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DHI 05-059 – HSR&D Study

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DHI 05-059
Physical and Sexual Assault in Deployed Women: Risks, Outcomes and Services
Anne G. Sadler PhD RN
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: July 2006 - September 2010

BACKGROUND/RATIONALE:
The VA faces radical changes in its delivery of health care as it becomes a major provider for women. Women are at elevated risk of trauma during military service, including sexual assault (SA) and deployment to combat areas (increasingly so in Reserve or National Guard (R/NG) populations). Unfortunately, there is limited understanding of the relationship between traumatic exposures and women's health outcomes and service use. Barriers to women's VA use are also unknown. Our prior work indicates that risk factors for intentional violence towards military women are identifiable, barriers to officially reporting gender-based violence and seeking post-trauma care exist, and that violence exposure and in-military reporting of this violence has significant, long-term health consequences.

OBJECTIVE(S):
The primary objectives of this study were to investigate antecedent risk factors for sexual assault and subsequent health consequences in R/NG servicewomen. We also sought to understand if R/NG servicemen had unique risk factors for rape during military.

METHODS:
There are two phases of data collection. Focus groups in Phase 1 of this research were the sole source of data for servicemen and for servicewomen, and were used to refine Phase 2 quantitative study questions. Phase 2 involved the identification and interview of 665 women, using random sampling with stratification by deployment status, state of service, and service branch (R/NG). For both phases, participants were selected from five states: Iowa, Illinois, Kansas, Missouri, and Nebraska. Phase 2 participants completed a computer-assisted telephone interview that assessed socio-demographic variables, trauma exposures, health history, current health status, military environmental factors, military and VA health care and barriers to this care, and self reported service-use.

FINDINGS/RESULTS:
Sexual assault (SA) is a significant health concern for R/NG servicewomen. Deployed women were not found to have an elevated risk of SA. However, SA risks associated with deployment could be characterized. Deployment to Iraq/Afghanistan (I/A) was found to have adverse health outcomes (PTSD, past year substance abuse). Deployed women acknowledged higher use of mental health care (compared to non-deployed peers) whereas sexually assaulted women reported higher use of both physical and mental health care than non-assaulted peers irrespective of deployment. The key barrier to seeking mental health care (MHC) for deployed women was fear of being blamed for their problems. Fortunately, women deployed to I/A report lower barriers to MHC than peers not deployed or deployed elsewhere. Approximately half of women who officially reported their military rape in DoD had negative experiences and endorsed more barriers to mental health care. Risk factors for male MST and subsequent barriers to care were also found to be identifiable.


IMPACT:
These findings improve our understanding of the health risks and outcomes of deployed R/NG servicewomen. Our results have implications for VA resource allocation and evidence-based interventions to address this population's specific treatment and access to care needs. Further studies are needed to evaluate existing and potentially new mental health interventions to attend to the unique needs of deployed R/NG servicewomen and of males sexually assaulted in the military. Findings also suggest that male R/NG sexually assaulted during military have identifiable gender-based violence risk factors and barriers to care.

PUBLICATIONS:

