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Gibson CJ, Bahorik A, Xia F, Peltz C, Yaffe K. Intimate Partner Violence, Mental Health, and Aging-Related Health Among Men and Women Veterans Across the Lifespan. J Gen Intern Med 2024; 39:931-939. [PMID: 37962725 DOI: 10.1007/s11606-023-08466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A growing body of evidence suggests adverse health outcomes related to intimate partner violence (IPV), including traumatic brain injury (TBI). However, most research in this area has focused on reproductive-aged women. OBJECTIVE To examine relationships between IPV (with and without TBI), mental health, and aging-related health outcomes among men and women Veterans across the lifespan. DESIGN Cross-sectional analysis of Department of Veterans Affairs (VA) administrative data from fiscal years 2000-2019. Descriptive statistics and chi-square analyses were used to compare key comorbidities in matched samples of Veterans with and without IPV (gender-stratified and matched 1:3 based on demographics and index date). Comparisons between those with IPV and TBI relative to IPV alone were also examined. SUBJECTS Veterans aged 18 + with and without documented IPV in Department of Veterans Affairs (VA) electronic health records (n = 4108 men, 2824 women). MAIN MEASURES ICD codes were used to identify IPV, TBI, and aging-related medical (sleep disorder, hypertension, diabetes, dementia) and common psychiatric (depression, posttraumatic stress disorder, alcohol use disorder, and substance use disorder) diagnoses. KEY RESULTS Demographic characteristics were reflective of VA-enrolled Veterans (men: mean age 66, SD 16; 72% non-Hispanic White; women: mean age 47, SD 13; 64% non-Hispanic White). Relative to Veterans without IPV, both men and women with IPV had higher rates of all examined medical (e.g., sleep disorders, men: 33% vs. 52%; women: 45% vs. 63%) and psychiatric diagnoses (e.g., depression, men 32% vs. 74%; women 59% vs. 91%; all ps < .001), with evidence of an additive effect of TBI on some psychiatric outcomes. CONCLUSIONS IPV is broadly associated with aging-related and mental health, and TBI is a common correlate that may further contribute to psychiatric outcomes. Findings highlight the importance of trauma-informed care and recognizing the potential role of these exposures on men and women Veterans' health across the lifespan.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, CA, USA.
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Amber Bahorik
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Feng Xia
- NCIRE-The Veterans' Health Research Institute, San Francisco, CA, USA
| | - Carrie Peltz
- NCIRE-The Veterans' Health Research Institute, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA
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Iverson KM, Livingston WS, Vogt D, Smith BN, Kehle-Forbes SM, Mitchell KS. Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples. J Gen Intern Med 2024; 39:418-427. [PMID: 38010460 PMCID: PMC10897119 DOI: 10.1007/s11606-023-08486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups. OBJECTIVE To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups. DESIGN Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age. PARTICIPANTS Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate). MAIN MEASURES SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool. KEY RESULTS Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation. CONCLUSIONS Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Whitney S Livingston
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dawne Vogt
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brian N Smith
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shannon M Kehle-Forbes
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Karen S Mitchell
- Women's Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Relyea MR, Presseau C, Runels T, Humbert MM, Martino S, Brandt CA, Haskell SG, Portnoy GA. Understanding Veterans' intimate partner violence use and patterns of healthcare utilization. Health Serv Res 2023; 58:1198-1208. [PMID: 37452496 PMCID: PMC10622301 DOI: 10.1111/1475-6773.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To understand the association between Veterans' healthcare utilization and intimate partner violence (IPV) use (i.e., perpetration) in order to (1) identify conditions comorbid with IPV use and (2) inform clinical settings to target for IPV use screening, intervention, and provider training. DATA SOURCES AND STUDY SETTING We examined survey data from a national sample of 834 Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) Veterans. STUDY DESIGN We assessed associations between past-year IPV use and medical treatment, health issues, and use of Veterans Health Administration (VA) and non-VA services using chi-square tests and logistic regression. DATA COLLECTION/EXTRACTION METHODS Data were derived from the Department of Defense OEF/OIF/OND Roster. Surveys were sent to all women Veterans and a random sample of men from participating study sites. PRINCIPAL FINDINGS Half (49%) of the Veterans who reported utilizing VA healthcare in the past year indicated using IPV. Q values using a 5% false discovery rate indicated that Veterans who used IPV were more likely than Veterans who did not use IPV to have received treatment for post-traumatic stress disorder (PTSD; 39% vs. 27%), chronic sleep problems (36% vs. 26%), anxiety or depression (44% vs. 36%), severe chronic pain (31% vs. 22%), and stomach or digestive disorders (24% vs. 16%). Veterans who used IPV were also more likely than Veterans who did not use IPV to have received medical treatment in the past year (86% vs. 80%), seen psychiatrists outside VA (39% vs. 20%), and have outpatient healthcare outside VA (49% vs. 41%). IPV use was not related to whether Veterans received care from VA or non-VA providers. CONCLUSIONS Veterans' IPV use was related to greater utilization of services for mental health, chronic pain, and digestive issues. Future research should examine whether these are risk factors or consequences of IPV use.
