Anne G. Sadler

Health-related consequences of physical and sexual violence: women in the military ☆

Objectives To identify differences in health-related quality of life among women veterans who were raped, physically assaulted (not in the context of rape or domestic violence), both, or neither during military service. Methods We did a cross-sectional telephone survey of a national sample of 558 women veterans who served in Vietnam and subsequent eras of military service. A stratified survey design selected subjects according to era of service and location. The interview included socioeconomic information, lifetime violence history, the Womens Military Environment Survey to assess womens military experiences, and the Medical Outcomes Study Short Form-36 to assess health-related quality of life. Results Five hundred thirty-seven women completed the interview. Half (48%) experienced violence during military service, including rape (30%), physical assault (35%), or both (16%). Women who were raped or dually victimized were more likely to report chronic health problems, prescription medication use for emotional problems, failure to complete college, and annual incomes less than

Rape, sex partnership, and substance use consequences in women veterans.

25,000 (P < .05). Women who were physically assaulted or raped reported significantly lower health-related quality of life (P < .05). Those who had both traumas reported the most severe impairment, comparable to women with chronic illnesses. Conclusion This study suggests that the sequelae of violence against women are an important public health concern. More than a decade after rape or physical assault during military service, women reported severely decreased health-related quality of life, with limitations of physical and emotional health, educational and financial attainment, and severe, recurrent problems with work and social activities.

The military environment: Risk factors for women's non-fatal assaults

The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.

Eating Disorders, Post-Traumatic Stress, and Sexual Trauma in Women Veterans

Little is known regarding environmental exposures for non-fatal violence toward women in the workplace. We sought to identify factors associated with non-fatal physical assault occurring to women during military service. A cross-sectional telephone survey of a national sample of 558 women veterans who served in Vietnam and subsequent eras of military service was conducted; 537 women were interviewed. Twenty-three percent experienced non-fatal physical assault during military service. Rates of assault were consistent across eras of service. Military environmental exposures, including sexual harassment allowed by officers (P < 0.0001) and unwanted sexual advances while on duty (P < .0001) and in sleeping quarters (P < 0.0001), were independent risk factors for assault. Environmental factors in the military workplace, including leadership behavior, appeared to promote violence toward military women. Such occupational factors can be identified and should be eliminated.

Effects of a six-week drug holiday on symptom status, relapse, and tardive dyskinesia in chronic schizophrenics.

We examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder (PTSD) and sexual trauma during various stages of the life course (childhood, during military service, and lifetime) among women veterans. The sample included 1,004 women aged 20 to 52 years who had enrolled at 2 Midwestern Veterans Affairs Medical Centers or outlying clinics completed a retrospective telephone interview. Over 16% reported a lifetime EDO (4.7% had received a diagnosis, and an additional 11.5% self-reported suffering from an EDO). Associations were found between lifetime EDO, PTSD, and sexual trauma. Relationships maintained significance for both diagnosed and self-reported EDOs as well as lifetime completed rape and attempted sexual assaults. Sexual trauma during military service was more strongly associated with lifetime EDOs than childhood sexual trauma. The significant associations found between EDOs, PTSD, and sexual trauma indicate that EDO screening among women veterans with PTSD or histories of sexual trauma may be warranted.ABSTRACTWe examine lifetime eating disorders (EDOs) and associations with post-traumatic stress disorder (PTSD) and sexual trauma during various stages of the life course (childhood, during military service, and lifetime) among women veterans. The sample included 1,004 women aged 20 to 52 years who had enrolled at 2 Midwestern Veterans Affairs Medical Centers or outlying clinics completed a retrospective telephone interview. Over 16% reported a lifetime EDO (4.7% had received a diagnosis, and an additional 11.5% self-reported suffering from an EDO). Associations were found between lifetime EDO, PTSD, and sexual trauma. Relationships maintained significance for both diagnosed and self-reported EDOs as well as lifetime completed rape and attempted sexual assaults. Sexual trauma during military service was more strongly associated with lifetime EDOs than childhood sexual trauma. The significant associations found between EDOs, PTSD, and sexual trauma indicate that EDO screening among women veterans with PTSD...

High-Risk Behavior and Sexually Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans

We have conducted a 6-wk drug withdrawal study in a group of chronic schizophrenic outpatients who had been maintained on injectable fluphenazine decanoate for at least 2 yr prior to the study. After two baseline assessments, patients were randomly assigned to two groups. The first group (holiday) received a placebo injection from a nurse who was not involved in the assessment (N = 17). The second group continued on their regular medication (N = 14). The assessment was done in a double-blind fashion at 3 and 6 wk using the Schedule for Affective Disorders and Schizophrenia (SADS) and the Global Assessment Scale (GAS) inventories to assess symptom status. Tardive dyskinesia was measured using the Abnormal Involuntary Movement Scale (AIMS). Community adjustment was assessed by means of the self-rated Weissman Social Adjustment Scale. We found that there were no relapses of any kind in either group of patients using the instruments mentioned above. The prevalence of tardive dyskinesia as measured by the AIMS was low, with only one patient having severe tardive dyskinesia. There was no significant worsening of the tardive dyskinesia during the drug holiday. Our study concludes that a 6-wk drug holiday was safe in this group of chronic schizophrenic patients maintained on fluphenazine decanoate. In contrast to other studies, no cases of covert tardive dyskinesia were detected during the drug holiday.

