Study Suggests Rape and Sex Partnership Adversely Associated with Lower Physical Functioning in Women Veterans

BACKGROUND:
There is evidence that women who are exposed to sexual assault across their lifetime have greater psychological difficulties, poorer physical health, and/or poorer health perceptions compared to those without these traumatic experiences. Veterans report high rates of sexual assault during childhood, and 11%-48% report sexual assault or military sexual trauma during their military service. VA defines military sexual trauma to include harassment as well as assault, and this study used the more specific term "rape in military" (RIM). Further, although poor physical health consequences have been reported among sexual minority groups (i.e., same sex partners), little is known about whether sex partnership with women places women Veterans at risk for poor physical health outcomes, and whether this risk persists when adjusting for RIM and mental health problems. This retrospective study sought to determine whether current physical health status in women Veterans is associated with RIM and same-sex partnering. Using data from computer-assisted telephone interviews with 995 women Veterans (ages < 51) living in the Midwest (88% used VA healthcare), investigators assessed information on rape history, including RIM; sex partnership history; demographics; medical history, including chronic pain and mental health (depression and PTSD); as well as the physical component of the Short Form (SF)-12. Participants were reimbursed $30 for their participation in this study, and were enrolled from 7/05 through 8/08.

FINDINGS:

• Women Veterans who reported a history of rape (during childhood or adolescence, in-military or post-military) and those with same-sex sexual partners at some point in their lives had significantly lower current physical health status compared to women without such histories.
• Of the participants in the study, 11% reported having women as sex partners (WSW). Women with same-sex partners reported significantly higher lifetime substance use disorder (SUD) and higher rates of rape, both lifetime and in separate time periods, compared to women who reported having sex with men exclusively. Three-quarters (74%) of WSW reported lifetime rape and one-third (35%) reported RIM compared to 48% and 23% in women with men as partners only.
• Physical health status was lowest for women with a history of chronic pain (12 points lower on average). Other factors significantly associated with lower physical health status were depression, PTSD, and not having a current SUD.

LIMITATIONS:

• Data were collected retrospectively, introducing the possibility of biased recall, especially for events in childhood and adolesence.
• This is a cross-sectional study and causal relationships should not be inferred.
• This study classified WSW as those who reported women only as well as both men and women as sex partners at some point. Pooling these two measures may have blurred some distinctions, but with a combined frequency of 11%, separating them would have reduced power for analysis.

NOTE:
Since this study began, VA has actively addressed programs of care specific to gay, lesbian and transgender (GLBT) Veterans. Military Sexual Trauma (MST) screening and programs of care continue to be in place.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (NRI 04-194). Drs. Booth and Cheney are part of HSR&D Center for Mental Healthcare and Outcomes Research, North Little Rock, AR. Drs. Mengeling and Sadler are part of HSR&D Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City.

Booth B, Davis T, Cheney A, Mengeling M, Torner J, and Sadler A. Physical Health Status of Women Veterans: Contributions of Sex Partnership and In-Military Rape. Psychosomatic Medicine October 15, 2012;e-pub ahead of print.