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Sexual Assault Prevalence Among Male, PTSD-Disabled Gulf War Veterans
Maureen Murdoch, MD MPH
Minneapolis VA Health Care System, Minneapolis, MN
Funding Period: September 2006 - August 2009
In an earlier study of former PTSD disability applicants, 13% of male Gulf War era veterans said they had been sexually assaulted while in the military; 5% had been sexually assaulted since leaving the service. These rates were almost 13 times higher than the lifetime prevalence reported by male civilians and 5 times higher than the prevalence reported by other male wartime veterans in the study. However, findings were limited by the small number of Gulf War era men studied (n = 60).
Our objective was to replicate or refute these earlier findings using a larger, more representative sample. Additional objectives included evaluating the effectiveness and efficacy of the VA's mandated sexual assault screening program in these men, identifying factors that facilitated or impeded such screening, and identifying risk or protective factors associated with experiencing military sexual assault (MSA).
We mailed a well-validated, cross-sectional survey to 2,653 male Gulf War era veterans who applied for PTSD disability benefits between 1990 and 2007. We used a rich sampling frame supplemented with VA administrative data to ascertain and adjust for non-response bias.
1,910 veterans returned surveys (71.9%), of which 1,827 (68.9%) were usable. Using complete-case analysis, 5.9% of participants reported MSA. Using multiple imputation and propensity methods to account for randomly missing values or survey non-response, the estimated rate of MSA was 7.1%. Using VA administrative data to account for non-ignorable MSA data not missing at random yielded an estimated MSA rate of 18.0%. Just 15% of respondents remembered being screened for MSA. Of those reporting MSA, 40% said they needed treatment for MSA, and just 17% said they had received treatment.
Individual vulnerability factors associated with MSA included reporting more childhood neglect; there was a trend toward having lower perceived self-efficacy. Military organizational factors associated with MSA included working in units that tolerated sexual harassment or where people challenged one's sexual identity. Few factors predicted MSA screening rates. Among those reporting MSA, predictors of receiving treatment included being willing to disclose a history of MSA, higher childhood neglect scores and having been sexually assaulted after leaving the service. Men who were screened by the VA for military sexual trauma had almost 10-fold higher odds of saying they had received treatment for MSA than their unscreened counterparts.
The extraordinarily high rate of MSA in this sample must take into account the fact that we sampled from a highly traumatized population. Nonetheless, findings show that MSA is underdetected and undertreated in this population. Increasing clinician awareness of the generally high rates of MSA in male veterans may promote improved screening and treatment. The discrepancy between MSA rates based on complete-case analysis versus analyses that accounted for non-random, missing MSA data indicate that many men with MSA experiences opt out of survey research. Thus, it seems likely that most survey estimates of MSA will underestimate the actual prevalence. Researchers should seek alternative data sources to adjust for non-response biases.
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DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational
Keywords: Gulf War I, PTSD, Sexual abuse
MeSH Terms: none