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Factors Associated with Military Sexual Trauma (MST) Disclosure During VA Screening Among Women Veterans

  • Original Research
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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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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available because patient consent was not obtained to do so. Additionally, women Veterans are a small enough subset of all Veterans that the survey data could be used to re-identify participants, which would run counter to VA human subjects protections requirements.

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Acknowledgements

We thank the Veterans who participated in this study and the patient survey team.

Funding

This research was supported in part by the Health Resources and Services Administration T32HP19025 (ASH), U.S. Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Award IK2 HX002402 (CJG), and VA HSR&D Implementation of Women’s Health Patient Aligned Care Teams study (Project #CRE 12–026) and the VA Women’s Health Research Network (Project #SDR 10–012) (EMJ). Dr. Yano’s time was covered by a VA HSR&D Senior Research Career Scientist Award (Project #RCS 05–195).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA

    Anita S. Hargrave MD MAS

  2. San Francisco VA Health Care System, San Francisco, CA, USA

    Anita S. Hargrave MD MAS & Carolyn J. Gibson PhD MPH

  3. Division of General Internal Medicine, Minneapolis VA Medical Center: Minneapolis VA Health Care System, Minneapolis, MN, USA

    Elisheva R. Danan MD MPH

  4. Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Elisheva R. Danan MD MPH

  5. Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Claire T. Than PhD & Elizabeth M. Yano PhD MSPH

  6. Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA

    Carolyn J. Gibson PhD MPH

  7. Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano PhD MSPH

  8. Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA

    Elizabeth M. Yano PhD MSPH

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  1. Anita S. Hargrave MD MAS
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Correspondence to Anita S. Hargrave MD MAS.

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Hargrave, A.S., Danan, E.R., Than, C.T. et al. Factors Associated with Military Sexual Trauma (MST) Disclosure During VA Screening Among Women Veterans. J GEN INTERN MED 38, 3188–3197 (2023). https://doi.org/10.1007/s11606-023-08257-6

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  • DOI: https://doi.org/10.1007/s11606-023-08257-6

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