces & Armed Groups, Militaries, Sexual Violence Regions: Americas, North America Countries: United States of America

Year: 2007

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