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Affiliation(s)
- Mark R. Relyea
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Candice Presseau
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Tessa Runels
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | | | - Steve Martino
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Sally G. Haskell
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Galina A. Portnoy
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of MedicineNew HavenConnecticutUSA
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Hargrave AS, Danan ER, Than CT, Gibson CJ, Yano EM. Factors Associated with Military Sexual Trauma (MST) Disclosure During VA Screening Among Women Veterans. J Gen Intern Med 2023; 38:3188-3197. [PMID: 37291361 PMCID: PMC10651589 DOI: 10.1007/s11606-023-08257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Capturing military sexual trauma (MST) exposure is critical for Veterans' health equity. For many, it improves access to VA services and allows for appropriate care. OBJECTIVE Identify factors associated with nondisclosure of MST in VA screening among women. DESIGN Cross-sectional telephone survey linked with VA electronic health record (EHR) data. PARTICIPANTS Women Veterans using primary care or women's health services at 12 VA facilities in nine states. MAIN MEASURES Survey self-reported MST (sexual assault and/or harassment during military service), socio-demographics and experiences with VA care, as well as EHR MST results. Responses were categorized as "no MST" (no survey or EHR MST), "MST captured by EHR and survey," and "MST not captured by EHR" (survey MST but no EHR MST). We used stepped multivariable logistic regression to examine "MST not captured by EHR" as a function of socio-demographics, patient experiences, and screening method (survey vs. EHR). KEY RESULTS Among 1287 women (mean age 50, SD 15), 35% were positive for MST by EHR and 61% were positive by survey. Approximately 38% had "no MST," 34% "MST captured by EHR and survey," and 26% "MST not captured by EHR". In fully adjusted models, odds of "MST not captured by EHR" were higher among Black and Latina women compared to white women (Black: OR = 1.6, 1.2-2.2; Latina: OR = 1.9, 1.0-3.6). Women who endorsed only sexual harassment in the survey (vs. sexual harassment and sexual assault) had fivefold higher odds of "MST not captured by EHR" (OR = 4.9, 3.2-7.3). Women who were screened for MST in the EHR more than once had lower odds of not being captured (OR = 0.3, 0.2-0.4). CONCLUSIONS VA screening for MST may disproportionately under capture patients from historically minoritized ethnic/racial groups, creating inequitable access to resources. Efforts to mitigate screening disparities could include re-screening and reinforcing that MST includes sexual harassment.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
- San Francisco VA Health Care System, San Francisco, CA, USA.
| | - Elisheva R Danan
- Division of General Internal Medicine, Minneapolis VA Medical Center: Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Claire T Than
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA
| | - Elizabeth M Yano
- 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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Portnoy GA, Relyea MR, Presseau C, Orazietti SA, Bruce LE, Brandt CA, Martino S. Screening for Intimate Partner Violence Experience and Use in the Veterans Health Administration. JAMA Netw Open 2023; 6:e2337685. [PMID: 37831451 PMCID: PMC10576210 DOI: 10.1001/jamanetworkopen.2023.37685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
Importance The practice of screening women for intimate partner violence (IPV) in health care settings has been a critical part of responding to this major public health problem. Yet, IPV prevention would be enhanced with detection efforts that extend beyond screening for IPV experiences to identifying those who use violence in relationships as well. Objective To determine rates of IPV experiences and use (ie, among perpetrators of IPV) and factors associated with disclosures among adult patients seeking mental health services at the Veterans Health Administration. Design, Setting, and Participants This cross-sectional study used electronic medical record data drawn from a quality improvement initiative at 5 Veterans Health Administration medical centers conducted between November 2021 and February 2022 to examine IPV disclosures following concurrent screening for IPV experience and use. Participants included patients engaged in mental health services. Data were analyzed in April and May 2023. Exposure Mental health clinicians were trained to screen for IPV experience and use concurrently and instructed to screen all patients encountered through routine mental health care visits during a 3-month period. Main Outcomes and Measures Outcomes of interest were past-year prevalence of IPV use and experience, sociodemographic characteristics, and clinical diagnoses among screened patients. Results A total of 200 patients were offered IPV screening. Of 155 participants (mean [SD] age, 52.45 [15.65] years; 124 [80.0%] men) with completed screenings, 74 (47.7%) denied past-year IPV experience and use, 76 (49.0%) endorsed past-year IPV experience, and 72 (46.4%) endorsed past-year IPV use, including 67 participants (43.2%) who reported IPV experience and use concurrently; only 9 participants (5.8%) endorsed unidirectional IPV experiences and 5 participants (3.2%) endorsed unidirectional IPV use. Patients who reported past-year IPV experience and use were younger than those who denied IPV (experience: mean difference, -7.34 [95% CI, 2.51-12.17] years; use: mean difference, -7.20 [95% CI, 2.40-12.00] years). Patients with a posttraumatic stress disorder diagnosis were more likely to report IPV use (43 patients [59.7%]) than those without a posttraumatic stress disorder diagnosis (29 patients [40.3%]; odds ratio, 2.14; [95% CI, 1.12-4.06]). No other demographic characteristics or clinical diagnoses were associated with IPV use or experience. Conclusions and Relevance In this cross-sectional study of IPV rates and associated factors, screening for IPV found high rates of both IPV experience and use among patients receiving mental health care. These findings highlight the benefit of screening for IPV experience and use concurrently across gender and age. Additionally, the associations found between PTSD and IPV use underscore the importance of strengthening and developing additional targeted treatment for IPV.
