Lifetime Sexual Assault and Emergency Room Use: A study examining the temporal relationship of single and repeat assaults on ER use in women Veterans

Abrams T, Mengeling M, Torner J, Booth B, Sadler AG. Lifetime Sexual Assault and Emergency Room Use: A study examining the temporal relationship of single and repeat assaults on ER use in women Veterans. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.

Related HSR&D Project(s)

• CDA 10-016 – Treatment Variation and Treatment Effectiveness in Veterans with PTSD
• CDP 11-236 – Accuracy and Validity of ICD9 Codes for PTSD in Veterans (CDA 10-016)
• NRI 04-194 – Sexual Violence and Women Veterans' Gynecologic Health

Objectives: Emerging reports indicate associations between LSA and emergency room (ER) use; yet findings and methods vary. Moreover, diagnostic complexity is associated with repeated sexual assault but reports have not tested for associations between 1) the temporal nature of LSA and ER use; or, 2) repeated LSA and ER use. Methods: A computer-assisted telephone survey captured the health status and the self-report of the time period of LSA exposures for N = 988 Iowa women veterans in the Veterans Health Administration (VHA). A data linkage for the prior 5 years VHA medical records captured ER use and physician recorded diagnoses. Four mutually exclusive categories defined first LSA exposure in either: a) childhood; b) young adulthood; c) military service; or d) post-military life. Chi square analyses tested associations between: 1) LSA and ER use; and 2) the temporal association between LSA and ER use; and 3) repeated LSA and ER use. Results: Overall 32.3% (N = 319) had at least one VHA ER visit; 61.4% (607) reported a LSA; with 66.4% (403) reporting first LSA in childhood; and 44.8% (272) with repeat LSA in different time periods. Any LSA was associated with VHA ER use (36.1% vs 26.3; P < .01). Repeat LSA was associated with more psychiatric (37.2% v 15.3; P < .01); gastrointestinal (33.3 v 22.1; P < .01), and lung (35.3 v 26.9; P = .01) comorbidity relative to one LSA survivors. First LSA occurrence in childhood was associated with ER use (39.2 v 26.3; P < .01); no significance was seen for first occurrence in other time periods. However, repeat LSA was associated with ER use (35.4 v 23.8; P < .001). Even if the most recent LSA was in childhood, the association persisted (35.9 v 26.3; P < .001); the association was stronger if the most recent LSA was during post military life (49.2 v 26.3; P < .001). Implications: Repeat LSA has a substantial impact illness burden and ER use and first LSA in childhood is associated with ER use regardless of whether or not LSA was repeated at different time periods. Impacts: These findings highlight the need for routine screening for LSA in the ER; placing a particular emphasis on the recognition of the long lasting impacts of childhood sexual trauma.