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Reinhardt KM, McCaughey VK, Vento SA, Street AE. In Their Own Words: Women Veterans Identify the Personal Consequences of Military Sexual Trauma Victimization. Violence Against Women 2024; 30:722-742. [PMID: 36617939 DOI: 10.1177/10778012221147909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study provides a platform for women veterans to inform our perspective of their experienced impacts following military sexual trauma (MST). We engaged 23 women veterans in semistructured interviews and used a grounded theory-informed thematic analytic approach, to interpret women's experiences. Women described negative impacts of their MST experiences across psychological, behavioral, and occupational domains. Less frequently, women discussed experiences of posttraumatic growth. These results aid our understanding of the complexities of women's posttrauma experiences and suggest that holistic intervention frameworks focused on a range of potential intervention targets are warranted in helping women veterans recover from MST.
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Affiliation(s)
| | - Virginia K McCaughey
- Suffolk University and National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
| | | | - Amy E Street
- National Center for PTSD at VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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Galovski TE, McSweeney LB, Woolley MG, Alpert E, Nillni YI. The Relative Impact of Different Types of Military Sexual Trauma on Long-Term PTSD, Depression, and Suicidality. JOURNAL OF INTERPERSONAL VIOLENCE 2023:8862605231168823. [PMID: 37102588 DOI: 10.1177/08862605231168823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sexual assault and harassment in the U.S. military are very common. Military sexual trauma (MST) is defined as sexual assault or harassment experienced during military service; yet, the relative impact of sexual assault, harassment, and their combination is not well understood. Given the extent and potential severity of the long-term outcomes of MST, it is critical to evaluate the relative impacts of these types of MST on long-term mental health outcomes. Veterans (n = 2,590; 55% female) completed self-report measures of experiences of sexual assault and harassment perpetrated by coworkers during military service, posttraumatic stress disorder (PTSD), depression, and suicidality. Controlling for combat exposure, all types of MST experiences (Harassment Only, Assault Only, or Both) compared to No MST predicted greater severity of PTSD, depression, and suicidality after military service. Compared to Veterans with No MST, those who experienced Both Assault and Harassment reported significantly more severe PTSD, depression, and suicidality followed by Harassment Only, and then Assault Only. Data suggest that different types of MST experiences have an impact on long-term mental health outcomes, and the combination of Both sexual Assault and Harassment is particularly deleterious.
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Affiliation(s)
- Tara E Galovski
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - Elizabeth Alpert
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Yael I Nillni
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Carlson GC, Sharifian N, Jacobson IG, LeardMann CA, Rull RP, Martin JL. Contribution of post-trauma insomnia to depression and posttraumatic stress disorder in women service members: findings from the Millennium Cohort Study. Sleep 2023; 46:zsac313. [PMID: 36546353 PMCID: PMC9995785 DOI: 10.1093/sleep/zsac313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/11/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES We examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes. METHODS We analyzed two waves of survey data (2011-2013, Time 1 [T1] and 2014-2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia. RESULTS Women who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24-2.10), sexual harassment (OR = 1.22; 95% CI = 1.05-1.41), and combat (OR = 1.34; 95% CI = 1.20-1.49) at T1 had a greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI = 2.31-3.06) and PTSD (OR = 2.57; 95% CI = 2.27-2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes. CONCLUSIONS Insomnia contributes to the risk of subsequent mental health conditions following trauma. The diagnosis and treatment of post-trauma insomnia should be prioritized to mitigate the development of posttraumatic mental health conditions.