Journal Articles

  1. Cucciare MA, Mengeling MA, Han X, Torner J, Sadler AG. Associations between Augmentee Status, Deployment Stress Preparedness and Depression, Post-Traumatic Stress Disorder, and Binge Drinking in U.S. Servicewomen. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2020 Feb 18.
  2. Sadler AG, Cheney AM, Mengeling MA, Booth BM, Torner JC, Young LB. Servicemen's Perceptions of Male Sexual Assault and Barriers to Reporting During Active Component and Reserve/National Guard Military Service. Journal of interpersonal violence. 2018 Jun 1; doi: 10.1177/0886260518780407.
  3. Sadler AG, Booth BM, Torner JC, Mengeling MA. Sexual assault in the US military: A comparison of risk in deployed and non-deployed locations among Operation Enduring Freedom/Operation Iraqi Freedom active component and Reserve/National Guard servicewomen. American Journal of Industrial Medicine. 2017 Nov 1; 60(11):947-955.
  4. Sadler AG, Mengeling MA, Booth BM, O'Shea AM, Torner JC. The Relationship Between US Military Officer Leadership Behaviors and Risk of Sexual Assault of Reserve, National Guard, and Active Component Servicewomen in Nondeployed Locations. American journal of public health. 2017 Jan 1; 107(1):147-155.
  5. Cucciare MA, Sadler AG, Mengeling MA, Torner JC, Curran GM, Han X, Booth BM. Associations between deployment, military rank, and binge drinking in active duty and Reserve/National Guard US servicewomen. Drug and Alcohol Dependence. 2015 Aug 1; 153:37-42.
  6. Mengeling MA, Booth BM, Torner JC, Sadler AG. Post-sexual assault health care utilization among OEF/OIF servicewomen. Medical care. 2015 Apr 1; 53(4 Suppl 1):S136-42.
  7. Vander Weg MW, Mengeling MA, Booth BM, Torner JC, Sadler AG. Prevalence and correlates of cigarette smoking among operation Iraqi freedom-era and operation enduring freedom-era women from the Active Component military and Reserve/National Guard. Medical care. 2015 Apr 1; 53(4 Suppl 1):S55-62.
  8. Cheney A, Reisinger HS, Booth B, Mengeling M, Torner J, Sadler AG. Servicewomen’s strategies to staying safe during military service. Gender Issues. 2015 Mar 1; 32(1):1-18.
  9. Mengeling MA, Booth BM, Torner JC, Sadler AG. Reporting sexual assault in the military: who reports and why most servicewomen don't. American journal of preventive medicine. 2014 Jul 1; 47(1):17-25.
  10. Mengeling MA, Sadler AG, Torner J, Booth BM. Evolving comprehensive VA women's health care: patient characteristics, needs, and preferences. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S120-9.
  11. Walton MA, Murray R, Cunningham RM, Chermack ST, Barry KL, Booth BM, Ilgen MA, Wojnar M, Blow FC. Correlates of intimate partner violence among men and women in an inner city emergency department. Journal of addictive diseases. 2009 Oct 1; 28(4):366-81.
  12. Cunningham RM, Murray R, Walton MA, Chermack ST, Wojnar M, Wozniak P, Booth BM, Blow FC. Prevalence of past year assault among inner-city emergency department patients. Annals of Emergency Medicine. 2009 Jun 1; 53(6):814-23.e15.
HSR&D or QUERI Articles

  1. Sadler AG. Women and Post-Deployment Health. HSR&D FORUM: Translating Research into Quality Health Care for Veterans. 2011 May 1; 6.
Conference Presentations

