Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

Journal of General Internal Medicine, Jul 2013

Background Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. Objective The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. Design Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. Participants Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). Main Measures Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. Key Results LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001). Conclusions Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

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Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

Kristin M. Mattocks 6 7 Anne Sadler RN 5 12 Elizabeth M. Yano MSPH 10 11 Erin E. Krebs 9 14 Laurie Zephyrin 13 Cynthia Brandt 3 8 Rachel Kimerling 4 Theo Sandfort 1 Melissa E. Dichter MSW 2 Jeffrey J. Weiss MS 0 Jeroan Allison MS 6 Sally Haskell 3 8 0 Department of Medicine, Division of General Internal MedicineMount Sinai School of Medicine , New York, NY, USA 1 HIV Center for Clinical and Behavioral StudiesColumbia University , New York, NY, USA 2 Center for Health Equity Research and Promotion (CHERP)Philadelphia VA Medical Center , Philadelphia, PA, USA 3 Yale University School of Medicine , New Haven, CT, USA 4 National Center for PTSD, Center for Health Care EvaluationVA Palo Alto Health Care System , Menlo Park, CA, USA 5 Comprehensive Access & Delivery Research and Evaluation (CADRE), Mental Health Service LineIowa City VA Health Care System , Iowa City, IA, USA 6 Department of Quantitative Health SciencesUniversity of Massachusetts Medical School , Worcester, MA, USA 7 VA Central Western Massachusetts , Leeds, MA, USA 8 VA Connecticut Healthcare System , West Haven, CT, USA 9 Center for Chronic Disease Outcomes ResearchMinneapolis VA Health Care System , Minneapolis, MN, USA 10 UCLA School of Public Health , Los Angeles, CA, USA 11 VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior , Sepulveda, CA, USA 12 Department of PsychiatryUniversity of Iowa Hospitals and Clinics , Iowa City, IA, USA 13 Department of Veterans Affairs , Washington, DC, USA 14 University of Minnesota Medical School , Minneapolis, MN, USA - BACKGROUND: Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. OBJECTIVE: The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. DESIGN: Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. PARTICIPANTS: Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). MAIN MEASURES: Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. KEY RESULTS: LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p<.001; childhood sexual trauma: 60 % vs. 36 %, p=.01), to be hazardous drinkers (32 % vs. 16 %, p=.03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p<.001). CONCLUSIONS: Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country. INTRODUCTION Many lesbian and bisexual (LB) veterans have been targets of victimization in the military based on their gender and presumed sexual orientation. Under Dont Ask, Dont Tell (DADT), thousands of LB women were discharged from military service, while countless others continued to serve in silence, and, as veterans, sought care from the Department of Veterans Affairs (VA).1,2 Prior research has shown that many LB veterans experience discrimination, rejection and/or poor care following disclosure of their sexuality to healthcare providers,3 and may engage in strategies to avoid conversations regarding sexual identity. These experiences may be particularly harmful for LB veterans returning from military deployments with substantial physical and mental health problems,47 and possibly compounded by lingering effects of targeted sexual assault and harassment experienced during military service based on perceived sexual orientation.8 Recent research9 indicates that 15.1 % of female OEF/OIF veterans report experiencing sexual trauma during military service. Given these healthcare needs among LB veterans, and the potential for underuse/care avoidance, understanding the healthcare needs of this population is crucial if the VA is to provide comprehensive care to all women veterans, regardless of sexual orientation. Study Design The Women Veter (...truncated)


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Kristin M. Mattocks PhD, MPH, Anne Sadler PhD, RN, Elizabeth M. Yano PhD, MSPH, Erin E. Krebs MD, MPH, Laurie Zephyrin MD, MPH, MBA, Cynthia Brandt MD, MPH, Rachel Kimerling PhD, Theo Sandfort PhD, Melissa E. Dichter PhD, MSW, Jeffrey J. Weiss PhD, MS, Jeroan Allison MD, MS, Sally Haskell MD. Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans, Journal of General Internal Medicine, 2013, pp. 604-608, Volume 28, Issue 2, DOI: 10.1007/s11606-013-2357-9