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Affiliation(s)
- Gwendolyn C Carlson
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Neika Sharifian
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Isabel G Jacobson
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Pre-service factors associated with sexual misconduct among male U.S. Marines. PLoS One 2022; 17:e0278640. [PMID: 36490284 PMCID: PMC9733839 DOI: 10.1371/journal.pone.0278640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Sexual assault is a prevalent and persistent problem in the military, yet few studies have examined predictors of sexual offenses. The study aim was to determine pre-service factors associated with sexual offense conviction among U.S. Marines. METHODS This retrospective cohort study analyzed data from male active duty U.S. Marines (2003-2018). Pre-service factors were assessed using survey data from the Recruit Assessment Program, obtained prior to recruit training at the Marine Corps Recruit Depot, San Diego, California. These survey data were linked with sexual offense conviction data obtained from the Naval Criminal Investigative Service Consolidated Law Enforcement Operations Center. RESULTS Of the 146,307 participants, the majority were 18-19 years old (66.7%) and non-Hispanic, White (62.1%) with a high school education or less (76.8%); 107 received convictions for a sexual offense. In unadjusted analyses, race and ethnicity, parental education, type of primary caregiver, parental death, family economic status, childhood emotional trauma, childhood physical abuse, childhood sexual abuse, and unprotected sex were associated with a sexual offense conviction. In the final multivariable model, race and ethnicity (American Indian/Alaskan Native, odds ratio [OR]: 5.28, 95% confidence interval [CI]: 1.86-14.98; Hispanic, OR: 1.83, 95% CI: 1.06-3.18; multiracial/other, OR: 3.28, 95% CI: 1.56-6.89), education (≤ high school, OR: 2.65; 95% CI: 1.21-5.80), parental death (OR: 2.27; 95% CI: 1.16-4.45), unprotected sex (OR: 1.78; 95% CI: 1.03-3.05), and school suspension/expulsion (OR: 1.64; 95% CI: 1.02-2.65) were significant predictors of a subsequent sexual offense conviction. CONCLUSIONS Results underscore the importance of understanding factors associated with sexual offense and highlight the large discrepancy between self-reported estimates of sexual assault and sexual offense convictions. Findings may inform the development of effective strategies to reduce sexual misconduct, such as technology-facilitated programs that provide private, targeted education; supportive assistance; and prevention materials to individuals who may have elevated sexual misconduct risk.
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Galovski TE, Street AE, Creech S, Lehavot K, Kelly UA, Yano EM. State of the Knowledge of VA Military Sexual Trauma Research. J Gen Intern Med 2022; 37:825-832. [PMID: 36042078 PMCID: PMC9481813 DOI: 10.1007/s11606-022-07580-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U.S. Department of Defense to establish a 90-day Independent Review Commission on Sexual Assault in the Military (IRC) to assess the department's efforts and make actionable recommendations. As servicemembers discharge from the military, effects of military sexual trauma (MST) are often seen in the Veterans Health Administration (VA). In response to an IRC inquiry about VA MST research, we organized an overview on prevalence, adverse consequences, and evidence-based treatments targeting the sequelae of MST. Women are significantly more likely to experience MST than their male counterparts. Other groups with low societal and institutional power (e.g., lower rank) are also at increased risk. Although not all MST survivors experience long-term adverse consequences, for many, they can be significant, chronic, and enduring and span mental and physical health outcomes, as well as cumulative impairments in functioning. Adverse consequences of MST come with commonalities shared with sexual trauma in other settings (e.g., interpersonal betrayal, victim-blaming) as well as unique aspects of the military context, where experiences of interpersonal betrayal may be compounded by perceptions of institutional betrayal (e.g., fear of reprisal or ostracism, having to work/live alongside a perpetrator). MST's most common mental health impact is posttraumatic stress disorder, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.
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Affiliation(s)
- Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Amy E Street
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Suzannah Creech
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA, Waco, TX, USA
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Keren Lehavot
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ursula A Kelly
- Atlanta VA Health Care System, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Scoglio AAJ, Molnar BE, Lincoln AK, Griffith J, Park C, Kraus SW. Sexual and physical revictimization in U.S. military veterans. J Trauma Stress 2022; 35:1129-1141. [PMID: 35233826 DOI: 10.1002/jts.22816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/15/2021] [Accepted: 01/23/2022] [Indexed: 11/08/2022]
Abstract
The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is associated with multiple negative mental health outcomes in the literature, identifying risk and protective factors can aid in the prevention of revictimization and associated poor health outcomes among veterans. In this sample, the proportion of adult revictimization was 2.7% for men, 95% CI [2.0, 3.6] and 22.9% for women, 95% CI [20.5, 25.8]. Using multilevel logistic models, we found that women, β = 2.2, p < .001; Navy veterans, β = 1.5, p < .001; and participants who reported posttraumatic stress symptoms, β = 0.2, p = .028, were at significantly higher risk of revictimization across time compared to nonrevictimized counterparts. Social support while in the military was protective, β = -0.1, p < .001, against revictimization. In addition, childhood abuse experiences combined with characteristics such as female gender were related to an increased risk of revictimization during and following military service. The findings highlight opportunities for intervention and areas of strength within this population; social connection garnered during military service may serve as a protective factor against revictimization. Future research is needed to examine the role of social support in possibly lowering veterans' risk of revictimization over time, particularly for post-9/11 veterans struggling with transitioning from military to civilian life.
