Abramovitz SM (National Center for PTSD, VA Boston Healthcare System), Harrington EF
(National Center for PTSD, VA Boston Healthcare System), Shipherd JC
(National Center for PTSD, VA Boston and Boston University)
Military sexual trauma (MST) is defined as sexual harassment and assault during military duty. Negative sequelae include both physical health (Frayne, Skinner et al., 2003) and mental health problems (Kang et al., 2005; Street et al., 2007). Studies of sex differences after MST show worse outcomes in men compared with women (e.g., Shipherd et al., in press; Street et al., 2008; Vogt et al., 2005; Polunsy and Murdoch, 2005). To our knowledge, no studies have examined sex differences in the impact of MST on type of healthcare utilization (physical/mental). Therefore, this study examines the influence of MST on later healthcare utilization for men and women.
Data were part of a larger longitudinal study of Marines (see Wolfe, et al., 2005, for details). T2 data assessed MST exposures during recruit training using the Sexual Experiences Questionnaire (SEQ; Donovan and Drasgow, 1999). T4 data (19 months later) assessed physical and mental health functioning via the SF-12 (Ware, Kosinski, and Keller, 1996). Healthcare utilization was assessed via four items: 1) used outpatient care, other than routine physicals (yes/no); 2) number of times used outpatient care; 3) received counseling or medication for an emotional problem (yes/no); and 4) received alcohol or other drug counseling (yes/no). Participants included 403 women and 356 men.
In women, SEQ Total at T2 predicted whether outpatient primary care was utilized at T4 (beta = .13, t = 2.48, p < .05), even after controlling for physical health at T4 (beta = .12, t = 2.42, p < .05) in hierarchical linear regressions. Among men, SEQ Total at T2 predicted receiving counseling/medication for an emotional problem at T4 (beta = .12, t = 2.21, p < .05), but not after controlling for mental health at T4 (beta = .02, t = .39, p > .10). No other healthcare utilization variables were predicted by SEQ Total.
For women, MST leads to more utilization of outpatient primary care 19 months later, even after controlling for self-reported physical health. For men, MST increased seeking mental health services at a later time-point, but not after accounting for mental health.
Sex differences in healthcare utilization following MST can inform VA healthcare planning.