Study Shows History of Military Sexual Trauma Common among Older Women Veterans
BACKGROUND:
Research on military sexual trauma (MST) among women Veterans has largely focused on younger women from recent service eras, with little attention to older women, who have unique and increased risks for a broad range of health concerns. The military experience and exposure to MST for older women Veterans also may differ, given changes in military roles for women and multiple service eras represented by this cohort. Further, the age-related prevalence of positive MST screens was last reported from 2003, the year after VA initiated universal annual MST screening for all Veterans receiving VA healthcare. This study sought to determine the prevalence of MST among older women Veterans – and investigate associations between MST and medical and mental health diagnoses. Using national VA medical record data, investigators identified 70,864 women Veterans aged 55 and older with at least one documented MST screen and one clinical visit between 2005 and 2015. Medical diagnoses were assessed for conditions including diabetes, hypertension, heart disease, obesity, chronic pain, dementia, and mental health conditions (i.e., anxiety, depression, PTSD, and substance use disorders). Investigators also assessed and adjusted for Veterans' sociodemographics (i.e., age, race/ethnicity, marital status).
FINDINGS:
- A history of MST was common among older women Veterans. Positive MST screens were observed in nearly 1 in 5 women aged 55-64, and 1 in 10 aged 65-74. [This is similar to the 23% prevalence found in previous studies in women younger than age 55.]
- Accounting for demographic risk factors, MST was associated with increased odds of a range of medical and mental health diagnoses. Most notably, MST was associated with 25 times the odds of PTSD and over two-fold odds of depression and suicidal ideation, as well as increased odds of anxiety, alcohol use disorder, substance use disorder, opioid use disorder, sleep disorders, and chronic pain.
- The most common medical diagnoses in the overall cohort included hypertension (66%), hyperlipidemia (60%), and diabetes (25%).
IMPLICATIONS:
- Older women Veterans remain at risk for the effects of potentially remote MST. Findings call attention to the need for additional research in this understudied population, and the importance of trauma-informed care approaches for women across the lifespan.
LIMITATIONS:
- Sexual trauma may be underreported; the degree to which positive MST screens reflect the underlying prevalence of MST in this population is unknown.
- The overall rate of MST found in this study also is affected by the low prevalence of documented MST in the oldest women in the cohort, which may be related to differential exposure related to service era and job roles over time, and/or underreporting or underscreening among older women.
AUTHOR/FUNDING INFORMATION:
Dr. Gibson is supported by an HSR&D Career Development Award (CDA 17-018). Drs. Gibson, Maguen, Barnes, and Yaffe are part of the San Francisco VA Health Care System.
Gibson C, Maguen S, Xia F, Barnes D, Peltz C, Yaffe K. Military Sexual Trauma in Older Women Veterans: Prevalence and Comorbidities. Journal of General Internal Medicine. November 11, 2019;epub ahead of print.
