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Military Sexual Assault and Homeless Women Veterans: Clinical Correlates and Treatment Preferences

  • Suzanne E. Decker
    Correspondence
    Correspondence to: Suzanne E. Decker, PhD, VACT, 950 Campbell Avenue, 116B, West Haven, CT 06516. Phone: 203-932-5711 ×3153; fax: 203-937-3478.
    Affiliations
    VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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  • Robert A. Rosenheck
    Affiliations
    VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut

    Yale School of Epidemiology and Public Health, New Haven, Connecticut
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  • Jack Tsai
    Affiliations
    VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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  • Rani Hoff
    Affiliations
    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut

    Yale School of Epidemiology and Public Health, New Haven, Connecticut

    Northeast Program Evaluation Center, West Haven, Connecticut
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  • Ilan Harpaz-Rotem
    Affiliations
    VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut

    Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut

    Clinical Neurosciences Division, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, Connecticut
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      Abstract

      Background

      Both homeless women and women who have experienced military sexual assault (MSA) are at high risk of serious psychological sequelae. However, little is known about the combined impact of MSA and current homelessness on psychological distress, or about distinctive treatment preferences among homeless female veterans affected by MSA.

      Methods

      This observational study compared clinical symptoms, pre-military experiences, and treatment preferences among 509 female veterans with and without MSA who enrolled in 11 VA Homeless Women Veterans Programs.

      Results

      Over one third of participants (41.1%) reported MSA. In multivariate analyses, homeless female veterans who reported MSA endorsed greater severity of PTSD and other psychiatric symptoms. Those who had experienced MSA were more likely to report interest in treatment, and treatment focused on safety was reported as especially attractive.

      Conclusions

      Among homeless female veterans, MSA is associated with greater mental health symptoms and greater interest in safety-focused treatment. Services targeting the needs of homeless MSA survivors should be encouraged.
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      Biography

      Suzanne E. Decker, PhD, completed the VA's Advanced Fellowship in Mental Illness Research and Treatment at VA New England MIRECC and Yale School of Medicine and is now a staff psychologist at VA Connecticut Health Care System and Assistant Clinical Professor in the department of Psychiatry at Yale University School of Medicine. Her interests include mental health services research, implementation science, and clinician training.

      Biography

      Robert A. Rosenheck, MD, is Professor of Psychiatry at the Yale University School of Medicine, and at the VA New England MIRECC. He has published over 600 peer-reviewed papers on program evaluation of homelessness, mental health services, and psychotropic medications.

      Biography

      Jack Tsai, PhD, is Assistant Professor of Psychiatry at Yale University School of Medicine and Investigator for the VA's New England Mental Illness, Research, Education, and Clinical Center. He is focused on health services research for homeless and traumatized populations.

      Biography

      Rani Hoff, MPH, PhD, is Associate Professor of Psychiatry and Epidemiology and Director of the Northeast Program Evaluation Center and Evaluation Division of the National Center for PTSD. Her interests include female Veterans, program evaluation, and PTSD.

      Biography

      Ilan Harpaz-Rotem, PhD, is Associate Professor of Psychiatry at Yale University School of Medicine and National Center for PTSD Clinical Neurosciences Division. His interests include PTSD, mental health services research, and psychotherapy outcomes research.