Lead/Presenter: Fernanda Rossi,
COIN - Palo Alto
All Authors: Rossi FS (Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine), Gaska K (Ross University School of Medicine; Department of Psychology, Georgia State University), Allen M (PGSP-Stanford Psy.D. Consortium, Palo Alto University) Kimerling K (Center for Innovation to Implementation, VA Palo Alto Health Care System)
Adverse childhood experiences (ACEs) predict poor adult health outcomes. ACEs can maintain an individual's position within resource impoverished social contexts, yielding cascading risks for subsequent trauma exposure. Yet, we know little regarding how ACEs are associated with military adversity for women veterans and how these adverse experiences together impact the risk of post-military intimate partner violence (IPV) victimization among women veterans. This study sought to: 1) identify unique patterns of childhood and military adversities among women veterans in VA health care; 2) examine how these constellations of experiences predict women veteran's risk for past-year IPV.
The sample was drawn from a nationally representative population-based telephone survey of women veterans using VHA primary care (N = 5384). IPV was identified using the HARK screen. We used latent class analysis to identify distinct constellations of co-occurring ACEs (physical abuse, sexual abuse, homelessness, parental incarceration, parental substance abuse, witnessing IPV, and parental mental illness) and military trauma (military sexual trauma (MST) and combat exposure). We modeled odds of past-year IPV as a function of class membership, adjusting for demographic and military risk factors.
A 5-class solution best fit the data: low adversity (39%), adverse family context (13%), military trauma (10%), all forms (27%), and an all forms-extreme class (11%). Each class was associated with significantly higher risk for IPV as compared to the low adversity class, with strongest effects for the all forms-extreme class. When classes were ordered by effect size, a statistically significant trend was observed for a higher predicted probability of IPV in each successive class (extreme: 35%; all forms: 28%; military: 22%, family: 18%, low: 12%).
For many women, military exposures continue trajectories of adversity from childhood, and these women face the greatest risk for subsequent interpersonal violence. The model also identified women with high probabilities of MST and combat exposure, despite relatively low adversity prior to military service, and these women were at a significantly lower risk for IPV.
Clinical attention to patient-reported military and childhood adversities may lead to higher value IPV care in VA, if it can help providers to better detect women veterans needing IPV screening and intervention.