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2019 HSR&D/QUERI National Conference Abstract

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4147 — Cumulative sexual trauma as a barrier to care for women Veterans

Lead/Presenter: Alison Hamilton,  COIN - Los Angeles
All Authors: Tennenbaum DL (VA Greater Los Angeles Healthcare System), Schweizer, CA (VA Greater Los Angeles Healthcare System), Brunner, J (VA Greater Los Angeles Healthcare System) Oishi, SM (VA Greater Los Angeles Healthcare System) Canelo, I (VA Greater Los Angeles Healthcare System) Darling, JE (VA Greater Los Angeles Healthcare System) Yano, EM (VA Greater Los Angeles Healthcare System; University of California, Los Angeles Department of Health Policy & Management) Hamilton, AB (VA Greater Los Angeles Healthcare System; University of California, Los Angeles Department of Psychiatry and Biobehavioral Sciences)

Objectives:
Military sexual assault (MSA) is associated with worse mental and physical health, and increased healthcare utilization. Despite increased utilization, there is evidence to suggest that there may still be gaps in care. It is not known whether multiple experiences of sexual trauma further increases these gaps in care, especially when seeking care at the VA. Our objective was to examine the association between cumulative experiences of sexual assault and delaying or going without needed care among women Veterans.

Methods:
Women VA primary care users (N = 1081) completed computer-assisted telephone interviews as part of a 12 VAMC randomized controlled trial. Our outcome was "delaying, putting off, or going without" needed or recommended care in the past 12 months. Respondents were asked about unwanted sexual contact at different time points: childhood sexual assault (CSA), military sexual assault (MSA), and adult civilian sexual assault (ASA). We calculated the predicted probability of delaying or going without care for subgroups defined by unique combinations of CSA, MSA, and ASA, adjusting for sociodemographics, care utilization, experience of care, and health status.

Results:
66% of the sample experienced sexual assault during childhood, military service, and/or as a civilian adult. The adjusted predicted probability of delaying or going without care among those with no sexual assault was 26%. Those with MSA plus ASA and CSA had the highest predicted probability of delaying or going without care (49%, p < .01), followed by those with MSA alone (36%, p < .01).

Implications:
Despite contact with medical providers, women Veterans who experienced military sexual assault were more likely to delay or go without needed medical or mental health care. Cumulative sexual assault, particularly military sexual assault in combination with sexual assault at another time in life, was common and associated with increased probability of delaying or going without care.

Impacts:
Cumulative sexual assaults may intensify the need for care, while simultaneously reinforcing medical and mental health sequelae and barriers. This highlights the need for trauma-informed training and interventions within VA primary care.