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Letters to the Editor

Physicians at Veterans Administration Hospitals Need to Be Knowledgeable About Military Sexual Trauma in Women

See Article by Scott et al.

Physicians at Veterans Administration Hospitals Need to Be Knowledgeable About Military Sexual Trauma in Women

To the Editor: The important recent article by Scott et al1 examined associations between military sexual trauma (MST), childhood trauma, combat exposure, and military-related posttraumatic stress symptomatology in women who served in the recent conflicts in Iraq and Afghanistan. The authors concluded that under conditions of high combat exposure, female veterans with MST had significantly higher posttraumatic stress symptomatology compared to female veterans without MST.

Multiple publications have documented that a substantial number of women who served in Iraq and Afghanistan had exposure to trauma as children and while in the military.2,3 Approximately 20%-25% of women are sexually assaulted at some point during their military service.4 MST, a form of high betrayal trauma, results in increased risk of suicidal ideation, cardiovascular disease, depression, and chronic physical problems.5,6

Today, women comprise approximately 14.5% of all active duty military and 18% of all National Guard and Reserves members.7 The number of women veterans using Veterans Affairs (VA) health care is increasing rapidly. By 2020, it is estimated that women will make up 10.7% of the US veteran population, necessitating significant changes to accommodate their unique needs.5 As members of the military return home from Iraq and Afghanistan, physicians at VA hospitals and medical centers will be interviewing and treating more women who served, including those who had combat exposure.

The VA has made organizational changes to improve quality of care for women veterans over the last few years.8 It is clear, however, that VA physicians must be aware of associations between MST, childhood trauma, combat exposure, and military-related posttraumatic stress symptomatology, as discussed in the recently published article by Scott et al.1 This knowledge will improve quality of care and ensure that treatment will be appropriate and successfully goal directed.

References

1. Scott JC, Pietrzak RH, Southwick SM, et al. Military sexual trauma interacts with combat exposure to increase risk for posttraumatic stress symptomatology in female Iraq and Afghanistan veterans. J Clin Psychiatry. 2014;75(6):637-643. PubMed doi:10.4088/JCP.13m08808

2. Hassija CM, Jakupcak M, Maguen S, et al. The influence of combat and interpersonal trauma on PTSD, depression, and alcohol misuse in US Gulf War and OEF/OIF women veterans. J Trauma Stress. 2012;25(2):216-219. PubMed doi:10.1002/jts.21686

3. Street AE, Vogt D, Dutra L. A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clin Psychol Rev. 2009;29(8):685-694. Published online Aug 24, 2009. PubMed doi:10.1016/j.cpr.2009.08.007

4. Kelly UA, Skelton K, Patel M, et al. More than military sexual trauma: interpersonal violence, PTSD, and mental health in women veterans. Res Nurs Health. 2011;34(6):457-467. Published online Sep 6, 2011. PubMed doi:10.1002/nur.20453

5. Lutwak N, Dill C. An innovative method to deliver treatment of military sexual trauma and post-traumatic stress disorder. Mil Med. 2013;178(10):1039-1040. PubMed doi:10.7205/MILMED-D-13-00226

6. Lutwak N, Dill C. Military sexual trauma increases risk of post-traumatic stress disorder and depression thereby amplifying the possibility of suicidal ideation and cardiovascular disease. Mil Med. 2013;178(4):359-361. PubMed doi:10.7205/MILMED-D-12-00427

7. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Women in the military and women veterans. https://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/WomeninMilitary.pdf. Published December 2012. Accessed September 1, 2014.

8. Lutwak N, Dill C. Organizational changes at VA will support quality improvement in women’s health care. Am J Med Qual. 2013;28(1):84. PubMed doi:10.1177/1062860612463166

Nancy Lutwak, MD

nancy.lutwak@va.gov

Author affiliation: VA New York Harbor Healthcare System, NYU School of Medicine, New York.

Potential conflicts of interest: None reported.

Funding/support: None reported.

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