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1.
J Gen Intern Med ; 39(3): 411-417, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37957529

ABSTRACT

BACKGROUND: Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health. OBJECTIVE: Examine associations of MST with menopause and mental health outcomes in midlife women Veterans. DESIGN: Cross-sectional. PARTICIPANTS: Women Veterans aged 45-64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020. MAIN MEASURES: Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds. KEY RESULTS: Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26-4.72), vaginal symptoms (OR 2.23, 95% CI 1.08-4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45-7.10), anxiety (OR 4.78, 95% CI 2.25-10.17), and probable PTSD (OR 6.74, 95% CI 2.27-19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72-5.88). CONCLUSIONS: Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women's health across the lifespan.


Subject(s)
Military Personnel , Sex Offenses , Sleep Initiation and Maintenance Disorders , Stress Disorders, Post-Traumatic , Veterans , Female , Humans , United States/epidemiology , Adult , Veterans/psychology , Sleep Initiation and Maintenance Disorders/epidemiology , Cross-Sectional Studies , Military Sexual Trauma , Military Personnel/psychology , Sex Offenses/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/diagnosis , Menopause
2.
Gynecol Oncol ; 185: 68-74, 2024 06.
Article in English | MEDLINE | ID: mdl-38368815

ABSTRACT

OBJECTIVE: Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to identify patients treated with intracavitary VBT and collect survey data to assess trauma endpoints. METHODS: We retrospectively identified patients with endometrial cancer who underwent intracavitary VBT at our institution between 01/2017 and 08/2022. Patients were mailed and/or electronically mailed a survey that included demographics, psychosocial background, and validated trauma surveys to be filled out as they relate to their trauma experiences prior to VBT and again considering any trauma symptomatology related to VBT. Electronic medical record review was performed. Descriptive statistics as well as multivariate analysis were performed. RESULTS: 206 patients met inclusion criteria, 66 (32.1%) of whom returned the survey and were included for analysis. Thirty-two percent of patients self-reported a personal history of any prior mental health diagnosis. Eighty-eight percent of patients screened positive for a history of trauma exposure, 23% endorsed symptoms of PTSD related to their VBT experience, and 5% screened positive for a likely PTSD diagnosis from VBT. CONCLUSION: A majority of included patients had a history of trauma exposure prior to VBT. In a subset of patients, VBT re-induced trauma and was considered to be an independent traumatic event. This study highlights the importance of practicing trauma informed care, particularly in this patient population.


Subject(s)
Brachytherapy , Endometrial Neoplasms , Humans , Female , Endometrial Neoplasms/radiotherapy , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/psychology , Brachytherapy/adverse effects , Brachytherapy/methods , Retrospective Studies , Middle Aged , Aged , Prevalence , Aged, 80 and over , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Adult , Vagina/radiation effects , Vagina/injuries
3.
J Sex Marital Ther ; 50(7): 787-810, 2024.
Article in English | MEDLINE | ID: mdl-38962932

ABSTRACT

Increasing evidence shows that survivors of sexual violence frequently experience relationship difficulties following their victimization. Little is known regarding how couples which formed post-assault cope with the impact of the prior assault. Hence, the aim of the current study was to gain insight into post-assault formed couples' experiences in coping with the impact of sexual violence. To this end, an interview study was conducted with five female survivors and their male partners who began their romantic relationship post-assault. A dyadic phenomenological interview analysis revealed that sexual victimization is a dyadic stressor but is not always considered as such by the couple. In addition, disclosure is described as a potential bonding experience. Flexibility and creativity from both partners are required as they adapt to the post-assault impact. In addition, meaningful communication and considering the perspective of one's partner seemed to be key to dyadically cope successfully. The current study also identified challenges couples had to manage, including caregiver burden and role confusion. Results suggest that interventions supporting couples in their continuous efforts toward mutual understanding can foster trust and growth.


