Joanne Pavao

Military-Related Sexual Trauma Among Veterans Health Administration Patients Returning From Afghanistan and Iraq

We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental health issue in this population.

Medical Care Needs of Returning Veterans with PTSD: Their Other Burden

ABSTRACTBACKGROUNDThere has been considerable focus on the burden of mental illness (including post-traumatic stress disorder, PTSD) in returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, but little attention to the burden of medical illness in those with PTSD.OBJECTIVES(1) Determine whether the burden of medical illness is higher in women and men OEF/OIF veterans with PTSD than in those with No Mental Health Conditions (MHC). (2) Identify conditions common in those with PTSD.DESIGNCross-sectional study using existing databases (Fiscal Year 2006–2007).SETTINGVeterans Health Administration (VHA) patients nationally.PATIENTSAll 90,558 OEF/OIF veterans using VHA outpatient care nationally, categorized into strata: PTSD, Stress-Related Disorders, Other MHCs, and No MHC.MEASUREMENTS(1) Count of medical conditions; (2) specific medical conditions (from ICD9 codes, using Agency for Health Research and Quality’s Clinical Classifications software framework).MAIN RESULTSThe median number of medical conditions for women was 7.0 versus 4.5 for those with PTSD versus No MHC (p < 0.001), and for men was 5.0 versus 4.0 (p < 0.001). For PTSD patients, the most frequent conditions among women were lumbosacral spine disorders, headache, and lower extremity joint disorders, and among men were lumbosacral spine disorders, lower extremity joint disorders, and hearing problems. These high frequency conditions were more common in those with PTSD than in those with No MHC.CONCLUSIONSBurden of medical illness is greater in women and men OEF/OIF veteran VHA users with PTSD than in those with No MHC. Health delivery systems serving them should align clinical program development with their medical care needs.

Unemployment Among Women Examining the Relationship of Physical and Psychological Intimate Partner Violence and Posttraumatic Stress Disorder

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and womens workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.

Women's childhood and adult adverse experiences, mental health, and binge drinking: The California Women's Health Survey

BackgroundThis study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.Materials and methodsData were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Womens Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.ResultsThe prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by womens poorer mental health status in adulthood.ConclusionIdentifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address womens mental health symptoms as well as circumstances in the childhood home.

Sexually Transmitted Infections and Sexual Dysfunctions Among Newly Returned Veterans With and Without Military Sexual Trauma

ABSTRACT This cross-sectional study examined the odds of being diagnosed with a sexually transmitted infection (STI) or a sexual dysfunction disorder (SDD) among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) American veterans receiving care in the Veterans’ Health Administration (VHA) in relation to whether or not they have experienced military sexual trauma (MST). Among those veterans who experienced MST, the influence of a diagnosis of posttraumatic stress disorder, a depressive disorder, or a substance use disorder on the odds of being diagnosed with an STI or SDD was also examined. The study utilized nationwide VHA records of 420,725 OEF/OIF male and female veterans who used VHA services in fiscal years 2002 to 2010. Veterans who reported a history of MST were more likely to have a number of STIs and SDDs compared with veterans without a history of MST. Among veterans with MST, the risk for having an STI or SDD increased with the presence of certain mental health diagnoses. Implications for clinical practice and assessment with veterans are discussed.

Utilization and Intensity of Outpatient Care Related to Military Sexual Trauma for Veterans from Afghanistan and Iraq

Little research has examined factors associated with the utilization of outpatient health care services related to sexual assault experiences. The Veterans Health Administration provides free outpatient treatment services to veterans who report military sexual trauma (MST); this system provides a unique opportunity to examine factors related to the utilization of mental health and non-mental health outpatient services by patients with sexual trauma. The current study examined sociodemographic, military service factors, and primary diagnoses related to utilization and utilization intensity of MST-related care among 4,458 Operation Enduring Freedom/Operation Iraqi Freedom Veterans in a 1-year period after reporting an experience of MST. Of the veterans who reported MST, 75.9% received MST-related care. The most notable factor that influenced receipt and intensity of MST-related care was gender, where male veterans used less care than female veterans. These results have important treatment implications for both veteran and civilian sexual trauma survivors.

Military sexual trauma among recent veterans: correlates of sexual assault and sexual harassment

INTRODUCTION Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans. METHODS MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014. RESULTS Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services. CONCLUSIONS These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST.

Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care

ABSTRACTOBJECTIVESThe objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics.DESIGNThis was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey.PARTICIPANTSA national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study.MAIN MEASURESPast-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via self-report and VHA administrative data.KEY RESULTSThe prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% - 25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers.CONCLUSIONSThe high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social services and MST-related care.

Access to mental health care among women Veterans: is VA meeting women's needs?

Background:Patient-centered access to mental health describes the fit between patient needs and resources of the system. To date, little data are available to guide implementation of services to women veterans, an underrepresented minority within Department of Veteran Affairs (VA) health care. The current study examines access to mental health care among women veterans, and identifies gender-related indicators of perceived access to mental health care. Methods:A population-based sample of 6287 women veterans using VA primary care services participated in a survey of past year perceived need for mental health care, mental health utilization, and gender-related mental health care experiences. Subjective rating of how well mental health care met their needs was used as an indicator of perceived access. Results:Half of all women reported perceived mental health need; 84.3% of those women received care. Nearly all mental health users (90.9%) used VA services, although only about half (48.8%) reported that their mental health care met their needs completely or very well. Gender related experiences (availability of female providers, women-only treatment settings, women-only treatment groups, and gender-related comfort) were each associated with 2-fold increased odds of perceived access, and associations remained after adjusting for ease of getting care. Conclusions:Women VA users demonstrate very good objective access to mental health services. Desire for, and access to specialized mental health services for women varies across the population and are important aspects of shared decision making in referral and treatment planning for women using VA primary care.

Veterans Health Administration mental health treatment settings of patients who report military sexual trauma.

The comprehensive Veterans Health Administration (VHA) policies on military sexual trauma (MST) include provider education and training at each VHA facility. No published data exist that indicate the settings in which VHA mental health patients with MST are treated. Such information could help set priorities for targeted MST-related education and training. The major aim of this article was to describe the VHA mental health outpatient settings in which patients with MST are most likely to be treated. National data from 79,903 female and 889,998 male veteran patients with at least one face-to-face outpatient mental health encounter at any VHA facility in fiscal year 2008 were analyzed. Among all veterans in VHA outpatient mental health care, 35.8% of women and 2.4% of men reported MST. The proportion of MST-positive patients ranged from 25.9% to 81.0% of women and from 1.5% to 56.1% of men across 9 major clinic setting categories. Proportions of women with MST were substantial across specialty MST clinics, specialty posttraumatic stress disorder clinics, psychosocial rehabilitation, and substance use disorder clinics, reflecting a wide range of settings. These settings should be prioritized for MST-related provider education and training. By contrast, male MST patients represented only a small proportion of patients in all clinics, with the exception of MST specialty clinics. Tailored conceptualizations of trauma-informed care are proposed for settings that encounter MST patients, even if these settings do not directly focus on the treatment of traumatic stress.