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Affiliation(s)
- Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Beth E Molnar
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts, USA.,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, Massachusetts, USA.,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - John Griffith
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Crystal Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada-Las Vegas, Las Vegas, Nevada, USA
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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8
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Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA. Sexual health difficulties among service women: the influence of posttraumatic stress disorder. J Affect Disord 2021; 292:678-686. [PMID: 34157663 DOI: 10.1016/j.jad.2021.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.
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Affiliation(s)
- Claire A Kolaja
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
| | - Ashley C Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - Jean A Orman
- University of Texas Health at San Antonio, TX, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Thomas CL, Nieh C, Hooper TI, Gackstetter GD, LeardMann CA, Porter B, Blazer DG. Sexual Harassment, Sexual Assault, and Physical Activity Among U.S. Military Service Members in the Millennium Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7043-7066. [PMID: 30827142 DOI: 10.1177/0886260519832904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness.
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Affiliation(s)
- Connie L Thomas
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Chiping Nieh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Tomoko I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Cynthia A LeardMann
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Ben Porter
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
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10
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Scoglio AA, Shirk SD, Hoff RA, Potenza MN, Mazure CM, Park CL, McKee SA, Porter EA, Kraus SW. Gender-Specific Risk Factors for Psychopathology and Reduced Functioning in a Post-9/11 Veteran Sample. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP1359-1374NP. [PMID: 29295023 PMCID: PMC6461523 DOI: 10.1177/0886260517746182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
U.S. combat veterans frequently encounter challenges after returning from deployment, and these challenges may lead to difficulties in psychological and social functioning. Currently, research is limited on gender-related differences within this population, despite female veterans comprising a growing portion of the U.S. military with roles and exposures similar to their male counterparts. Using secondary analysis, we examined 283 returning combat veterans (female = 29.4%) for differences in psychopathology and trauma history. Female veterans were more likely to report a history of sexual trauma than their male counterparts, whereas male veterans were more likely to report greater frequency of gambling in the past year, impulsivity, and hypersexuality. No gender-related differences were identified for depression, anxiety, insomnia, or substance-use disorders, although both men and women veterans had higher rates than those found in the general population. While both male and female combat veterans report various mental health problems as they transition back into civilian life, gender-related differences relating to sexual trauma, hypersexuality, and impulsivity warrant additional investigations with respect to the potential impact they may have on veteran reintegration and treatment.