Subject(s)
Adaptation, Psychological , Interpersonal Relations , Sexual Partners , Humans , Female , Male , Adult , Sexual Partners/psychology , Sex Offenses/psychology , Crime Victims/psychology , Survivors/psychology
4.
BMC Pregnancy Childbirth ; 24(1): 186, 2024 Mar 08.
Article in English | MEDLINE | ID: mdl-38459457

ABSTRACT

BACKGROUND: A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour. METHODS: A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma. RESULTS: Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(ß) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(ß) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth. CONCLUSION: This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.


Subject(s)
Child Abuse , Premature Birth , Pregnancy , Female , Infant, Newborn , Humans , Child , Parturition , Cross-Sectional Studies , Premature Birth/epidemiology , Delivery, Obstetric , Russia
5.
Eur J Oral Sci ; 132(2): e12976, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38305706

ABSTRACT

This study aimed to explore the differences in anxiety, depression, and oral health-related quality of life between people with dental anxiety who reported abuse experience (n = 60) and people with dental anxiety who did not report abuse experience (n = 97). Both groups attended a dental service focused on the treatment of dental anxiety intended for people with a history of physiological or psychological trauma, or odontophobia. The participants responded to a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), Oral Impacts on Daily Performance (OIDP), and the Index of Dental Anxiety and Fear (IDAF-4C+ ). The differences between groups were tested for statistical significance using Welch's T-tests, and linear regression was used to adjust for gender. The participants with reported abuse experience expressed greater psychological symptoms of anxiety and poorer oral health-related quality of life. The participants with reported abuse experience also expressed a higher fear of losing control, as well as feeling shame and disgust. This study shows that individuals with dental anxiety and a history of abuse may face more complex challenges than those with dental anxiety and no history of abuse.


Subject(s)
Dental Anxiety , Quality of Life , Humans , Dental Anxiety/diagnosis , Depression , Psychometrics , Fear , Surveys and Questionnaires
6.
BMC Womens Health ; 24(1): 509, 2024 Sep 13.
Article in English | MEDLINE | ID: mdl-39272185

ABSTRACT

Intimate partner violence affects 20-30% of women in the United States. Disparities in routine cervical cancer surveillance have been demonstrated in certain populations, including victims of intimate partner violence (IPV). This study examined and assessed the acceptability of high-risk HPV (hrHPV) self-collection among individuals who have experienced IPV. We conducted an observational study using qualitative data collection and analysis. We interviewed individuals with a history of IPV and who currently reside in Oregon. This study identified key themes describing knowledge and attitudes towards cervical cancer screening for individuals who have experienced IPV. They include: guideline knowledge, prior office-based cervical cancer screening experience, barriers to cervical cancer screening, at-home hrHPV self-collection experience, and testing confidence. Participants experienced fewer barriers and expressed increased comfort and control with hrHPV self-collection process. Individuals with a history of IPV have lower rates of cervical cancer screening adherence and higher rates of cervical dysplasia and cancer than other populations. The patient-centered approach of hrHPV self-collection for cervical cancer screening can reduce barriers related to the pelvic exam and empower patients to reduce their risks of developing cervical cancer by enabling greater control of the testing process.


Subject(s)
Early Detection of Cancer , Qualitative Research , Uterine Cervical Neoplasms , Humans , Female , Uterine Cervical Neoplasms/diagnosis , Adult , Early Detection of Cancer/methods , Early Detection of Cancer/psychology , Middle Aged , Papillomavirus Infections/diagnosis , Health Knowledge, Attitudes, Practice , Intimate Partner Violence/psychology , Intimate Partner Violence/statistics & numerical data , Specimen Handling/methods , Oregon , Self Care/methods , Self Care/psychology , Survivors/psychology , Vaginal Smears/methods , Vaginal Smears/psychology , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Young Adult
7.
Br J Clin Psychol ; 63(3): 378-393, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38563456

ABSTRACT

OBJECTIVES: Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables. METHODS: 155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. RESULTS: An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution. CONCLUSIONS: That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.


Subject(s)
Empathy , Stress Disorders, Post-Traumatic , Humans , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Adult , Female , Male , Middle Aged , Sexual Trauma/psychology , Young Adult , Psychological Distress , Surveys and Questionnaires , Sex Offenses/psychology , Adolescent , Shame
8.
Cogn Behav Ther ; 53(4): 351-363, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38317621

ABSTRACT

Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans' treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol [FP] or receiving minimally adequate care [MAC; defined as attending eight or more sessions]). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.


