Publication year
2013
Citation Title
Military sexual trauma among homeless veterans.
Journal Name
Journal of General Internal Medicine
Journal Volume
28
Issue Number
S2
Page Numbers
S536-S541
DOI
10.1007/s11606-013-2341-4
Summary
Data from homeless Veterans who visited the Veterans Health Administration (VHA) between October 2009 and September 2010 were analyzed to examine gender and mental health differences between those who had experienced military sexual trauma and those who had not. Homeless Veterans who had experienced military sexual trauma were significantly more likely to have mental health concerns than homeless Veterans who had not experienced military sexual trauma. Females were significantly more likely than males to report having experienced military sexual trauma.
Key Findings
The prevalence of military sexual trauma was significantly higher among women (40%) than men (3%).
Homeless Veteran women who had experienced military sexual trauma had significantly more mental health concerns than homeless Veteran women who had not experienced military sexual trauma, including an increased incidence of depression, PTSD, substance use disorders, anxiety disorders, bipolar and personality disorders, and suicidal ideation.
Homeless Veteran men who experienced military sexual trauma were significantly more likely to have more mental health concerns than homeless Veteran men without military sexual trauma experience across all domains of mental health issues studied, with the exception of adjustment disorders.
Homeless Veteran men and women who had experienced military sexual trauma visited mental health care services significantly more frequently than homeless Veterans without military sexual trauma experience.
Implications for Program Leaders
Provide special services for victims of military sexual trauma (e.g., opportunities for peer support, referrals to practitioners who provide evidence-based treatments)
Educate couples who have a history of trauma before deployment on positive coping skills
Collaborate with community programs to offer appropriate referrals to help Service members and their families receive appropriate services after a trauma
Implications for Policy Makers
Recommend annual screenings to try to uncover military sexual trauma so as to improve timely referrals to mental health services
Continue to advocate for and support comprehensive services and research related to victims of military sexual trauma
Continue to provide support for programs that work to increase family readiness
Methods
Data were collected by multiple databases within the VHA to gather information on homeless Veterans seeking care between October 2009 and September 2010.
Military sexual trauma was assessed by asking patients whether they had ever received unwanted sexual touching, or been pressured or forced to complete sexual acts while in the military.
Mental health status data were collected from the Agency for Health Research and Quality’s Clinical Classifications Software, including information on depressive disorders, PTSD, substance- and alcohol-abuse disorders, anxiety disorders, bipolar disorders, adjustment disorders, personality disorders, schizophrenia, and suicidal ideation.
Participants
Participants included 126,598 homeless Veterans (female = 8,915; male = 117,683).
The majority of homeless Veterans were White (48%) or Black (42%) and were divorced (44%) or single (39%). Branch of military service was not provided.
Most female participants were between the ages of 45-54 years (39%), whereas males were split between 45-54 years (37%), and 54-64 years (37%).
Limitations
This study only included Veterans who had identified themselves as homeless with the VHA, so results may not generalize to homeless Veterans that have not self-identified as homeless or sought care from the VHA.
Increased susceptibility to interpersonal violence (IPV) in general may be a greater risk factor for mental health issues that was not addressed in this study, making it difficult to determine if military sexual trauma is indeed a risk-factor.
The cross-sectional design limits causal inference.
Avenues for Future Research
Study the utilization of mental health services by homeless Veterans to determine overall utilization rates, and whether homeless Veterans experience any obstacles to receiving services
Examine the relation between military sexual trauma and previous interpersonal violence to determine if IPV is a greater risk-factor for mental health issues
Collect longitudinal data from Service members about their experiences of military sexual trauma to determine if certain risk factors increase or decrease over time
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
BACKGROUND: Military sexual trauma (MST) is the Veteran Health Administration’s (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. OBJECTIVE: To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. DESIGN AND PARTICIPANTS: National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. MAIN MEASURES: All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. KEY RESULTS: Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. CONCLUSIONS: A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in improving access to mental health care among homeless Veterans.
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