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2023 HSR&D/QUERI National Conference Abstract

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4115 — Factors associated with military sexual trauma (MST) disclosure during VA screening among women Veterans

Lead/Presenter: Anita Hargrave,  San Francisco VA Medical Center
All Authors: Hargrave AS (University of California San Francisco; San Francisco VA Medical Center starting August 2022), Danan ER (Minneapolis VA Medical Center) Than CT (Department of Veterans Affairs Greater Los Angeles) Gibson CJ (San Francisco VA Medical Center) Yano EM (Department of Veterans Affairs Greater Los Angeles)

Objectives:
Approximately 33% of women Veterans disclose past military sexual trauma (MST) during Veteran Health Administration (VA) screening. However, up to 70% of women Veterans report MST in research surveys, suggesting that a significant proportion of MST experiences are not captured by VA screening. Veterans with a positive MST screen qualify for free treatment and resources for MST-related health conditions. Identifying Veterans who experienced MST but are missed by current VA screening is critical for health equity and access to treatment services in the VA. We aim to identify sociodemographic characteristics, MST screening methods, and VA experiences associated with nondisclosure of MST during VA screening among women Veterans who report MST in a research survey.

Methods:
We collected cross-sectional telephone surveys with women Veterans at 12 VA medical centers in 9 states during 2015. The survey asked about MST experiences using standard VA screening language to describe harassment and assault during military service. Survey measures of VA experiences included feeling safe in the VA, experiencing stranger harassment at a VA facility, and feeling comfortable disclosing emotional issues to VA providers. Surveys captured sociodemographic and health information. Most (93%) of participants consented to link survey and VA electronic health record (EHR) data, including EHR-documented MST responses from routine VA screening and information on screening methods such as frequency of and time since screening. We compared survey MST and EHR-documented MST responses, and categorized Veterans into “no MST” (no survey or EHR-documented MST), “captured” (both survey and EHR-documented MST), and “missed” (survey MST but no EHR-documented MST). We used stepped multivariable logistic regression to examine associations between sociodemographic characteristics, VA experiences, screening methods, and “missed” MST.

Results:
In this sample of 1,287 women Veterans (mean age 50, SD 15), 35% had EHR-documented MST and 61% had a positive MST survey response. Approximately 38% had “no MST,” 34% “captured,” 27% “missed,” and 1% documented by EHR but not reported by survey. In fully adjusted models of women who ever reported MST (“captured” and “missed”), Black and Latina women had higher odds of being missed by VA screening compared to white peers (Black: aOR 1.6 95% CI 1.2-2.2; Latina: aOR 1.9, 95% CI 1.0-3.6). Women who endorsed only military sexual harassment in the research survey (vs. sexual harassment and/or sexual assault) had ~5-fold higher odds of being missed (aOR 4.9, 95% CI 3.2-7.3). Women who were screened for MST more than once in the VA had lower odds of being missed (aOR 0.3 95% CI 0.2-0.4).

Implications:
VA screening for MST failed to capture at least a quarter of women who experienced MST and may disproportionately miss patients from historically minoritized ethnic and racial groups, potentially creating inequitable access to VA resources.

Impacts:
Future efforts to mitigate screening disparities may include educating patients and staff that military sexual harassment qualifies as MST and rescreening patients who do not initially report MST. Advancing health equity within the VA requires increased attention to the needs and preferences of BIPOC women Veterans during VA screening for MST.