Subject(s)
Sexual Trauma , Sexual and Gender Minorities , Stress Disorders, Post-Traumatic , Veterans , Humans , Veterans/psychology , Male , Female , Adult , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/psychology , Sexual Trauma/therapy , Sexual Trauma/psychology , Sexual and Gender Minorities/psychology , Middle Aged , Survivors/psychology , Cognitive Behavioral Therapy , Implosive Therapy , Military Personnel/psychology , Military Sexual Trauma
9.
J Clin Psychol ; 80(6): 1377-1390, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38401144

ABSTRACT

OBJECTIVES: Posttraumatic stress disorder symptoms (PTSS) and posttraumatic growth (PTG) are possible reactions to exposure to potentially traumatic events (PTEs) during military service. However, knowledge about patterns of both PTSS and PTG among female combat veterans is sparse. This study examines constellations of PTSS and PTG among Israeli female combat veterans, as well as military-related exposure and positive psychological correlates of these constellations. METHODS: A volunteer sample of Israeli women combat veterans (n = 885) responded to self-report questionnaires in a cross-sectional design study. RESULTS: Latent profile analysis (LPA) was used to identify four profiles characterized by unique constellations of PTSS and PTG: moderate PTSS and high PTG (33%), moderate PTSS and moderate PTG (30%), low PTSS and high PTG (30%), and low PTSS and PTG (5.5%). Higher levels of combat experiences were associated with higher odds of inclusion in the moderate PTSS and high PTG and moderate PTSS and moderate PTG profiles. Moreover, compared to the other classes, both low PTSS and high PTG and moderate PTSS and high PTG classes were associated with higher levels of satisfaction with life and happiness psychological outcomes. CONCLUSION: The study's findings offer an overview of the complex pattern of associations between PTSS, PTG, and associated predictors and outcomes. Clinicians treating female veterans should be aware of the varying reactions to military service challenges, including the presence of moderate to high levels of PTG reactions in addition to PTSS.


Subject(s)
Posttraumatic Growth, Psychological , Stress Disorders, Post-Traumatic , Veterans , Humans , Female , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Israel , Adult , Cross-Sectional Studies , Middle Aged
10.
Violence Vict ; 39(5): 588-597, 2024 Oct 14.
Article in English | MEDLINE | ID: mdl-39214597

ABSTRACT

Histrionic personality disorder is among the most common forms of personality pathology, and recent research has focused on its associations with trauma. This research has focused primarily on the types of traumatic experiences people endure, highlighting the role of sexual trauma in particular. However, recent research on the association between traumatic events and histrionic personality characteristics has not taken into account the role of traumatic experiences characterized by interpersonal betrayal, which research suggests is associated with personality pathology in general. In this study, we examine this, evaluating the association between traumatic experiences with varying degrees of betrayal and histrionic personality characteristics in a sample of men and women recruited online (N = 364). The results suggested that interpersonal trauma without a high degree of betrayal as well as non-interpersonal trauma had positive associations with histrionic personality characteristics, but interpersonal trauma with a high degree of betrayal did not. Further analysis indicated that sexual trauma, both with and without a component of betrayal, was associated with histrionic personality characteristics for women but not men. Study findings add to the research on the potential traumatogenic origins of histrionic personality characteristics and provide numerous directions for future research.


Subject(s)
Interpersonal Relations , Humans , Male , Female , Adult , Young Adult , Personality Disorders/psychology , Middle Aged , Sexual Trauma/psychology , Adolescent
11.
J Trauma Dissociation ; 25(1): 62-82, 2024.
Article in English | MEDLINE | ID: mdl-37415426

ABSTRACT

Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress.


Subject(s)
Sexual Dysfunctions, Psychological , Stress Disorders, Post-Traumatic , Male , Humans , Female , Sexual Behavior/psychology , Anxiety/psychology , Shame , Students , Stress Disorders, Post-Traumatic/psychology
12.
J Community Psychol ; 52(2): 399-414, 2024 03.
Article in English | MEDLINE | ID: mdl-38289875

ABSTRACT

Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness. Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female). Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses. These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.