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Affiliation(s)
- Arielle A.J. Scoglio
- Social and Community Reintegration Research Program, Bedford, MA USA
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Steven D. Shirk
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
| | - Rani A. Hoff
- Northeast Program Evaluation Center; Director, Evaluation Division, National Center for PTSD, West Haven, CT USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Marc N. Potenza
- Connecticut Mental Health Center, Yale University School of Medicine, New Haven, CT USA
- Departments of Psychiatry, Child Study, Neuroscience, and the National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT USA
| | - Carolyn M. Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Crystal L. Park
- University of Connecticut, Department of Psychological Sciences, Storrs, CT USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Elizabeth A. Porter
- Northeast Program Evaluation Center; Evaluation Division, National Center for PTSD, West Haven, CT USA
| | - Shane W. Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA USA
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11
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Examining the Association between Trauma Exposure and Work-Related Outcomes in Women Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124585. [PMID: 32630579 PMCID: PMC7344422 DOI: 10.3390/ijerph17124585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
Women veterans have high rates of trauma exposure, including military sexual trauma (MST), which are associated with numerous health and psychosocial consequences. However, associations between trauma history and work-related outcomes are less well-characterized. We examined whether military-related and non-military trauma types were associated with work-related outcomes and whether posttraumatic stress disorder (PTSD) and depression symptoms mediated these associations. A total of 369 women veterans completed up to two mailed surveys, 12 months apart, assessing trauma exposure, depression and PTSD symptoms, occupational functioning, and employment status (unemployed, out of the workforce, employed). Participants reported high rates of trauma exposure. Nearly half (47.5%) were out of the workforce. Military-related trauma, military sexual assault, and adult sexual assault were associated with worse occupational functioning. Only PTSD symptoms mediated associations between trauma types and occupational functioning. No trauma types were significantly directly associated with employment status; however, PTSD and depression symptoms mediated associations between trauma types and being out of the workforce. Findings can inform screening for military trauma exposures, mental health, and work-related needs among women veterans.
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12
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Abstract
Therapists trained to provide eye movement desensitization and reprocessing (EMDR) therapy have a global responsibility. This article summarizes the multiple impacts of high stress events, and their long-term effects on individuals, families, communities, and nations. While it is well documented that EMDR treatment will remediate the individual symptoms of posttraumatic stress, research is still needed to determine how far-reaching such outcomes are. Future studies should determine whether treatment reverses the neurobiological changes, cognitive deficits, and affective dysregulation, which are associated with exposure to traumatic events. Research should also investigate whether successful treatment decreases high-risk and/or perpetrator behavior, and whether these effects are translated into behavioral and attitudinal changes sufficient to bring an end to intergenerational trauma and ethnopolitical conflicts. It seems self-evident that the ideal way to address pressing societal needs, on both local and global levels, is by the integration of science and practice. The article also discusses the development of nonprofit EMDR humanitarian assistance programs, and their essential work in the alleviation of suffering around the world. In addition to recommending the examination of EMDR's efficacy in treating traumatization from direct, natural, structural, and cultural causes, this article advocates that research resources be dedicated for testing interventions in the areas of the world with the greatest needs. The alleviation of suffering is the duty of our profession.
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13
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Skopp NA, Roggenkamp H, Hoyt TV, Major HM, Williams TJ. Army Sexual Harassment/Sexual Assault Response & Prevention Program (SHARP) Tiger Team: A Model to Inform Prevention. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2019.1670763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nancy A. Skopp
- Psychological Health Center of Excellence (PHCoE), Research and Development Dictorate (J-9), Defense Health Agency (DHA), Tacoma, Washington
| | - Hannah Roggenkamp
- Trauma Recovery Services, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | | | | | - Tammy J. Williams
- Madigan Army Medical Center Department of Behavioral Health, JBLM, Tacoma, Washington
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14
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Blais RK, Brignone E, Fargo JD, Livingston WS, Andresen FJ. The importance of distinguishing between harassment-only and assault military sexual trauma during screening. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1598218] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Emily Brignone
- Department of Psychology, Utah State University, Logan, Utah
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15
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Daniel S, Neria A, Moore A, Davis E. The Impact of Leadership Responses to Sexual Harassment and Gender Discrimination Reports on Emotional Distress and Retention Intentions in Military Members. J Trauma Dissociation 2019; 20:357-372. [PMID: 30784361 DOI: 10.1080/15299732.2019.1571887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reporting instances of sexual harassment and gender discrimination in the workplace is an integral part of the prevention and response efforts of the United States Department of Defense (DoD). Any military member who comes forward to report their experience should be provided appropriate intervention, support, and restorative care. While much research has focused on prevention efforts and encouraging reporting, few researchers have systematically examined what happens when military members come forward. In the military, leaders (the chain of command) are primarily responsible for receiving and investigating reports of potential sex-based military equal opportunity violations (SBMEO) involving sexual harassment or gender discrimination. This study used results from the congressionally-mandated 2016 Workplace and Gender Relations Survey of Active Duty Members (2016 WGRA) to identify military members who indicated experiencing a potential SBMEO violation and reported to their chain of command (n = 3,982) in order to examine the relationships among the actions as a result of reporting, reporting satisfaction, emotional distress, and retention intentions. Findings revealed experiencing positive actions as a result of reporting was associated with increased satisfaction with reporting, which in turn, was associated with decreased emotional distress and increased retention intentions. Conversely, experiencing negative actions as a result of reporting was associated with decreased satisfaction with reporting, increased emotional distress, and decreased retention intentions. These findings highlight the crucial role military leaders serve in supporting those who come forward in mitigating potential negative outcomes associated with SBMEO violations that could impact military readiness.
