Military Sexual Assault:
Prevalence and Associated Health
Conditions
Donna L. Washington, MD, MPH
Women’s Health Focused R...
Disclosures & Disclaimers
u No conflicts of interest
u The views expressed in this talk are
solely mine, and do not necess...
Overview
u Military Sexual Trauma (MST) defined
u Prevalence
u Risk factors
u Mental health diagnoses associated
with MST
...
What is Military Sexual Trauma (MST)?
u Term VHA uses for sexual assault or sexual
harassment occurring during military se...
VHA MST Screening Questions
While you were in the military . . .
u Did you ever receive uninvited or unwanted
sexual atten...
How common is MST?
It depends – it varies by:
u Method of assessment
u Definition used
u Type of sample
6
Prevalence of MST
u 0.4% to 71% using in-person interviews
― 0.4% from open-ended question, “In what ways
were you treated...
How common is MST?
It depends – it varies by:
u Method of assessment
u Definition used
― Varies greatly across studies, ra...
It depends – it varies by:
u Method of assessment
u Definition used
u Type of sample
― Research: National Survey of Women
...
Gender Differences in MST
Prevalence among VHA Users
10
Women Men
% of All Veteran VHA users with a
positive MST screen*
(...
Risk Factors for MST
u Younger age upon military entry
(age 19 or younger)
― 49% reported escape from home
environment as ...
How Can MST Affect Veterans?
u MST is an experience, not a diagnosis or
a mental health condition
u Veterans can have a va...
Mental Health Diagnoses
Commonly Associated with MST*
u PTSD
u Major Depression
u Mania/Bipolar Disorders
u Schizophrenia ...
Mental Health Issues Associated
with Sexual Assault in Men
u Scant research specifically addresses
MST in Male Veterans
u ...
Physical Health Consequences
Associated with MST
u Cardiovascular risk factors (obesity, smoking,
alcohol use) and behavio...
Sources: Washington DL, et.al. JHCPU. 2010; 21: 81-91.
McCutcheon SJ, Pavao J. Summit 2011 National Training Summit on Wom...
Association between MST and
Vulnerability for Homelessness
MST confers
4-fold increased
risk for
homelessness
Source: Wash...
Take-Home Points
u MST prevalence varies across groups
and settings: higher prevalence in
women; absolute number affected ...
19
Focus Group Quotes
u “Part of the reason that I went into the military
was to be like a safe haven for me. And then
after ...
Focus Group Quotes
u “I wanted a career to make something of myself – to
put the 20 years in and retire out. And it didn’t...
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Washington donna

  1. 1. Military Sexual Assault: Prevalence and Associated Health Conditions Donna L. Washington, MD, MPH Women’s Health Focused Research Area Lead, VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy Professor of Medicine, UCLA UCLA Bixby Center, Symposium on Military Sexual Assault Los Angeles, CA — May 29, 2014 1
  2. 2. Disclosures & Disclaimers u No conflicts of interest u The views expressed in this talk are solely mine, and do not necessarily represent the Department of Veterans Affairs or the U.S. Government 2
  3. 3. Overview u Military Sexual Trauma (MST) defined u Prevalence u Risk factors u Mental health diagnoses associated with MST u Medical issues associated with MST 3
  4. 4. What is Military Sexual Trauma (MST)? u Term VHA uses for sexual assault or sexual harassment occurring during military service u VHA’s definition of MST comes from Public Law “Psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment [“repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character”] that occurred while a Veteran was serving on active duty or active duty for training.” 4 Title 38 US Code 1720D
  5. 5. VHA MST Screening Questions While you were in the military . . . u Did you ever receive uninvited or unwanted sexual attention (e.g., touching, cornering, pressure for sexual favors, or inappropriate verbal remarks)? u Did anyone ever use force or the threat of force to have sex with you against your will? Veterans who respond positively to either item are considered to have a positive screen for MST 5
  6. 6. How common is MST? It depends – it varies by: u Method of assessment u Definition used u Type of sample 6
  7. 7. Prevalence of MST u 0.4% to 71% using in-person interviews ― 0.4% from open-ended question, “In what ways were you treated badly?” ― 71% from sample seeking VA benefits for PTSD u 17% to 30% using mail or phone surveys u Lower rates in earlier era of Veterans u Overall, most studies report rates ranging from 20% to 43% 7 Source: Suris A, Lind L. Trauma Violence Abuse 2008; 9:250-269.
  8. 8. How common is MST? It depends – it varies by: u Method of assessment u Definition used ― Varies greatly across studies, ranging from no definition given (i.e., open-ended) to completed +/- attempted rape ― Therefore different constructs measured; accounts for different prevalence rates u Type of sample 8
  9. 9. It depends – it varies by: u Method of assessment u Definition used u Type of sample ― Research: National Survey of Women Veterans: 43% of PTSD(+)’s, 5% of (-)’s ― Clinical: varies ― Benefits seeking: higher 9 How common is MST? Source: Washington DL, et.al. J Gen Intern Med. 2013; 28: 894-900.