Subject(s)
Adverse Childhood Experiences , Ill-Housed Persons , Veterans , Male , Humans , Female , Military Sexual Trauma , Social Support
13.
Mil Psychol ; : 1-12, 2024 May 23.
Article in English | MEDLINE | ID: mdl-38781487

ABSTRACT

Military sexual trauma (MST) and combat trauma (CT) survivors experience disproportionate risk for disordered eating. A survey of MST, CT, disordered eating, trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation among military personnel with a history of military-related trauma was conducted. These survey-based cross-sectional data were analyzed via parallel mediation analyses and Analyses of Covariance (ANCOVA). Six parallel mediation analyses were conducted examining trauma-related self-blame, emotion regulation challenges, body dissatisfaction, and dissociation as mediators linking MST and CT, separately, with purging, restricting, and bingeing. ANCOVAs were also performed to examine differences in levels of bingeing, restriction, and purging among people exposed to MST, CT, both MST and CT, and neither. MST and CT exposure was indirectly related to bingeing via emotion regulation challenges. MST and CT was also indirectly related to both restriction and purging via emotion regulation challenges and trauma-related self-blame. Dissociation and body dissatisfaction were not significant mediators in any model. Participants endorsed high levels of disordered eating. Individuals exposed to both MST and CT reported greater bingeing, restricting, and purging than individuals exposed to either CT, MST, or neither. Findings highlight the nuanced symptoms that may increase risk for disordered eating among MST and/or CT survivors. Future treatment research should explore how addressing emotion regulation and trauma-related self-blame among individuals with MST and/or CT may help address disordered eating. Implications and future directions for this area of research are discussed.

14.
Urologiia ; (1): 96-99, 2024 Mar.
Article in Russian | MEDLINE | ID: mdl-38650413

ABSTRACT

A clinical case of a penile fracture as a result of an unsuccessful sexual intercourse, which later required surgical treatment in the form of corporoplasty with opening and draining of the hematoma, is discussed in the article. Penile fracture is a rare urological emergency that requires immediate medical attention to avoid long-term complications, including penile curvature and erectile dysfunction.


Subject(s)
Penis , Humans , Male , Penis/injuries , Penis/surgery , Rupture/surgery , Adult , Coitus , Hematoma/surgery , Hematoma/etiology , Hematoma/diagnostic imaging , Penile Diseases/surgery , Penile Diseases/etiology
15.
J Gen Intern Med ; 38(14): 3188-3197, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37291361

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.


Subject(s)
Military Personnel , Sex Offenses , Veterans , Humans , Female , United States/epidemiology , Middle Aged , Disclosure , Cross-Sectional Studies , Military Sexual Trauma , United States Department of Veterans Affairs
16.
Dev Psychopathol ; : 1-11, 2023 Jul 05.
Article in English | MEDLINE | ID: mdl-37403737

ABSTRACT

Early-life adversity accelerates the maturation of affect-related circuitry, which might be a short-term adaptation with long-term tradeoffs. Sexual trauma is associated with a particularly strong impact on pubertal development and mental health outcomes. Our objective was to test the relations between trauma type, affective network maturity, and mental health outcomes in young women with trauma history. Trauma-exposed women aged 18-29 completed a clinical interview (n = 35) and an fMRI scan (n = 28). We used a public data set to train a machine learning algorithm to predict age from resting-state affective network connectivity and calculated network maturity as the difference between predicted and true age. We also performed principal component analysis on mental health outcomes and retained two components: clinical and state psychological outcomes. Compared to nonsexual trauma (n = 17), sexual trauma (n = 11) was associated with greater affective network maturity. In addition, for sexual trauma only, greater affective network maturity was associated with better clinical but not state psychological outcomes. These results suggest that sexual trauma during development might uniquely alter the maturational trajectory of affect-related circuitry, with distinct mental health consequences in emerging adulthood. Whereas delayed affective network maturation is associated with adverse clinical outcomes, accelerated affective network maturation might confer resilience in survivors.

