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Sexual Assault in Women Veterans: An Examination of PTSD Risk, Health Care Utilization, and Cost of Care

Surís, Alina PhD; Lind, Lisa PhD; Kashner, T Michael JD, PhD, MPH; Borman, Patricia D. PhD; Petty, Frederick PhD, MD

doi: 10.1097/01.psy.0000138117.58559.7b
Original Articles

Objective: This study examines the differential impact of military, civilian adult, and childhood sexual assault on the likelihood of developing posttraumatic stress disorder (PTSD). It also examines the relationship of military sexual assault (MSA) to service utilization and health care costs among women who access services through Veterans Affairs (VA).

Methods: A convenience sample of 270 veteran women receiving medical and/or mental health treatment at the VA North Texas Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS) and categorized into a sexual assault group using the Interview of Sexual Experiences (ISE). A chart review was also conducted to determine the frequency of diagnoses among the women. Data regarding health care utilization was obtained from self-report using the Utilization and Cost Patient Questionnaire (UAC-PQ) and VA administrative records.

Results: Compared with those without a history of sexual assault, women veterans were 9 times more likely to have PTSD if they had a history of MSA, 7 times more likely if they had childhood sexual assault (CSA) histories, and 5 times more likely if they had civilian sexual assault histories. An investigation of medical charts revealed that PTSD is diagnosed more often for women with a history of MSA than CSA. CSA was associated with a significant increase in health care utilization and cost for services, but there was no related increase in use or cost associated with MSA.

Conclusion: Women veterans have differential rates of PTSD due to sexual assault, with higher rates found among those assaulted while on active duty. Although women with MSA are more likely to have PTSD, results suggest that they are receiving fewer health care services.

PTSD = posttraumatic stress disorder; MSA = military sexual assault; CSA = civilian sexual assault; ChSA = childhood sexual assault; VA = Veterans Affairs; UAC-PQ = Utilization and Cost Patient Questionnaire; ISE = Interview of Sexual Experiences; CAPS = Clinician Administered PTSD Scale; NSA = no sexual assault; SD = standard deviation; ER = emergency room; SE = standard error.

From the Department of Veterans Affairs (A.S., L.L., T.M.K.), Research Service, North Texas Health Care System, Dallas, Texas; the Department of Psychiatry (A.S., T.M.K., P.D.B.), University of Texas Southwestern Medical Center, Dallas, Texas; the Department of Psychiatry (F.P.), Creighton University, Omaha, Nebraska; and the Nebraska/Western Iowa Health Care System (F.P.), Omaha, Nebraska.

Address correspondence and reprint requests to Alina M. Suris, PhD, Veterans Affairs North Texas Healthcare System, Mental Health, 4500 South Lancaster Road (151), Dallas, TX 75216. E-mail:

Received for publication January 23, 2004; revision received May 7, 2004.

Portions of this manuscript were presented at the 2001 International Society for Traumatic Stress Studies, December 6–9, New Orleans, Louisiana.

This study was partially funded by a grant from the Department of Veterans Affairs Veterans Integrated Service Network –17 (Protocol #98-125 to A.S.) and an HSR&D Career Scientist Award (RCS 92-403 to T.M.K.).

Copyright © 2004 by American Psychosomatic Society
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