Skip to main content

Advertisement

Log in

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

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kimerling R, Street AE, Pavao J, et al. Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American Journal of Public Health 2010;100(8):1409-1412.

    Article  PubMed  Google Scholar 

  2. Frayne SM, Skinner KM, Sullivan LM, et al. Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military. Journal of Women's Health & Gender-Based Medicine 1999;8(6):835-845.

    Article  CAS  Google Scholar 

  3. Kimerling R, Gima K, Smith MW, et al. The Veterans Health Administration and military sexual trauma. American Journal of Public Health 2007;97(12):2160-2166.

    Article  PubMed  Google Scholar 

  4. Kessler RC, Sonnega A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 1995;52(12):1048-1060.

    Article  PubMed  CAS  Google Scholar 

  5. Yaeger D, Himmelfarb N, Cammack A, et al. DSM-IV diagnosed posttraumatic stress disorder in women veterans with and without military sexual trauma. Journal of General Internal Medicine 2006;21 Suppl 3:S65-S69.

    Article  PubMed  Google Scholar 

  6. Himmelfarb N, Yaeger D, Mintz J. Posttraumatic stress disorder in female veterans with military and civilian sexual trauma. Journal of Traumatic Stress 2006;19(6):837-846.

    Article  PubMed  Google Scholar 

  7. Suris AM, Lind L, Kashner TM, et al. Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care. Psychosomatic Medicine 2004;66(5):749-756.

    Article  PubMed  Google Scholar 

  8. Agar K, Read J, Bush J-M. Identification of abuse histories in a community mental health centre. Journal of Mental Health 2002;11:533-543.

    Article  Google Scholar 

  9. Campbell R, Raja S. The sexual assault and secondary victimization of female veterans: help-seeking experiences with military and civilian social systems. Psychology of Women Quarterly 2005;29(1):97-106.

    Article  Google Scholar 

  10. Friedman LS, Samet JH, Roberts MS, et al. Inquiry about victimization experiences. A survey of patient preferences and physician practices. Archives of Internal Medicine 1992;152(6):1186-1190.

    Article  PubMed  CAS  Google Scholar 

  11. McCauley J, Yurk RA, Jenckes MW, et al. Inside “Pandora's box”: abused women's experiences with clinicians and health services. Journal of General Internal Medicine 1998;13(8):549-55.

    Article  PubMed  CAS  Google Scholar 

  12. Hurst C, MacDonald J, Say J, et al. Routine questioning about non-consenting sex: a survey of practice in Australian sexual health clinics. International Journal of STD and AIDS 2003;14(5):329-333.

    Article  PubMed  Google Scholar 

  13. Pruitt J, Kappius R. Routine inquiry into sexual victimization: a survey of therapists' practices. Professional Psychology: Research and Practice 1992;23:474-479.

    Article  Google Scholar 

  14. Military Sexual Trauma Support Team. Military Sexual Trauma (MST) Screening Report, Fiscal Year 2009. Washington: Department of Veterans Affairs, Office of Mental Health Services; 2010.

    Google Scholar 

  15. Golding JM, Stein JA, Siegel JM, et al. Sexual assault history and use of health and mental health services. American Journal of Community Psychology 1988;16(5):625-644.

    Article  PubMed  CAS  Google Scholar 

  16. Koss MP, Koss PG, Woodruff WJ. Deleterious effects of criminal victimization on women's health and medical utilization. Archives of Internal Medicine 1991;151(2):342-347.

    Article  PubMed  CAS  Google Scholar 

  17. New M, Berliner L. Mental health service utilization by victims of crime. Journal of Traumatic Stress 2000;13(4):693-707.

    Article  PubMed  CAS  Google Scholar 

  18. Waigandt A, Wallace DL, Phelps L, et al. The impact of sexual assault on physical health status. Journal of Traumatic Stress 1990;3(1):93-102.

    Article  Google Scholar 

  19. Kimerling R, Street AE, Gima K, et al. Evaluation of universal screening for military-related sexual trauma. Psychiatric Services 2008;59(6):635-640.

    Article  PubMed  Google Scholar 

  20. Sadler AG, Booth BM, Mengeling MA, et al. Life span and repeated violence against women during military service: Effects on health status and outpatient utilization. Journal of Women's Health 2004;13(7):799-811.

    Article  PubMed  Google Scholar 

  21. Valdez C, Kimerling R, Mark HF, et al. VHA mental health treatment settings of patients who report military sexual trauma. Journal of Trauma and Dissociation 2011;12(3):232–243.

