Military sexual trauma (MST) is the term that VA uses when referring to sexual assault or repeated, threatening sexual harassment that occurred while a Veteran was in the military. Both men and women have experienced MST during their service. Data from VA's national screening program indicates that about 1 in 4 women and 1 in 100 men have experienced MST, keeping in mind that this reflects only the rate of MST among Veterans who have chosen to seek VA healthcare - and to report MST.1 Intimate partner violence (IPV) includes physical attacks, sexual assault or coercion, threats of violence, verbal assaults, and stalking by a current or former intimate partner, and also is a serious public health challenge. Approximately 29% of women and 10% of men in the U.S. have experienced rape, physical violence, and/or stalking by an intimate partner, and research suggests that IPV is common in women Veterans, particularly those who access VA healthcare services.2
Military sexual trauma can result in both mental and physical illness, including: PTSD, depression, substance abuse, as well as higher rates of headaches, gastrointestinal difficulties, sexual dysfunction, chronic pain, and chronic fatigue.1 Therefore, it is important for MST to be diagnosed and treated early.
Following are descriptions of just a few select studies that HSR&D and QUERI investigators conduct on research to improve prevention of and treatment for sexual assault.
This study sought to identify factors associated with officially reporting sexual assault while in-military (SAIM), examining demographic, military, and sexual assault characteristics, as well as perceptions and experiences of reporting. Investigators identified a Midwestern community sample of active component (n=674) and Reserve and National Guard (n=665) servicewomen. Interviews were conducted from 3/10 through 12/11, and data were analyzed in 2013. Participants in this study were provided with definitions of restricted (law enforcement is not informed, nor does the command structure become involved) and unrestricted (law enforcement and the command structure are notified, and a criminal investigation is initiated) reporting before being asked about their use of either option. Findings show:
Until SAIM can be prevented, addressing reporting outcomes (e.g., ensuring confidentiality, preventing reprisal, investigating offenders) is needed for service members to believe that reporting is in their best interest and that of the larger military community.
Mengeling M, Booth B, Tomer J, and Sadler A. Reporting sexual assault in the military: Who reports and why most servicewomen don't. American Journal of Preventive Medicine. July 2014;47(1):17-25.
This study, partly funded by HSR&D, sought to provide an overview of the risk and impact of experiencing intimate partner violence (IPV) among women Veterans, who currently make up 10% of the Veteran population, and who appear particularly likely to report IPV (research has shown prevalence ranges from 24% to 29% of past-year IPV). Investigators also examined evidence-based treatment for IPV and identified future priorities for research and clinical programming. Findings show:
Recently, both the U.S. Preventive Services Task Force and the Institute of Medicine issued recommendations supporting the screening and identification of women at risk for IPV. Since publication, VA has implemented a national Domestic Violence/Intimate Partner Violence Assistance program which recommends universal screening of reproductive aged women using the five-item E-HITS (Extended Hurt/Insult/Threaten/Scream) tool. Recent VA research has established the clinical utility of the E-HITS in a sample of women VA patients.
Gerber MR, Iverson KM, Dichter ME, et al. Women Veterans and intimate partner violence: Current state of knowledge and future directions. Journal of Women's Health. April 2014;23(4):302-309.
Studies have shown that intimate partner violence (IPV) victimization is associated with a variety of health conditions, including mental health problems, as well as greater healthcare utilization, yet little is known about the IPV experiences of contemporary women Veterans. This study sought to fill gaps in knowledge by examining demographic and clinical characteristics of women Veterans who have disclosed IPV victimization to a VA healthcare provider. Investigators conducted a five-year retrospective chart review (2005-2009) of women Veterans age 55 and younger (n=531) who had received primary care at one VAMC in 2009. Findings show:
Study findings, coupled with the redesign of VA clinical practice through Patient Aligned Care Teams and a focus on gender-specific care, suggest that it may be an optimal time to establish a comprehensive IPV assessment and response program within the VA healthcare system.
Dichter M and Marcus S. Intimate partner violence victimization among women Veterans: Health, healthcare service use, and opportunities for intervention. Military Behavioral Health. October 2013;1(2):107-113.
Partly funded by HSR&D, this study sought to identify specific health status and health risk behaviors associated with sexual intimate partner violence (IPV) among women Veterans. Based on data collected through interviews with 249 women Veterans who received VA healthcare, investigators found that among those who reported experiencing sexual IPV: 58% reported a diagnosis of PTSD; 81% reported a diagnosis of depression, bipolar disorder, or anxiety; 79% reported difficulty sleeping; 71% reported chronic pain; 45% reported smoking cigarettes; and 27% reported problem drinking. Controlling for age, race, and income, compared with those who reported no IPV experience, those who reported sexual IPV were 3.07 times more likely to report poor or fair overall health; 2.85 times more likely to report a PTSD diagnosis; 2.82 times more likely to report a diagnosis of depression, bipolar disorder, or anxiety; 2.52 times more likely to report difficulty sleeping, 3.15 times more likely to report smoking cigarettes; and 3.84 times more likely to report problem drinking.
Dichter M, Marcus S, Wagner C, and Bonomi A. Associations between psychological, physical, and sexual intimate partner violence and health outcomes among women Veteran VA patients Social Work in Mental Health. January 2015;12:5-6.
This HSR&D pilot study sought to establish the feasibility of conducting a study of a trauma-sensitive yoga intervention in women Veterans with PTSD who experienced military sexual trauma (MST). Specifically, investigators sought to assess the feasibility of recruitment, retention, and intervention implementation - and to determine the viability of obtaining biological and psycho-physiological data as outcomes for yoga and PTSD research in this population. Two cohorts of women Veterans seeking MST-related PTSD treatment in a VA medical center were randomized to a 10-week trauma-sensitive yoga intervention (n=17) or a 12-week Cognitive-Processing Therapy-Cognitive (CPT-C) intervention (n=25). Data were collected at baseline, mid-intervention, 2-weeks post-intervention, and 3-months post-intervention. Findings show:
Results support the design of a larger study to evaluate the effectiveness of trauma-sensitive yoga in reducing PTSD and depression symptoms, chronic pain, and biological and physiological stress in women Veterans who experienced MST. Trauma-sensitive yoga may be an effective alternative or adjunct to current first-line PTSD treatment (i.e. CPT) that could be implemented in VA nationally.