Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3029 — MST Screening and Associated Medical and Mental Health Conditions

Kimerling R (VA Palo Alto HCS) , Gima K (VA Palo Alto HCS), Smith M (VA Palo Alto HCS), Street A (VA Boston HCS), Frayne S (VA Palo Alto HCS)

Public Laws and VA Directives have implemented universal screening for Military Sexual Trauma (MST) and made treatment a permanent VA benefit. Our objective was to determine the prevalence of MST in VA as indicated by positive screens, and examine the association with medical and mental health diagnoses in order to determine the treatment needs of MST-exposed men and women.

We identified 4,139,888 male and 185,880 female veteran outpatients eligible for screening in FY2003. MST Screening data was matched against the National Patient Care Database to determine screening rates and prevalence. Medical and Mental Health comorbidity categories were calculated using AHRQ software to group ICD-9 codes into validated and non-overlapping categories. Adjusted odds ratios and 99% confidence intervals were calculated to determine the association of MST to medical and mental health conditions. All analyses were stratified by gender.

Screening was completed for 70% of patients; 22% of women and 1% of men reported MST. Positive screens were associated with greater odds of virtually all categories of mental health comorbidities, including PTSD (AOR = 8.83 [99% CI = 8.34 - 9.35] for women; AOR= 3.00 [2.89 – 3.12] for men). Medical conditions also showed significant, but weaker, associations with MST. Significant gender differences emerged.

MST screening occurs at a rate commensurate with many other VA screening-related performance measures, and both men and women who screen positive may have significant treatment needs. MST-related treatment is most likely to be associated with mental health conditions, though many medical conditions may be related to some extent to MST.

While MST screening is mandatory for all VA patients, more research is needed to maximize the clinical utility of this screening program. Mental health services, particularly trauma related services, could be key treatment resources for patients who screen positive for MST. It is particularly important for MST-related services to be tailored according to gender to meet the specific needs of both men and women.