Washington DL (VA Greater Los Angeles Healthcare System)
Simon B (VA Greater Los Angeles Healthcare System)
Sasso B (VA Greater Los Angeles Healthcare System)
Sun S (VA Greater Los Angeles Healthcare System)
Canning M (VA Greater Los Angeles Healthcare System)
Yano EM (VA Greater Los Angeles Healthcare System)
Fifteen percent of U.S. military troops currently deployed in Iraq and Afghanistan are female. Periodic media reports and research in VA patient populations identify military sexual assault (MST) as a risk to which these women are exposed. The extent and consequences of MST in the general women veteran population are unknown.
We conducted a telephone survey of a stratified random sample of 2,174 women veterans residing in the southern California and southern Nevada area (VISN22), to determine MST prevalence, associated co-morbidity, and subsequent treatment. Stratification was by current VA use and age group, with similar numbers of VA users and non-users, and age groups enrolled. All analyses applied weights to account for disproportional allocation of the population by strata.
570 women (representing 17.1% of the weighted VISN22 women veteran population) reported rape or physical assault in the military that was not a result of combat. MST prevalence by war era was 7.3% for pre-Vietnam, 18.8% for Vietnam, and 20.0% post-Vietnam. Of women reporting MST, 15.9% currently use VA healthcare, however, 16.6% avoided or delayed using the VA because of their MST experience. MST was associated with lower SF-12 physical (5.4 point mean difference) and mental (4.6 point) component scores, and with greater likelihood of screening positive for depression (OR=2.8), anxiety disorder (OR=3.0), post-traumatic stress disorder (OR=17.4), and hazardous alcohol use (OR=1.3) (all p<.05). 6.3% of women received VA MST counseling or treatment; 21.7% received care in non-VA settings; 72.0% received no care for these incidents. In adjusted analysis, screening positive for a mental disorder, having a service-connected disability, and fair or poor health predicted receipt of MST care.
MST is highly prevalent, associated with significant co-morbidity, but often untreated.
Since a majority of women veterans receive healthcare exclusively in non-VA settings, then VA-wide availability of MST screening and treatment can only reach the tip of this proverbial iceberg. Interventions to increase MST prevention, detection, and early treatment in non-VA settings are actions warranted by these findings. Such actions include attention to barriers to MST prevention and reporting, and assessment for MST at military discharge to facilitate access to needed care.