Veterans Health Administration Screening for Military Sexual Trauma May Not Capture Over Half of Cases Among Midlife Women Veterans



      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.


      We compared MST identified by VHA screening to survey-reported MST within the same sample and identified participant characteristics associated with discordant responses.


      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.


      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).


      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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      Anita S. Hargrave, MD, is a general internist and National Clinician Scholars Program (NCSP)/Health Resources and Services Administration T32 Fellow at the University of California San Francisco (UCSF) whose research interests are focused on the intersection of trauma, women's health, and health equity.


      Shira Maguen, PhD, is Professor in the Dept. of Psychiatry, UCSF School of Medicine and Mental Health Director of the Post-9/11 Integrated Care Clinic and Staff Psychologist at the San Francisco VA Health Care System. Her research interests fall under the umbrella of PTSD, moral injury, and suicide, and include risk and resilience factors in veterans, with a particular focus on female veterans.


      Sabra S. Inslicht, PhD, MS, is an Associate Professor of Psychiatry in the School of Medicine at UCSF whose research goals include identifying psychobiological causes and consequences of traumatic stress symptoms, utilizing fear conditioning and extinction models to better understand PTSD, characterizing sex differences in the biology of PTSD, improving measurement techniques in the laboratory and the field such as with mobile health devices, and conducting research that will inform novel interventions for ameliorating prolonged PTSD responses.


      Amy L. Byers, PhD, MPH, is a Research Career Scientist at the SFVA Health Care System and Professor of Psychiatry & Behavioral Sciences and Medicine, Division of Geriatrics, UCSF. Her research areas are focused on late-life suicide and neuropsychiatric disorders.


      Karen H. Seal, MD, MPH, is a Professor of Medicine and Psychiatry at UCSF and Chief, Integrative Health at the San Francisco VA Health Care System. Research interests include chronic pain, opioid dependence, and complementary and integrative health approaches in veterans.


      Alison J. Huang, MD, MAS, is an academic general internal medicine physician at UCSF, where she conducted patient-oriented research to advance understanding and improve management of the impact of aging on health and functioning among women in the community.


      Carolyn J. Gibson, PhD, MPH, is a Clinical Research Psychologist at the San Francisco VA Health Care System and Assistant Professor in the UCSF Department of Psychiatry & Behavioral Sciences. Her areas of expertise include women's health, with a focus on menopause and aging.