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Affiliation(s)
| | - Adon Neria
- a Office of People Analytics , Alexandria , VA , USA
| | - Abigail Moore
- a Office of People Analytics , Alexandria , VA , USA
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16
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Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV. Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans. Semin Reprod Med 2019; 36:361-370. [PMID: 31003251 DOI: 10.1055/s-0039-1678749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
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Affiliation(s)
- Lori M Gawron
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - April F Mohanty
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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17
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Prescod DJ, Zeligman M. Career Adaptability of Trauma Survivors: The Moderating Role of Posttraumatic Growth. CAREER DEVELOPMENT QUARTERLY 2018. [DOI: 10.1002/cdq.12126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Diandra J. Prescod
- Department of Educational Psychology, Counseling, and Special Education; Pennsylvania State University
| | - Melissa Zeligman
- Department of Counseling and Psychological Services; Georgia State University
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18
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Armenta RF, Rush T, LeardMann CA, Millegan J, Cooper A, Hoge CW. Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry 2018; 18:48. [PMID: 29452590 PMCID: PMC5816529 DOI: 10.1186/s12888-018-1590-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 01/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) can have long-term and far-reaching impacts on health and social and occupational functioning. This study examined factors associated with persistent PTSD among U.S. service members and veterans. METHODS Using baseline and follow-up (2001-2013) questionnaire data collected approximately every 3 years from the Millennium Cohort Study, multivariable logistic regression was conducted to determine factors associated with persistent PTSD. Participants included those who screened positive for PTSD using the PTSD Checklist-Civilian Version at baseline (N = 2409). Participants were classified as having remitted or persistent PTSD based on screening negative or positive, respectively, at follow-up. RESULTS Almost half of participants (N = 1132; 47%) met criteria for persistent PTSD at the first follow-up; of those, 804 (71%) also screened positive for PTSD at the second follow-up. Multiple factors were independently associated with persistent PTSD in an adjusted model at the first follow-up, including older age, deployment with high combat exposure, enlisted rank, initial PTSD severity, depression, history of physical assault, disabling injury/illness, and somatic symptoms. Among those with persistent PTSD at the first follow-up, additional factors of less sleep, separation from the military, and lack of social support were associated with persistent PTSD at the second follow-up. CONCLUSIONS Combat experiences and PTSD severity were the most salient risk factors for persistent PTSD. Comorbid conditions, including injury/illness, somatic symptoms, and sleep problems, also played a significant role and should be addressed during treatment. The high percentage of participants with persistent PTSD supports the need for more comprehensive and accessible treatment, especially after separation from the military.
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Affiliation(s)
- Richard F. Armenta
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA ,0000 0004 0614 9826grid.201075.1The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD USA
| | - Toni Rush
- 0000 0001 2107 4242grid.266100.3Department of Family Medicine and Public Health, La Jolla, University of California, San Diego, School of Medicine, San Diego, CA USA
| | - Cynthia A. LeardMann
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA ,0000 0004 0614 9826grid.201075.1The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD USA
| | - Jeffrey Millegan
- 0000 0001 0639 7318grid.415879.6Directorate of Mental Health, Naval Medical Center San Diego, San Diego, CA USA
| | - Adam Cooper
- 0000 0004 0587 8664grid.415913.bDeployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
| | - Charles W. Hoge
- 0000 0001 0036 4726grid.420210.5Walter Reed Army Institute of Research, Silver Spring, MD USA
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19
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Seelig AD, Rivera AC, Powell TM, Williams EC, Peterson AV, Littman AJ, Maynard C, Street AE, Bricker JB, Boyko EJ. Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members. J Trauma Stress 2017; 30:502-511. [PMID: 28906037 DOI: 10.1002/jts.22214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.
