3011 — Agreement between Women Veterans’ Study Interview Self-Report of Military Sexual Trauma and VHA MST Screening Data

Booth BM (Central Arkansas Veterans Healthcare System and Department of Psychiatry, University of Arkansas for Medical Sciences), Mengeling MA (Iowa City VAMC and University of Iowa), Torner J (Iowa City VAMC and University of Iowa), Sadler AG (Iowa City VAMC)

Objectives:
To estimate agreement between VHA screening military sexual trauma (MST) data and a comprehensive evaluation of sexual assault in a cohort of 1004 female veterans.

Methods:
1004 women veterans (age < 52 years) who received care from the Iowa City VAMC and clinics within preceding 5 years completed a computer-assisted telephone interview with data on socio-demographic variables and sexual assault exposures. Comprehensive measures of military sexual assault included details regarding attempted and completed rape in regular military and Reserve/National Guard. Interview sexual assault reports were collapsed into a dichotomous variable -- “Study MST.” VHA MST screening data (N = 827 matches) were electronically extracted from the VistA system and collapsed to a single measure -- “Screening MST.”

Results:
Average age of subjects was 38yrs (S.D = 8.8), most were white (80%), with at least some college/technical training (85%), and a median income $21,750. The sample was mostly (95%) enlisted personnel. Overall, 28.8% reported Screening MST and 33.5% reported Study MST, with 77.2% agreement. Kappa was 0.47 (95% CI = 0.40, 0.53), indicating moderate agreement. McNemar’s Test for change was significant (p < 0.01) with 13.8% denying Screening MST but positive on Study MST, compared to only 9.1% reporting Screening MST but negative on Study MST.

Implications:
There is the potential for under-reporting of MST during VHA screening interviews, which might be even greater with interview information regarding in-military sexual harassment (known to be relatively frequent). The 9.1% with unconfirmed Screening MST may be women reporting sexual harassment unmeasured in our interviews. These results confirm clinical anecdotes that women experiencing MST are reluctant to report during a regular clinic visit that may be under sub-optimum conditions (e.g., male interviewer, lack of complete privacy, uneven interviewer training).

Impacts:
VHA has commendably undertaken universal screening for MST. However, given the well-published physical and mental health correlates of MST, VHA must ensure that screening is done under optimum circumstances that allow women (and men) to feel comfortable with accurate self-report. However, the extent to which the Screening MST information is used to provide relevant services and referrals is still unknown. Responses to the two separate issues (assault and harassment) also would be useful for clinical and research.