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Affiliation(s)
- Galina A. Portnoy
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Mark R. Relyea
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Candice Presseau
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | | | - LeAnn E. Bruce
- Veterans Healthcare Administration Intimate Partner Violence Assistance Program, Washington, District of Columbia
- Western Kentucky University School of Social Work, Bowling Green
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven
- Yale School of Medicine, New Haven, Connecticut
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Iverson KM, Stolzmann KL, Brady JE, Adjognon OL, Dichter ME, Lew RA, Gerber MR, Portnoy GA, Iqbal S, Haskell SG, Bruce LE, Miller CJ. Integrating Intimate Partner Violence Screening Programs in Primary Care: Results from a Hybrid-II Implementation-Effectiveness RCT. Am J Prev Med 2023; 65:251-260. [PMID: 37031032 PMCID: PMC10568536 DOI: 10.1016/j.amepre.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The Veterans Health Administration initiated implementation facilitation to integrate intimate partner screening programs in primary care. This study investigates implementation facilitation's impact on implementation and clinical effectiveness outcomes. STUDY DESIGN A cluster randomized, stepped-wedge, hybrid-II implementation-effectiveness trial (January 2021-April 2022) was conducted amidst the COVID-19 pandemic. SETTING/PARTICIPANTS Implementation facilitation was applied at 9 Veterans Health Administration facilities, staged across 2 waves. Participants were all women receiving care at participating primary care clinics 3 months before (pre-implementation facilitation n=2,272) and 9 months after initiation of implementation facilitation (implementation facilitation n=5,149). INTERVENTION Implementation facilitation included an operations-funded external facilitator working for 6 months with a facility-funded internal facilitator from participating clinics. The pre-implementation facilitation period comprised implementation as usual in the Veterans Health Administration. MAIN OUTCOME MEASURES Primary outcomes were changes in (1) reach of intimate partner violence (IPV) screening programs among eligible women (i.e., those seen within participating clinics during the assessment period; implementation outcome) and (2) disclosure rates among screened women (effectiveness outcome). Secondary outcomes included disclosure rates among all eligible women and post-screening psychosocial service use. Administrative data were analyzed. RESULTS For primary outcomes, women seen during the implementation facilitation period were nearly 3 times more likely to be screened for IPV than women seen during the pre-implementation facilitation period (OR=2.70, 95% CI=2.46, 2.97). Women screened during the implementation facilitation period were not more likely to disclose IPV than those screened during the pre-implementation facilitation period (OR=1.14, 95% CI=0.86, 1.51). For secondary outcomes, owing to increased reach of screening during implementation facilitation, women seen during the implementation facilitation period were more likely to disclose IPV than those seen during the pre-implementation facilitation period (OR=2.09, 95% CI=1.52, 2.86). Women screened during implementation facilitation were more likely to use post-screening psychosocial services than those screened during pre-implementation facilitation (OR=1.29, 95% CI=1.06, 1.57). CONCLUSIONS Findings indicate that implementation facilitation may be a promising strategy for increasing the reach of IPV screening programs in primary care, thereby increasing IPV detection and strengthening connections to support services among the patient population. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT04106193.
