Sexual Assault of Women in the U.S. Military – Population-based Prevalence and Health Consequences from the National Survey of Women Veterans

Washington DL, Kimerling R, Yano EM. Sexual Assault of Women in the U.S. Military – Population-based Prevalence and Health Consequences from the National Survey of Women Veterans. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.

Related HSR&D Project(s)

• SDR 08-270 – Assessment of the Health Care Needs and Barriers to VA Use Experienced by Women
• SDR 12-196 – The VA Women's Overall Mental Health Assessment of Needs (WOMAN)
• RCS 05-195 – Research Career Scientist Award

Objectives: Though sexual assault and harassment of women in the U.S. military (military sexual trauma [MST]) has been the subject of much research, these studies have primarily been conducted among Department of Veterans Affairs (VA) healthcare users or among women Veterans (WVs) of selected military service eras. National population-based estimates of MST and its health consequences are lacking. Our objectives were to determine the national prevalence of MST among WVs, overall and by military service era, and to determine the proportion of post-traumatic stress disorder (PTSD) attributable to MST. Methods: We conducted the National Survey of Women Veterans in 2008-09, enrolling a population-based stratified random sample of WV VA users and nonusers from all military service eras. Experiences of unwanted sexual attention (harassment) and forced sexual relations (rape) during military service were assessed using the VA 2-item MST screen; any positive response indicated a positive screen. We also assessed combat exposure, and administered a validated PTSD screen. We used Poisson regression with robust error variance to estimate the relative risk (RR) for PTSD, then calculated population attributable fraction of PTSD from MST, adjusting for combat exposure, military service era, and demographic characteristics. Results: Overall, 10.0% of WVs had been sexually assaulted during military service (WWII 1.5%; Korea/Vietnam 10.0%; Persian Gulf War [GW] 11.2%; Operations Enduring and Iraqi Freedom [OEF/OIF] 8.7%; p < 0.001). Sexual harassment without assault occurred in 33.7% (WWII 11.3%; Korea/Vietnam 31.9%; GW 37.9%; OEF/OIF 41.3%; p = 0.00201). Adjusted RR for PTSD was highest from sexual assault (RR = 7.3, 95% C.I., 4.0-13.1), followed by sexual harassment-alone (RR = 1.7,0.9-3.2), and combat (RR = 1.4, 0.9-2.1). The percent of PTSD attributable to sexual assault, harassment-alone, and combat was 37.1%, 11.4%, and 7.7%, respectively. The overall population-attributable fraction of PTSD from MST was 48.5%. Conclusions: Among women, MST exposure is associated with 6-times the amount of PTSD as combat exposure. The prevalence of MST has not decreased significantly over time. Impacts: Nearly half of PTSD cases among women Veterans would be prevented if MST was eliminated. Though VA provides universal MST and PTSD screening and treatment, MST primary prevention efforts during military service should be at the forefront.