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Affiliation(s)
- Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Anna C Rivera
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Teresa M Powell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Arthur V Peterson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Charles Maynard
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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20
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Watkins K, Bennett R, Zamorski MA, Richer I. Military-related sexual assault in Canada: a cross-sectional survey. CMAJ Open 2017; 5:E496-E507. [PMID: 28642253 PMCID: PMC5498324 DOI: 10.9778/cmajo.20160140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most research on military-related sexual assault is based on the United States military and has important limitations, such as low response rates. We sought to estimate the lifetime prevalence of sexual assault, assess its relation to military service and identify the circumstances, correlates and associations with mental disorders of military-related sexual assault among Canadian military personnel. METHODS We used the 2013 Canadian Forces Mental Health Survey, a cross-sectional representative survey of Canadian Regular Force personnel (n = 6696). The sample was weighted to be representative of the entire Canadian Armed Forces Regular Force population in 2012 (n = 67 776), as per Statistics Canada requirements. We assessed lifetime trauma exposure and past-year mental disorders using the Composite International Diagnostic Interview. We defined lifetime military-related sexual assault as forced sexual activity or unwanted sexual touching that occurred on deployment or in another military workplace, or was perpetrated by Department of National Defence or Canadian Armed Forces personnel. We defined all other sexual assault as non-military-related sexual assault. RESULTS Self-reported sexual assault was more prevalent among women (non-military-related sexual assault 24.2%, military-related sexual assault 15.5%) than men (5.9% and 0.8%, respectively). About a quarter of women with military-related sexual assault reported experiencing at least 1 event on deployment. After covariates were controlled for, military-related sexual assault was independently associated with any lifetime and any past-year mental disorder (adjusted odds ratio 2.9 and 3.0, respectively) and lifetime and past-year posttraumatic stress disorder (adjusted odds ratio 4.3 and 4.1, respectively). INTERPRETATION Canadian military women are at increased risk for sexual assault and military-related sexual assault relative to their male counterparts. Deployment may be a period of elevated risk for military-related sexual assault, and women who reported military-related sexual assault are more likely to have experienced mental disorders, especially posttraumatic stress disorder.
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Affiliation(s)
| | - Rachel Bennett
- Affiliation: Department of National Defence, Ottawa, Ont
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21
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Rosellini AJ, Street AE, Ursano RJ, Chiu WT, Heeringa SG, Monahan J, Naifeh JA, Petukhova MV, Reis BY, Sampson NA, Bliese PD, Stein MB, Zaslavsky AM, Kessler RC. Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army. Am J Public Health 2017; 107:732-739. [PMID: 28323466 DOI: 10.2105/ajph.2017.303693] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure. METHODS We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes. RESULTS Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2). CONCLUSIONS Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.
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Affiliation(s)
- Anthony J Rosellini
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Amy E Street
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Robert J Ursano
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Wai Tat Chiu
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Steven G Heeringa
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - John Monahan
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - James A Naifeh
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Maria V Petukhova
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Ben Y Reis
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Nancy A Sampson
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Paul D Bliese
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Murray B Stein
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Alan M Zaslavsky
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
| | - Ronald C Kessler
- Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego
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22
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Millegan J, Wang L, LeardMann CA, Miletich D, Street AE. Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military. J Trauma Stress 2016; 29:132-40. [PMID: 27077493 DOI: 10.1002/jts.22081] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/14/2015] [Accepted: 12/31/2015] [Indexed: 11/08/2022]
Abstract
Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004-2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.
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Affiliation(s)
- Jeffrey Millegan
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, California, USA
| | - Lawrence Wang
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Cynthia A LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Derek Miletich
- Directorate of Mental Health, Naval Medical Center San Diego, San Diego, California, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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