  1. Mengeling M, Booth BM, Smith J, Torner J, Sadler AG. Veteran mental health in post deployment: Patterns of help-seeking among those with positive screens serious mental health challenges. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2015 Nov 2; Chicago, IL.
  2. Sadler AG, Mengeling M, Torner J, Cook BL, Booth BM. Does mixed-gender housing influence risk of sexual assault in deployed OEF/OIF service women? Paper presented at: American Public Health Association Annual Meeting and Exposition; 2015 Nov 2; Chicago, IL.
  3. Sadler AG, Mengeling M, Torner J, Cook BL, Booth BM. OEF/OIF Servicewomen Deployed to Combat Regions: The Impact of Sexual Assault in Military on Post-Deployment Readjustment and Social Support. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  4. Ryan GL, Reisinger HS, Booth BM, Mengeling M, Summers KM, Torner J, Sadler AG. "I Can’t Be a Mother and Be in the Military": Military-related Role Stress and Behavioral Alterations of Servicewomen. Paper presented at: VA Women's Health Research Conference; 2014 Jul 31; Arlington, VA.
  5. McClain M, Cheney A, Mengeling M, Reisinger HS, Torner J, Booth B, Sadler AG. Reporting male military sexual assault: challenges as viewed by male enlisted and officer personnel in the Reserves and National Guard. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  6. Ryan GL, Mengeling M, Booth BM, Torner J, Syrop CH, Sadler AG. The Impact of Lifetime Sexual Assault and Post-Traumatic Stress Disorder on Voluntary and Involuntary Childlessness in American Women Veterans. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2013 Nov 7; Philadelphia, PA.
  7. Mengeling M, Booth BM, Torner J, Sadler AG. Unique barriers to seeking mental health care while deployed: OEF/OIF servicewomen's perceptions and provider effects. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 6; Boston, MA.
  8. Sadler AG, Mengeling M, Torner J, Booth BM. Rape in active component and reserve/ national guard servicewomen: Deployed and non-deployed environments. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 5; Boston, MA.
  9. Mengeling M, Booth B, Torner J, Sadler AG. Deployed Servicewomen's Views and Experiences with Reportinig Sexual Assault: Focus Groups with OEF/OIF Active Component and Reserve/National Guard Servicewomen. Presented at: AcademyHealth Annual Research Meeting; 2013 Jun 25; Baltimore, MD.
  10. Mengeling M, Booth BM, Torner J, Sadler AG. OEF/OIF Servicewomen’s Perception of Seeking Mental Health Care While Deployed: Unique Barriers and Provider Effects. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
  11. Mengeling M, Sadler AG, Torner J, Barron S, Booth B. Intimate Partner Violence During Military Service and OEF/OIF Active Component and Reserve and National Guard Service Women. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
  12. McClain MP, Mengeling M, Reisinger HS, Booth BM, Torner J, Sadler AG. Cultural Barriers in Reporting Male Military Sexual Trauma in a Reserve and National Guard Deployment Context. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  13. Ryan GL, Mengeling M, Booth BM, Torner J, Syrop CH, Sadler AG. Voluntary and Involuntary Childlessness in Women Veterans - The Impact of Sexual Assault and Race. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  14. Sadler AG, Mengeling M, Torner J, Barron S, Booth BM. Deployment and Sexual Assault in Active Component and Reserve/National Guard Servicewomen. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  15. Booth BM, Cheney AM, Mengeling M, Torner J, Sadler A. Mental and Physical Health Correlates of Sex Partnership in U.S. Women Veterans. Poster session presented at: International Association for Women's Mental Health Biennial World Congress; 2013 Mar 7; Lima, Peru.
  16. Mengeling M, Sadler AG, Torner J, Booth B. Reporting In-Military Sexual Assault and Current Mental Health of OEF/OIF Active Component, Reserve, and National Guard Servicewomen. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 23; Orlando, FL.
  17. Cretzmeyer MT, Reisinger HS, Mengeling M, Booth B, Torner J, Sadler AG. In Their own Words: Service Women's Perceptions of the Role of Alcohol in Sexual Assault in the Military. Paper presented at: Women's Research and Education Institute: Women in the Military Annual Conference; 2011 Oct 28; Arlington, VA.
  18. Sadler AG, Mengeling M, Torner J, Cook BL, Booth BM. Sexual Assault in OEF/OIF Reserve/National Guard Servicewomen: Deployment Comparisons. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 13; Seattle, WA.
  19. McClain MP, Cretzmeyer MT, Young LB, Mengeling M, Reisinger HS, Torner J, Booth BM, Sadler AG. Perceptions of Male Military Sexual Trauma Victimization. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  20. Mengeling M, Sadler AG, Booth B, Torner J. Current Health Care Use by Reserve and National Guard Servicewomen with Varied Deployment and Trauma Exposures. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  21. Morcuende A, Sadler AG, Mengeling M, Torner J, Booth B. Comorbid PTSD and Borderline Personality Disorder in Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  22. Sadler AG, McClain M, Cretzmeyer MT, Young LB, Booth BM, Torner J, Reisinger HS, Mengeling M. Risk Factors for Sexual Assault in OEF/OIF Reserve and National Guard Servicemen. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  23. Mengeling M, Cretzmeyer MT, Torner J, Sadler AG, Booth BM. OEF/OIF Active Component and Reserve/National Guard Female Health Care Provider’s Barriers to Care. Poster session presented at: Women's Health Annual Congress; 2011 Apr 2; Arlington, VA.