Physical health status of female veterans: contributions of sex partnership and in-military rape.

The number of women who are active duty service members or veterans of the U.S. military is increasing. Studies among young, unmarried, active duty servicewomen who are sexually active indicate a high prevalence of risky sexual behaviors, including inconsistent condom use, multiple sexual partners, and binge drinking, that lead to unintended and unsafe sex. These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the U.S. general population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen. Little is known about the sexual practices and rates of sexually transmitted infections among older servicewomen and women veterans; however, women veterans with a history of sexual assault may be at high risk for HPV infection and cervical dysplasia. To address the reproductive health needs of military women, investigations into the prevalence of unsafe sexual behaviors and consequent infection among older servicewomen and women veterans are needed. Direct comparison of military and civilian women is needed to determine if servicewomen are a truly high-risk group. Additionally, subgroups of military women at greatest risk for these adverse reproductive health outcomes need to be identified.

Overactive Bladder and Mental Health Symptoms in Recently Deployed Female Veterans

Objective The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Methods Retrospective computer-assisted telephone interviews of 1004 Midwestern US female veterans identified from Veterans Affairs electronic records were conducted. Data included rape history including rape in military, sex partnership history, demographics, and medical history including chronic pain, mental health (depression and posttraumatic stress disorder [PTSD]), and the physical health component of the Short-Form 12-item interview (PCS-12). Results Physical health in this sample was lower than norm values [PCS-12: mean (standard deviation) = 43 [12]; norm: mean (standard deviation) = 50 [10]). Fifty-one percent of the participants reported rape in their lifetime, 25% reported rape in military, 11% reported history of women as sex partners, and 71% reported history of chronic pain. Multiple regression analysis indicated that physical health (PCS-12) was associated with chronic pain history (&bgr; = −.40, p < .001), rape in military (&bgr; = −.09, p = .002), and current PTSD (&bgr; = .07, p = .03), adjusting for demographic data. Mediational analysis indicated that chronic pain history significantly mediated relationships of women who have sex with women, childhood rape, PTSD, depression, and current substance use disorder with PCS-12. Conclusions Both rape and sex partnership are adversely associated with lower physical functioning in female veterans. Clinicians evaluating the physical health of this population should therefore consider obtaining detailed sexual histories, and a multidisciplinary team is needed to address mental health issues in female veterans.

Patient-Centered Mental Health Care for Female Veterans

PURPOSE We estimate the prevalence of current overactive bladder symptoms in recently deployed female veterans, and determine if overactive bladder symptoms are associated with problems commonly reported after deployment including mental health symptoms and prior sexual assault. MATERIALS AND METHODS Baseline data were analyzed from a nationwide cohort study of urogenital symptoms in female veterans. Women returning from deployment to Iraq or Afghanistan in the prior 2 years and ending military service were eligible. Self-reported data were collected by computer assisted telephone interview. Overactive bladder and mental health conditions were identified using standardized definitions as well as validated urinary and mental health instruments. Associations between overactive bladder and depression, post-traumatic stress disorder, anxiety and sexual assault were assessed in separate logistic regression models using propensity scores to adjust for confounding. RESULTS The 1,702 participants had a mean (SD) age of 31.1 (8.4) years and were racially/ethnically diverse. Overall 375 participants (22%; 95% CI 20.1, 24.1) reported overactive bladder. Mental health outcomes included post-traumatic stress disorder (19%), anxiety (21%), depression (10%) and prior sexual assault (27%). All outcomes were associated with overactive bladder (adjusted OR 2.7, 95% CI [2.0, 3.6], 2.7 [2.0, 3.5], 2.5 [1.5, 4.3] and 1.4 [1.1, 1.9], respectively). CONCLUSIONS Overactive bladder symptoms occurred in 22% of recently deployed female veterans, and were associated with self-reported mental health symptoms and traumatic events including prior sexual assault. Screening and evaluation for bothersome urinary symptoms and mental health problems appear warranted in female veterans presenting for primary and urological care after deployment.

Correlates of Sexual Functioning in Women Veterans: Mental Health, Gynecologic Health, Health Status, and Sexual Assault History

OBJECTIVE Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding womens needs and priorities is essential to guide the implementation of patient-centered behavioral health services. METHODS In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated womens mental health services for each of the mental health services that emerged as key priorities. RESULTS Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as womens key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated womens mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated womens services. CONCLUSIONS Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated womens mental health care in the VHA.