  10. 10. Gender Differences in MST Prevalence among VHA Users 10 Women Men % of All Veteran VHA users with a positive MST screen* (VHA MST Screening Data FY2010) 22.4% 1.2% % of civilians in U.S. general population who experienced attempted or completed rape** (Nat’l Violence Against Women Survey) 16.7% 3.0% *Rates usually based on 2-6 year time period; **lifetime *Though higher proportion women experience MST, absolute numbers of women and men are similar
  11. 11. Risk Factors for MST u Younger age upon military entry (age 19 or younger) ― 49% reported escape from home environment as main reason for military entry u Enlisted rank u Not a college graduate u Childhood sexual assault history 11 Source: Sadler AG, et.al. American J Industrial Medicine. 2003; 43:262-73.
  12. 12. How Can MST Affect Veterans? u MST is an experience, not a diagnosis or a mental health condition u Veterans can have a variety of reactions in response u Type, severity, and duration of these reactions will vary based on prior trauma history, types of responses from others at the time of the MST, frequency of MST (e.g., once vs. repeated) 12
  13. 13. Mental Health Diagnoses Commonly Associated with MST* u PTSD u Major Depression u Mania/Bipolar Disorders u Schizophrenia and Psychoses u Somatization Disorders 13 *Most studies were conducted in women Source: Suris A, Lind L. Trauma Violence Abuse 2008; 9:250-269. u Substance Abuse u Eating Disorders
  14. 14. Mental Health Issues Associated with Sexual Assault in Men u Scant research specifically addresses MST in Male Veterans u Men with sexual assault history more likely than Women to report subsequent alcohol abuse u Suicide and self-harm also higher in men with sexual assault experience compared with women 14
  15. 15. Physical Health Consequences Associated with MST u Cardiovascular risk factors (obesity, smoking, alcohol use) and behaviorally linked conditions (liver disease, pulmonary disease) u Sexually transmitted infection and sexual dysfunction disorders u Physical symptoms including pelvic pain, menstrual problems, back pain, headaches, gastrointestinal symptoms, chronic fatigue u Poorer overall health status 15 Sources: Kimerling R, et.al. AJPH 2007. 97:2160-6. Frayne S, et.al. Violence and Victims. 2003;18:219-25.
  16. 16. Sources: Washington DL, et.al. JHCPU. 2010; 21: 81-91. McCutcheon SJ, Pavao J. Summit 2011 National Training Summit on Women Veterans. Available at: http://www.va.gov/WOMENVET/2011Summit/Breakout- ResourcesforMSTSurvivors2011.pdf Other Issues Associated with MST u Relationship problems u Impact on parenting u Employment problems u Adjustment issues u Spirituality issues / crisis of faith u Homelessness 16
  17. 17. Association between MST and Vulnerability for Homelessness MST confers 4-fold increased risk for homelessness Source: Washington DL, et.al. JHCPU. 2010; 21: 81-91. 17
  18. 18. Take-Home Points u MST prevalence varies across groups and settings: higher prevalence in women; absolute number affected similar in men and women (VHA statistics) u Multiple mental health, physical health, and psychosocial sequellae u Amount of MST-related care required by each Veteran will vary due to the wide range of associated clinical conditions and their severity 18
  19. 19. 19
  20. 20. Focus Group Quotes u “Part of the reason that I went into the military was to be like a safe haven for me. And then after I encountered the same type of abuse in the military, it was no longer safe for me, and I had thought that that could have been my home away from home. Then that’s when I started with the alcohol and stuff when I was in the military because I was just lost … I didn’t report [the abuse] ... So that left me kind of numb. And when I got out of the military, the same things started to happen all over again.” 20 Source: Hamilton AB, Poza I, Washington DL. Women’s Health Issues. 2011 Jul-Aug; 21 (4 Suppl): S203-9
  21. 21. Focus Group Quotes u “I wanted a career to make something of myself – to put the 20 years in and retire out. And it didn’t turn out that way. I was harassed, sexually, non-sexually. I did not feel a part of the family. I felt very pushed out, pushed away. And the harassment that I had gone through was so severe that I have anxiety, even more depression, major PTSD. I have a lot of physical and emotional and mental problems now… After the military I felt so lost. I had no self-esteem. I didn’t know what to do. I thought everyone hated me. I couldn’t go back to my family. I felt I had to just take off somewhere and just isolate myself. I felt so detached from society.” 21 Source: Hamilton AB, Poza I, Washington DL. Women’s Health Issues. 2011 Jul-Aug; 21 (4 Suppl): S203-9

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