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Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care.

Department of Veterans Affairs, Research Service, North Texas Health Care System, Dallas, Texas 75216, USA.
Psychosomatic Medicine (Impact Factor: 4.09). 01/2004; 66(5):749-56. DOI: 10.1097/01.psy.0000138117.58559.7b
Source: PubMed

ABSTRACT This study examines the differential impact of military, civilian adult, and childhood sexual assault on the likelihood of developing posttraumatic stress disorder (PTSD). It also examines the relationship of military sexual assault (MSA) to service utilization and health care costs among women who access services through Veterans Affairs (VA).
A convenience sample of 270 veteran women receiving medical and/or mental health treatment at the VA North Texas Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS) and categorized into a sexual assault group using the Interview of Sexual Experiences (ISE). A chart review was also conducted to determine the frequency of diagnoses among the women. Data regarding health care utilization was obtained from self-report using the Utilization and Cost Patient Questionnaire (UAC-PQ) and VA administrative records.
Compared with those without a history of sexual assault, women veterans were 9 times more likely to have PTSD if they had a history of MSA, 7 times more likely if they had childhood sexual assault (CSA) histories, and 5 times more likely if they had civilian sexual assault histories. An investigation of medical charts revealed that PTSD is diagnosed more often for women with a history of MSA than CSA. CSA was associated with a significant increase in health care utilization and cost for services, but there was no related increase in use or cost associated with MSA.
Women veterans have differential rates of PTSD due to sexual assault, with higher rates found among those assaulted while on active duty. Although women with MSA are more likely to have PTSD, results suggest that they are receiving fewer health care services.

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    • "Data regarding potential differences between military sexual trauma and sexual trauma occurring prior to military service (i. e., premilitary sexual trauma) such as child sexual abuse and/or other forms of sexual victimization during adolescence or early adulthood suggest that military sexual trauma is associated with relatively worse physical health (Suris et al., 2007) and increased rates of PTSD (Himmelfarb et al., 2006; Kimerling et al., 2010), whereas other studies have reported no differences in outcomes between military sexual trauma and premilitary sexual trauma (Suris et al., 2004). Although the relative weight of military sexual trauma vs. premilitary sexual trauma with mental health outcomes is not yet clear, military sexual trauma is clearly associated with more severe psychopathology among military personnel and veterans. "
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    ABSTRACT: Military sexual trauma is a strong predictor of psychiatric disorders and negative health outcomes among military personnel and veterans, but little is known about its relationship with suicide risk. The current study investigates the association of military sexual trauma with suicide risk among 464 U.S. military personnel and veterans enrolled in college classes. Results indicate that premilitary sexual assault was associated with significantly increased risk for later suicide ideation, plans, and attempts during military service. Unwanted sexual experiences occurring during military service was associated with significantly increased risk for suicide ideation and suicide plans for male participants. When considered simultaneously, premilitary sexual trauma showed relatively stronger associations with suicide risk among women whereas military sexual trauma showed relatively stronger associations with suicide risk among men. Results suggest differences in the relation of sexual trauma to suicide risk among male and female military personnel and veterans. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    04/2015; 227(2-3). DOI:10.1016/j.psychres.2015.01.030
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    • "Both female and male survivors of military sexual trauma are more likely to report general psychological distress, anxiety, depression, eating disorders, sexual dysfunction , sleep disturbances, alcohol dependence, drug abuse, suicidal ideation, and self-harm (Harned et al. 2002; Kimerling et al. 2007; Martin et al. 2000). Survivors of military sexual assault report greater likelihood of developing posttraumatic stress disorder (PTSD; Kang et al. 2005; Surís et al. 2004). Physiological consequences of sexual trauma include chronic health issues (Kimerling et al. 2007; Sadler et al. 2000), perceptions of health dissatisfaction (Harned et al. 2002), as well as negative physiological health in general (Martin et al. 2000). "
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    ABSTRACT: Sexual assault is an insidious problem in the United States military. In 2005 the Department of Defense (DoD) created the Sexual Assault Prevention and Response Office, which centralizes responsibility for sexual assault training. However, this training initiative has undergone little evaluation by outside researchers. Addressing this need, we analyzed responses from over 24,000 active duty personnel who completed the 2010 DoD Workplace and Gender Relations Survey. We assessed whether sexual assault training exposure (None, Minimal, Partial, or Comprehensive) predicted accurate knowledge of sexual assault resources and protocols. Using a social-ecological framework, we investigated whether institutional and individual factors influenced Service members' training exposure and judgment of training effectiveness. According to our results, exposure to comprehensive training predicted lower sexual assault incidence and superior knowledge. However, comprehensive training differed as a function of military branch, rank, gender, and sexual assault history. Judgments of training effectiveness also varied across these dimensions. Our results highlight the importance of considering context, gender, and victimization history when evaluating institutional efforts to end sexual violence. The DoD's 2010 annual report on military sexual assault concluded that "most Active Duty members receive effective training on sexual assault" (p. 104). Our results cast doubt on that assertion.
    American Journal of Community Psychology 09/2014; 54(3-4). DOI:10.1007/s10464-014-9672-0 · 1.74 Impact Factor
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    • "Further, the authors of the study note that a large segment of German older adults experienced World War II war traumas or long-term effects of the war, such as displacement from their homes. Given that different types of trauma may have different associations with health and health care use, the results from that study may not generalize to older adults in other countries [35] [36]. In addition, age and gender were the only covariates adjusted for in the analyses. "
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    ABSTRACT: Objective : Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors was prospectively associated with an increased number of doctor visits and nights spent in the hospital. Methods : Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50 + in the United States (n = 7,168). We analyzed the data using a generalized linear model with a gamma distribution and log link. Results : A higher number of potentially traumatic events and serious life stressors was associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8% increase in doctor visits after controlling for sociodemographic factors (RR = 1.08, 95% CI = 1.06-1.11; p < .001). Each additional potentially traumatic event or serious life stressor was also associated with an 18% increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR = 1.18, 95% CI = 1.10-1.27; p < .001). Conclusion : Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care.
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