This document discusses military sexual trauma (MST), including its prevalence, associated health conditions, and impact on veterans. Some key points: - MST prevalence varies widely in studies but is estimated between 20-43%, with higher rates in women. Risk factors include younger age, enlisted rank, and prior trauma. - MST is associated with numerous mental health diagnoses like PTSD, depression, substance abuse, as well as physical health issues. It also impacts relationships, parenting, employment and can increase homelessness risk. - Veterans experience a wide range of reactions to MST depending on trauma history and support received. Quotes from focus groups illustrate feelings of loss of safety, isolation, and detachment from society after

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. 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. 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. 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. 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
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6. How common is MST?
It depends – it varies by:
u Method of assessment
u Definition used
u Type of sample
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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. 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. 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. 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. 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. 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. Mental Health Diagnoses
Commonly Associated with MST*
u PTSD
u Major Depression
u Mania/Bipolar Disorders
u Schizophrenia and Psychoses
u Somatization Disorders
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*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. 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
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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. 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. 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.
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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
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19. 19

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. 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