Abstract

Background: Military sexual trauma (MST) is associated with significant morbidity – including PTSD and depression, substance use, suicide, and medical comorbidities – yet men who have experienced MST are known to underutilize treatment. Gender-based stigma and shame, distrust of the VA, and the debilitating impact of trauma likely all contribute to treatment underutilization among men MST survivors. Gender-tailored care for this population holds the potential for earlier and more sustained engagement in care. The Men’s MST Group (MMG) was developed and delivered by the applicant with this prospect in mind. In this study, a synthesis of Intervention Mapping and the Access Re-conceptualization Model will guide the process of refining, testing, and evaluating MMG, which has shown promise in engaging Veterans, promoting recovery, and reducing trauma symptoms. Significance/Impact: Approximately 3.5% of Veteran men (and 44% of Veteran women) report a history of MST, yet the absolute number of men who report MST (55,500 from 2004- 2013) is relatively similar due to the larger proportion of men in the military. Due to its association with numerous deleterious health impacts, MST remains one of the VA’s highest commitments, yet health services research on men’s MST is limited. Moreover, despite the role of gender-based shame contributing to underutilization of treatment, and despite evidence that gender-tailored treatment approaches enhance engagement and outcomes, current MST best practices are not gender-tailored. Innovation: This study is the first known effort to refine and test an intervention tailored to men MST survivors, and to measure access, engagement, and mental health recovery-oriented outcomes among this population. This study: 1) addresses a critical gap in research on men MST survivors, 2) focuses on improving treatment access and engagement through refining an innovative, recovery-oriented, and gender-tailored group therapy (MMG) developed specifically for men MST survivors, and 3) assesses and enhances the intervention from a system-level perspective. Specific Aims: Building on promising pilot data, the Specific Aims are to: 1) revise the MMG protocol, with attention to factors that support men’s access to, and engagement and retention in, mental health interventions; 2) test MMG in a pilot randomized controlled trial (RCT) and explore men’s engagement and recovery-oriented and psychological outcomes; 3) understand process and treatment engagement factors and strategies for implementation, and prepare for a multisite trial. Merit proposals will be submitted in Year 3 to conduct a national mixed methods study of men’s MST treatment approaches in the VA, and in Year 5 to conduct a multisite trial of MMG. Methodology: Aim 1: conduct semi-structured interviews with MST-focused clinicians and researchers (n=24), two focus groups with two recent MMG cohorts (n=8), and convene an MST Expert Panel. Aim 2: randomize men MST survivors (n=32) to MMG or Present-Centered Group Therapy at an outpatient mental health clinic, collecting baseline, post-, and 6-month quantitative data, assessing engagement as well as recovery measures (primary) and psychological symptoms (secondary). Aim 3: conduct qualitative interviews with pilot RCT participants and interventionists to assess process outcomes, return to the Aim 1 Expert Panel, and collaborate with operations partners to refine the protocol with system-level considerations. Aims 1 and 3 qualitative data will be analyzed using rapid qualitative analysis and thematic analysis. Aim 2 quantitative data will be analyzed using a linear mixed model. An integrated mixed methods analysis will examine potential convergence of clinical and process outcomes. Next Steps/Implementation: This study was strategically designed to engage key stakeholders, particularly Veteran men, throughout, and results of this study will be shared with VA leaders in MST, mental health leaders, and Veterans. If outcomes are achieved, next steps will include testing the intervention in a multisite trial, with the long-term goal of system-wide implementation to expand appropriate gender-tailored health services for men with MST histories.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/10998293


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