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Affiliation(s)
- Katherine M Iverson
- Women's Health Sciences Division, PTSD: National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts; Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
| | - Kelly L Stolzmann
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Julianne E Brady
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Omonyêlé L Adjognon
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, Pennsylvania; School of Social Work, Temple University, Philadelphia, Pennsylvania
| | - Robert A Lew
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) & CSP Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Megan R Gerber
- Division of General Internal Medicine, Department of Medicine, Albany Medical College, Albany, New York; Albany Stratton VA Medical Center, Albany, New York
| | - Galina A Portnoy
- Pain Research Informatics Multi-Morbidity Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Samina Iqbal
- VA Palo Alto Healthcare System, Palo Alto, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sally G Haskell
- Pain Research Informatics Multi-Morbidity Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - LeAnn E Bruce
- Intimate Partner Violence Assistance Program, Care Management and Social Work, U.S. Department of Veterans Affairs, Washington, District of Columbia; Department of Social Work, Western Kentucky University, Bowling Green, Kentucky
| | - Christopher J Miller
- Center for Healthcare Organization & Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Hargrave AS, Maguen S, Inslicht SS, Byers AL, Seal KH, Huang AJ, Gibson CJ. Veterans Health Administration Screening for Military Sexual Trauma May Not Capture Over Half of Cases Among Midlife Women Veterans. Womens Health Issues 2022; 32:509-516. [PMID: 35821182 PMCID: PMC9949350 DOI: 10.1016/j.whi.2022.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately 1 in 3 women veterans endorse military sexual trauma (MST) during Veterans Health Administration (VHA) screening. Higher rates have been reported in anonymous surveys. OBJECTIVE We compared MST identified by VHA screening to survey-reported MST within the same sample and identified participant characteristics associated with discordant responses. METHODS Cross-sectional data were drawn from an observational study of women veterans aged 45-64 enrolled in VHA care in Northern California, with data from mail- and web-based surveys linked to VHA electronic health records (EHRs). Between March 2019 and May 2020, participants reported sociodemographic characteristics, current depressive (Patient Health Questionnaire-9) and posttraumatic stress (PTSD checklist for DSM-5) symptoms, and MST (using standard VHA screening questions) in a survey; depression and posttraumatic stress disorder diagnoses (ICD-10 codes) and documented MST were identified from EHRs. Associations between sociodemographic characteristics, mental health symptoms and diagnoses, and discordant MST reports (EHR-documented MST vs. MST reported on survey, not in EHR) were examined with multivariable logistic regression. RESULTS In this sample of midlife women veterans (n = 202; mean age 56, SD = 5), 40% had EHR-documented MST, and 74% reported MST on the survey. Sociodemographic characteristics, mental health symptoms, and diagnosed depression were not associated with discordant MST responses. Women with an EHR-documented PTSD diagnosis had fivefold higher odds of having EHR-documented MST (vs. survey only; odds ratio 5.2; 95% confidence interval 2.3-11.9). CONCLUSIONS VHA screening may not capture more than half of women who reported MST on the survey. VHA screening may underestimate true rates of MST, which could lead to a gap in recognition and care for women veterans.
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Affiliation(s)
- Anita S Hargrave
- University of California San Francisco, San Francisco, California.
| | - Shira Maguen
- University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, VA Health Care System, San Francisco, California
| | - Sabra S Inslicht
- University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, VA Health Care System, San Francisco, California
| | - Amy L Byers
- University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, VA Health Care System, San Francisco, California
| | - Karen H Seal
- University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, VA Health Care System, San Francisco, California
| | - Alison J Huang
- University of California San Francisco, San Francisco, California
| | - Carolyn J Gibson
- University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, VA Health Care System, San Francisco, California
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Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE): Initial Evaluation of the Clinical Effects of RISE Administered in Routine Care in the US Veterans Health Administration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148793. [PMID: 35886645 PMCID: PMC9320416 DOI: 10.3390/ijerph19148793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023]
Abstract
Intimate partner violence (IPV) is a common concern among military Veterans that negatively impacts health. The United States’ Veterans Health Administration (VHA) has launched a national IPV Assistance Program (IPVAP) to provide comprehensive services to Veterans, their families and caregivers, and VHA employees who use or experience IPV. Grounded in a holistic, Veteran-centered psychosocial rehabilitation framework that guides all facets of the program, the IPVAP initiated the pilot implementation of a novel intervention called Recovering from IPV through Strengths and Empowerment (RISE). This evidence-based, person-centered, trauma-informed, and empowerment-oriented brief counseling intervention is designed to support those who experience IPV and to improve their psychosocial wellbeing. This program evaluation study describes clinical outcomes from patients who participated in a pilot implementation of RISE in routine care. We examined changes in general self-efficacy, depression, and valued living, as well as treatment satisfaction among patients who received RISE and completed program evaluation measures at VHA facilities during the pilot. Results from 45 patients (84% women) indicate that RISE was associated with significant pretreatment to posttreatment improvements in self-efficacy, depression, and valued living (Cohen’s d s of 0.97, 1.09, and 0.51, respectively). Patients reported high satisfaction with treatment. Though preliminary results were similar across gender and IPV types, findings from the evaluation of the pilot implementation of RISE demonstrate the intervention’s feasibility, acceptability, and clinical utility in routine VHA care and inform the scalability of RISE. Additionally, findings provide preliminary support for the effectiveness and acceptability of RISE with men. Modification to RISE and its implementation are discussed, which may be useful to other settings implementing IPV interventions.
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