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Military Sexual Trauma

Attention to women's health issues in VA has led to increased recognition and treatment resources for military-related sexual assault and harassment, referred to as Military Sexual Trauma (MST). Evaluation of these programs suggests important genderspecific health care needs for both women and men.

Beginning in 1992, public law authorized VA to provide up to one year of treatment to women veterans for psychological trauma resulting from "physical assault of a sexual nature, battery of a sexual nature, or sexual harassment" occurring during military service. Sexual harassment was defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character." Since then, a series of public laws and VA directives reflected the growing knowledge that these issues, referred to by VA as 'military sexual trauma' affect both women and men and are associated with lasting health consequences. VA has now implemented training for all staff, universal screening, and unlimited care for all MST related conditions for all veteran patients.

Screening Uncovers Mental Health, Chronic Conditions

In FY 2007, 22.2 percent of females and 1.3 percent of males seen in VA outpatient care reported MST when screened.¹ Because VA patients are predominantly male, the size of each clinical population that reports MST is actually similar: 45,570 women and 47,764 men. Screening is important in the detection of MST because individuals seldom disclose such stigmatizing experiences unless asked. Standardized universal screening frames this as a mainstream health care issue, which helps many veterans cope with feelings of isolation and self-blame.

Researchers at the Center for Health Care Evaluation and the National Center for PTSD examined the gender-specific burden of illness associated with positive MST screens in an effort to guide the health care services authorized for MST-related conditions.² The study found that MST was associated with a broad range of mental health conditions. Diagnoses of PTSD, other anxiety disorders, and alcohol use disorders were overrepresented among all patients with MST, but effect sizes were significantly stronger for women than men. In contrast, effects for adjustment disorders were significantly stronger among men compared to women.

While fewer associations with physical health conditions were observed, a number of behaviorally-linked chronic medical conditions, such as liver disease and pulmonary disease, were associated with MST for both men and women. Associations of obesity and hypothyroidism were unique to women and an association of MST with HIV/AIDS was unique to men. MST screening, therefore, detects a significant burden of illness and calls for a genderspecific approach to treatment

MST Screening Promotes Use of Mental Health Services

Since MST was most strongly associated with mental health conditions, a key outcome by which to evaluate universal screening is utilization of mental health treatment. We compared utilization before and after screening, to assess whether patients with positive screens were more likely to initiate or continue mental health treatment. We found that the majority of patients who reported MST had not received mental health treatment prior to screening. However, for both women and men, a positive MST screen was associated with a significantly increased likelihood of post-screen mental health care, as compared to patients with negative screens. We found that one additional patient receives mental health care for every five women and seven men with positive MST screens. While screening appears to be somewhat more effective in promoting treatment for women as compared to men, these low numbers indicate that universal screening is an efficient way to help both women and men with MST access mental health care.³

MST Care for the Newest Generation of Veterans

Treatment of MST among OEF/OIF veterans presents new challenges for VA providers. We will be able to detect and treat sexual trauma more closely following separation from military service, allowing new opportunities to prevent potentially chronic health and mental health consequences. Access to mental health care should be a key focus, especially with VA's dissemination of evidence-based treatments for PTSD, which have demonstrated effectiveness for sexual trauma. Coupled with the younger age of these patients, we may also need research into broader foci of treatment, such as preventing revictimization and treating reproductive health issues among women. VA has implemented one of the most comprehensive programs to detect and treat interpersonal violence of any health care setting. Continued focus in this area will help to provide a strong basis for treating the full range of deployment-related stressors among OEF/OIF veterans in VA care.

References

1. Military Sexual Trauma Support Team. Military Sexual Trauma Screening Report: Fiscal Year 2006. Washington, DC: Department of Veterans Affairs, Office of Mental Health Services, MST Support Team; 2007.
2. Kimerling R, et al. The Veterans Health Administration and Military Sexual Trauma, American Journal of Public Health 2007; 97:2160-6.
3. Kimerling R, et al. Evaluation of Universal Screening for Military-Related Sexual Trauma. Psychiatric Services 2008; 59:635-40.