    Article  PubMed  Google Scholar 

  22. Zinzow HM, Grubaugh AL, Frueh BC, et al. Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: a multi-site study. Psychiatry Research 2008;159(1-2):226-236.

    Article  PubMed  Google Scholar 

  23. Agency for Healthcare Research and Quality. Medical examination and treatment for victims of sexual assault: evidence-based clinical practice and provider training. Rockville: AHRQ; 2003. Report to Congress: No. 03-R210.

    Google Scholar 

  24. Liang K, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986;73(1):13-22.

    Article  Google Scholar 

  25. Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Social Science and Medicine 1990;30(7):811-818.

    Article  PubMed  CAS  Google Scholar 

  26. Pierce PF, Antonakos C, Deroba BA. Health care utilization and satisfaction concerning gender-specific health problems among military women. Military Medicine 1999;164(2):98-102.

    PubMed  CAS  Google Scholar 

  27. Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. The New England Journal of Medicine 2004;351(1):13-22.

    Article  PubMed  CAS  Google Scholar 

  28. Banyard V, Ward S, Cohn E, et al. Unwanted sexual contact on campus: A comparison of women's and men's experiences. Violence & Victims 2007;22(1):52-70.

    Google Scholar 

  29. Street AE, Gradus JL, Stafford J, et al. Gender differences in experiences of sexual harassment: data from a male-dominated environment. Journal of Consulting and Clinical Psychology 2007;75(3):464-474.

    Article  PubMed  Google Scholar 

  30. Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin 2006;132(6):959-92.

    Article  PubMed  Google Scholar 

  31. Hosoda M, Stone DL. Current gender stereotypes and their evaluative content. Perceptual and Motor Skills 2000;90(3):1283-1294.

    Article  PubMed  CAS  Google Scholar 

  32. Kassing L, Beesley D, Frey L. Gender role conflict, homophobia, age, and education as predictors of male rape myth acceptance. Journal of Mental Health Counseling 2005;27:311-328.

    Google Scholar 

  33. Lisak D. Men as victims: challenging cultural myths. Journal of Traumatic Stress 1993;6:577-580.

    Article  Google Scholar 

  34. Struckman-Johnson C, Struckman-Johnson D. Acceptance of male rape myths among college men and women. Sex Roles 1992;27:85-100.

    Article  Google Scholar 

  35. Turchik JA, Edwards KM. Myths about male rape: a literature review. Psychology of Men & Masculinity 2012; doi: 10.1037/a0023207

  36. Anderson I, Quinn A. Gender differences in medical students' attitudes toward male and female rape victims. Psychology, Health & Medicine 2009;14:105-110.

    Article  Google Scholar 

  37. Long JA, Bamba MI, Ling B, et al. Missing race/ethnicity data in Veterans Health Administration based disparities research: a systematic review. Journal of Health Care for the Poor and Underserved 2006;17:128-140.

    Article  PubMed  Google Scholar 

  38. Jia H, Zheng YE, Cowper DC, et al. Race/ethnicity: who is counting what?. Journal of Rehabilitation Research and Development 2006;43(4):475-484.

    Article  PubMed  Google Scholar 

  39. Cohen B, Gima K, Bertenthal D, et al. Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. Journal of General Internal Medicine 2009;25(1):18-24.

    Article  PubMed  Google Scholar 

  40. Turchik JA, Wilson SM. Sexual assault in the US military: a review of the literature and recommendations for the future. Aggression and violent behavior 2010;15:267-277.

    Article  Google Scholar 

  41. Smith MW, Chow A, Kimerling R. Estimating lost revenue from a free-care mandate in the U.S. Department of Veterans Affairs. Psychiatric Services 2010;61(11):1150-1152.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Writing of this manuscript was supported by the VA Advanced Fellowship Program in Mental Illness Research and Treatment, VA Office of Academic Affiliations. The authors would like to thank Dr. Deborah Nazarian for her helpful feedback on this manuscript and Meghan Saweikis, M.S. for her programming assistance.

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jessica A. Turchik PhD.

Additional information

Disclaimer:

The views and opinions of authors expressed herein do not necessarily reflect those of the Department of Veterans Affairs or the United States Government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turchik, J.A., Pavao, J., Hyun, J. et al. Utilization and Intensity of Outpatient Care Related to Military Sexual Trauma for Veterans from Afghanistan and Iraq. J Behav Health Serv Res 39, 220–233 (2012). https://doi.org/10.1007/s11414-012-9272-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-012-9272-4

Keywords

Navigation