Booth BM (REAP, Center for Mental Health Care Outcomes and Research, Central Arkansas Veterans Health Care System, Little Rock, Arkansas), Mengeling MA
(Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VAMC and University of Iowa), Gillette PA
(Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VAMC, Iowa City, IA), Torner JC
(Darver College of Medicine, University of Iowa, Iowa City, IA)
The association among sexual assault, Post-Traumatic Stress Disorder (PTSD) and head injury has not been well studied in military women or veterans.
800 women participated in a cross sectional study of current health, and health care utilization of women with and without lifetime sexual assault exposure. Consenting women veterans seeking care from the Iowa City VAMC and clinics within the preceding 5 years ( < 51 years of age) completed a computer-assisted telephone interview assessing socio-demographic variables, rape exposures, health history and care utilization, health status, post-traumatic stress, and access to care.
Lifespan sexual assault (attempted and completed) was reported by 63% (n=507), with almost half of these women acknowledging rape during military (48%, n=243). Combat exposure was experienced by 28%. Compared to non-victimized peers, women with lifespan violence were significantly more likely to have a PTSD diagnosis (33% vs 10%, P < .01); and to acknowledge a head injury, skull fracture, or concussion (38% vs 25%,P < .01). Of those reporting head injury, 57% noted losing consciousness. Co-morbid PTSD, head injury, and sexual assault were found in 10% of participants, and of this group 59% (n=47) had experienced sexual assault in military. Women reporting all three co-morbidities were more likely to have used illegal drugs (66% v. 46%, P < .01) have been diagnosed with depression (88% v. 51%), and to be currently unemployed (66% v. 35%, P < .01).
Women reporting lifetime sexual assault are more likely to acknowledge PTSD diagnosis and head injury. Assaulted women with both PTSD and head injury demonstrate adverse health and vocational consequences.
Current screening and traditional treatments for PTSD associated with sexual assault may not be effective for victimized women with co-morbid head injury. Findings have direct implications for resource allocations for this VAMC priority population, and indicate the need for a subsequent population based study.