Military Sexual Trauma Among Homeless Veterans
Military sexual trauma (MST) is the Veteran Health Administration’s (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans.
To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men.
DESIGN AND PARTICIPANTS
National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010.
All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization.
Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST.
A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.
- Kimerling, R, Gima, K, Smith, MW, Street, AE, Frayne, S (2007) The Veterans Health Administration and military sexual trauma. Am J Public Health 97: pp. 2160-6 CrossRef
- Kimerling, R, Street, AE, Pavao, J (2010) Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. Am J Public Health 100: pp. 1409-12 CrossRef
- Hamilton, AB, Poza, I, Washington, DL (2011) Homelessness and trauma go hand-in-hand: pathways to homelessness among women veterans. Womens Health Issues 21: pp. S203-9 CrossRef
- Washington, DL, Yano, EM, McGuire, J, Hines, V, Lee, M, Gelberg, L (2010) Risk factors for homelessness among women veterans. J Health Care Poor Underserved 21: pp. 82-91 CrossRef
- Benda, B (2006) Survival analyses of social support and trauma among homeless male and female veterans who abuse substances. Am J Orthopsychiatry 76: pp. 70-9 CrossRef
- Balshem H, Christensen V, Tuepker A, Kansagara D. A critical review of the literature regarding homelessness among veterans: VA-Evidence Based Synthesis Program Project #05-225; 2011.
- Kushel, MB, Evans, JL, Perry, S, Robertson, MJ, Moss, AR (2003) No door to lock: victimization among homeless and marginally housed persons. Arch Intern Med 163: pp. 2492-9 CrossRef
- Wenzel, SL, Koegel, P, Gelberg, L (2000) Antecedents of physical and sexual victimization among homeless women: a comparison to homeless men. Am J Community Psychol 28: pp. 367-90 CrossRef
- Adams, J, Rosenheck, RA, Gee, L, Seibyl, C, Kushel, M (2007) Hospitalized younger: a comparison of a national sample of homeless and housed inpatient veterans. J Health Care Poor Underserved 18: pp. 173-84 CrossRef
- O’Toole, TP, Conde-Martel, A, Gibbon, JL, Hanusa, BH, Fine, MJ (2003) Health care of homeless veterans. J Gen Intern Med 18: pp. 929-33 CrossRef
- Desai, RA, Harpaz-Rotem, I, Najavits, LM, Rosenheck, RA (2008) Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders. Psychiatr Serv 59: pp. 996-1003 CrossRef
- Wenzel, SL, Leake, BD, Gelberg, L (2000) Health of homeless women with recent experience of rape. J Gen Intern Med 15: pp. 265-8 CrossRef
- Harris, M, Fallot, R eds. (2001) Using Trauma Theory to Design Service Systems. Jossey-Bass, San Francisco
- Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS): U.S. Agency for Healthcare Research and Quality; 2008: Available: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.
- The International Classification of Diseases (9th Rev., Clinical Modification). Authors, Washington
- Suris, AM, Lind, L, Kashner, TM, Borman, PD, Petty, F (2004) Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care. Psychosom Med 66: pp. 749-56 CrossRef
- Street, AE, Stafford, J, Mahan, CM, Hendricks, A (2008) Sexual harassment and assault experienced by reservists during military service: prevalence and health correlates. J Rehabil Res Dev 45: pp. 409-20 CrossRef
- North, CS, Smith, EM, Spitznagel, EL (1994) Violence and the homeless: an epidemiologic study of victimization and aggression. J Trauma Stress 7: pp. 95-110 CrossRef
- Yaeger, D, Himmelfarb, N, Cammack, A, Mintz, J (2006) DSM-IV diagnosed posttraumatic stress disorder in women veterans with and without military sexual trauma. J Gen Intern Med 21: pp. S65-9 CrossRef
- Sadler, AG, Booth, BM, Cook, BL, Doebbeling, BN (2003) Factors associated with women’s risk of rape in the military environment. Am J Ind Med 43: pp. 262-73 CrossRef
- Gidycz, CA, Coble, CN, Latham, L, Layman, MJ (1993) Sexual assault experience in adulthood and prior victimization experiences: a prospective analysis. Psychol Women Q 17: pp. 151-68 CrossRef
- McIntyre, LM, Butterfield, MI, Nanda, K (1999) Validation of a trauma questionnaire in veteran women. J Gen Intern Med 14: pp. 186-9 CrossRef
- Agar, K, Read, J, Bush, J-M (2002) Identification of abuse histories in a community mental health centre. J Ment Heal 11: pp. 533-43 CrossRef
- Campbell, R, Raja, S (2005) The sexual assault and secondary victimization of female veterans: help-seeking experiences with military and civilian social systems. Psychol Women Q 29: pp. 97-106 CrossRef
- Friedman, LS, Samet, JH, Roberts, MS, Hudlin, M, Hans, P (1992) Inquiry about victimization experiences: a survey of patient preferences and physician practices. Arch Intern Med 152: pp. 1186-90 CrossRef
- McCauley, J, Yurk, RA, Jenckes, MW, Ford, DE (1998) Inside “Pandora’s box”: abused women’s experiences with clinicians and health services. J Gen Intern Med 13: pp. 549-55 CrossRef
- Hamilton, AB, Poza, I, Hines, V, Washington, DL (2012) Barriers to psychosocial services among homeless women veterans. J Soc Work Pract Addict 12: pp. 52-68 CrossRef
- Smelson DA, Sawh L, Kane V, Kuhn J, Ziedonis D. The MISSION-VET Treatment Manual: United States Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development and The National Center on Homelessness Among Veterans; 2011.
- Military Sexual Trauma Among Homeless Veterans
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Journal of General Internal Medicine
Volume 28, Issue 2 Supplement, pp 536-541
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- Author Affiliations
- 1. National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, 795 Willow Rd (PTSD-324), Menlo Park, CA, 94025, USA
- 2. Department of Veterans Affairs, Mental Health Services, Washington, DC, USA
- 3. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- 4. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA
- 5. Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA, USA