  24. Cretzmeyer MT, Reisinger HS, Mengeling M, Sadler AG, Torner J, Booth BM. In Their own Words: Service Women’s Perceptions of the Role of Alcohol in Sexual Assault in the Military. Poster session presented at: Women's Health Annual Congress; 2011 Apr 1; Arlington, VA.
  25. Cretzmeyer MT, Mengeling M, Booth B, Torner J, Reisinger HS, Sadler AG. Similarities and Differences in Perception of Sexual Harassment and Rape by Race among Female Reserve and National Guard Service Women. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 13; Boston, MA.
  26. Mengeling M, Booth BM, Torner J, Sadler AG. Rural and Urban Women Veterans: Health Care Needs and Use of VA Care. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
  27. Sadler AG, Mengeling M, Torner J, Booth BM. Women Veterans: Combat, Sexual Assault, PTSD, and Depression in Reserve & National Guard Compared to Regular Military Members. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
  28. Torner J, Mengeling M, Booth BM, Sadler AG. Women Veterans: Head Injury Prevalence and Associated Medical Conditions Among Women. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
  29. Cretzmeyer MT, Mengeling M, Booth BM, Torner J, Sadler AG. Women Veterans: Alcohol use by Female Veterans Receiving Antidepressant Therapy. Poster session presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 28; Little Rock, AR.
  30. Mengeling M, Sadler AG, Torner J, Booth B. Type of Traumatic Exposure and the Effect on Women Veteran's Health Outcomes. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 7; Atlanta, GA.
  31. Sadler AG, Torner J, Mengeling M, Booth B, Reisinger HS. Post-deployment Adjustment and Barriers to Care for OEP/OIP Reserve and National Guard Servicewomen. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 7; Atlanta, GA.
  32. Mengeling M, Cretzmeyer MT, Booth B, Torner J, Reisinger HS, Sadler AG. Similarities in Perceived Stigma Related to Seeking Mental Health Treatment and Reporting Rape in the Military. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 6; Atlanta, GA.
  33. Sadler AG, Mengeling M, Torner J, Reisinger HS, Cretzmeyer MT, Franciscus CL, Silander AB, Booth B. Post-Deployment Adjustment and Cross-Leveling Concerns of Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Paper presented at: Department of Defense / Congressionally Directed Medical Research Programs Military Health Research Forum; 2009 Sep 1; Kansas City, MO.
  34. Cretzmeyer MT, Mengeling M, Booth B, Torner J, Reisinger HS, Silander AB, Franciscus CL, Sadler AG. Similarities in Perceived Stigma Related to Seeking Mental Health Treatment and Reporting Rape in the Military. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
  35. Booth B, Mengeling MA, Torner JC, Sadler AG. Agreement between women veteran's study interview self-report of military sexual trauma and VHA MST screening data. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  36. Mengeling MA, Booth BM, Cretzmeyer MT, Reisinger HS, Silander AB, Torner J, Franciscus CL, Sadler AG. Barriers to DVA Access for Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  37. Mengeling MA, Sadler AG, Torner J, Booth BM. The Effect on Women's Health Outcomes by Type of Trauma Exposure. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  38. Sadler AG. Effective Strategies and Realistic Expectations for Research with Military Populations: Process, University-Military IRB Interface, and Military Cultures. Paper presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  39. Sadler AG, Mengeling M, Torner J, Reisinger HS, Cretzmeyer MT, Franciscus CL, Silander AB, Booth B. Post-Deployment Adjustment Concerns of Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Paper presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  40. Syrop CH, Sadler AG, Mengeling MA, Booth BM, Torner JC. Sexual assault and women veteran's childbearing decisions. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  41. Torner JC, Sadler AG, Mengeling MA, Gillette PP, Booth BM. Head injury in women veterans. Presented at: VA HSR&D National Meeting; 2008 Feb 14; Washington, DC.
  42. Hoffman V, Mengeling MA, Booth BM, Torner JC, Sadler AG. Eating disorders, PTSD, and sexual assault histories in female gulf war and OIF/OEF veterans: worrisome associations. Presented at: VA HSR&D National Meeting; 2008 Feb 12; Washington, DC.
  43. Sadler AG, Booth BM, Mengeling MA, Gillette PA, Torner JC. Sexual assault, post-traumatic stress, and head injury in women veterans. Presented at: VA HSR&D National Meeting; 2008 Feb 12; Baltimore, MD.
  44. Vander Weg MW, Sadler AG, Mengeling MA, Booth BM, Torner JC, Rosenthal GE. Associations between post-traumatic stress disorder and substance use in female veterans. Presented at: VA HSR&D National Meeting; 2008 Feb 12; Baltimore, MD.


DRA: Military and Environmental Exposures, Health Systems
DRE: Epidemiology
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, Women - or gender differences
MeSH Terms: none

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