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: 3.47). 09/2004; 66(5):749-56. DOI: 10.1097/01.psy.0000138117.58559.7b
Source: PubMed


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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    • "The prevalence of sexual assault during military service in pre-9/11 female veterans was particularly high with almost half reporting being the victim of sexual assault during their military service. Although this is consistent with similar studies (Fontana & Rosenheck, 1998; Sadler, Booth, Cook, Torner, & Doebbeling, 2001), incidences reported in our study were higher than most of what has been reported in previous research on female veterans serving before 9/11; several studies have reported a prevalence of sexual assault in the military of approximately 23%–33% (Butterfield, McIntyre, Stechuchak, Nanda, & Bastian, 1998; Coyle, Wolan, & Van Horn, 1996; Frayne et al., 1999; Hankin et al., 1999; Sadler et al., 2004; Sadler, Booth, Nielson, & Doebbeling, Surís et al., 2004). Among our sample of post-9/11 veterans, incidents of sexual assault were consistent with those found in research focused on females who served post-9/11 (Katz, Bloor, Cojucar, & Draper, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a 6-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault. (PsycINFO Database Record
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    • "The extant research has previously delineated the negative physical health, mental health, and socioeconomic consequences associated with Vietnam era veterans living with PTSD (Schnurr, Spiro, & Paris, 2000 ; Surís, Holliday , Weitlauf, North, & the Veteran Safety Initiative Writing Collaborative, 2013a; Surís & Lind, 2008). Furthermore, PTSD within this population has been tied to significant costs of care for the Veterans Health Administration in terms of health care utilization and service connected disability (Hermes et al., 2014; Surís, Lind, Kashner, Borman, & Petty, 2004). As such, significant research has been conducted to disseminate efficacious, evidence-based treatments for PTSD within this population (Karlin et al., 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: This study examined if military sexual trauma (MST)-related posttraumatic stress disorder (PTSD) and combat-related PTSD are different in their psychiatric presentation in Vietnam era veterans. Data were utilized from two previously conducted randomized clinical trials. Thirty-eight Vietnam era veterans who experienced either a combat (n = 17) or military sexual trauma (MST; n = 21) were identified. Results indicated that survivors of both trauma types reported high depressive and PTSD symptom severity. Results of analysis of covariance did not indicate a significant difference in depressive symptomatology between groups. However, a significant difference in terms of PTSD symptom severity was found, with survivors of MST experiencing significantly greater PTSD symptomatology than survivors of combat trauma. The need for continued PTSD treatment for Vietnam era veteran survivors of trauma, as well as potential future research directions are discussed.
    No preview · Article · Jul 2015
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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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2015
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