17.
Can J Psychiatry ; 68(9): 682-690, 2023 09.
Article in English | MEDLINE | ID: mdl-36124372

ABSTRACT

INTRODUCTION: Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST. METHODS: Data came from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941, ages 33 years + ). Individuals endorsing sexual trauma were stratified into MST and non-MST and compared to individuals with no sexual trauma. The prevalence of lifetime MST was computed, and correlates of sexual trauma were examined using multinomial regression analyses. RESULTS: The overall prevalence of MST was 44.6% in females and 4.8% in males. Estimates were comparable between currently serving members and veterans. In adjusted models in both sexes, MST was more likely among younger individuals (i.e., 33-49 years), and MST and non-MST were more likely in those reporting more non-sexual traumatic events. Among females, MST and non-MST were more likely in those reporting lower household income, non-MST was less likely among Officers, and MST was more likely among those with a deployment history and serving in an air environment. Unwanted sexual touching by a Canadian military member or employee was the most prevalent type and context of MST. INTERPRETATION: A high prevalence of MST was observed in a follow-up sample of Canadian Armed Forces members and veterans. Results may inform further research as well as MST prevention efforts.


Subject(s)
Military Personnel , Sex Offenses , Stress Disorders, Post-Traumatic , Veterans , Male , Female , Humans , Mental Health , Military Sexual Trauma , Prevalence , Follow-Up Studies , Canada/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology
18.
Psychiatr Q ; 94(2): 321-341, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37300735

ABSTRACT

Much has been written about the COVID-19 pandemic's epidemiological, psychological, and sociological consequences. Yet, the question about the role of the lockdown policy from psychological and sociological points of view has not been sufficiently addressed. Using epidemiological, psychological, and sociological daily data, we examined the causal role of lockdown and variation in morbidity referring to emotional and behavioral aspects. Dynamics of support requests to the Sahar organization concerning loneliness, depression, anxiety, family difficulties, and sexual trauma were investigated alongside processes of emergency and domestic violence reports to the Ministry of Welfare and Social Affairs. By exploring the signals and predictive modeling for a situation with no lockdown implementation, the lockdown was found as a critical factor in distress rising among the general population, which could affect long after the improvement in pandemic case counts. Applications and implications are discussed in the context of decision-making in dealing with crises as well as the need to allocate resources for adaptive coping.


Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Communicable Disease Control , Adaptation, Psychological , Anxiety
19.
J Gen Intern Med ; 37(Suppl 3): 742-750, 2022 09.
Article in English | MEDLINE | ID: mdl-36042075

ABSTRACT

BACKGROUND: Military sexual trauma (MST) is associated with negative mental health outcomes. Mental health beliefs, such as stigma or secondary victimization, have been identified as possible barriers to care; however, it is unclear whether such beliefs impact receiving care. OBJECTIVE: To assess if mental health beliefs impact MST-related mental health care access and engagement. DESIGN: Veterans completed a survey following detection of MST. Survey data were linked to Veteran's Health Administration administrative data in order to examine associations with outpatient MST-related care in the year following MST detection. PARTICIPANTS: A national sample of women and men Veterans (N = 1,185) with newly detected MST who reported a perceived need for MST-related mental health treatment. MAIN MEASURES: Building on prior work that identified four latent classes of mental health beliefs (Hahn et al., J Trauma Stress 34:394-404, 2020; low barrier, stigma-related beliefs, negative perceptions of care, high barrier), we examined associations with outpatient mental health care indicated by a provider as related to MST. Care was examined in total, as well as the specific categories of medication management, individual psychotherapy, and group psychotherapy. KEY RESULTS: Access to care following MST detection was high: most (71.6%) Veterans had an MST-related mental health visit within 30 days, and nearly all (83.6%) within 180 days, with the median number of days to receiving care being 2. Negative perceptions of care predicted a lower likelihood of treatment engagement (3+ encounters) with MST-related individual psychotherapy (OR = 0.65, 95% CI (0.43-0.96)), whereas the stigma-related beliefs and high barrier classes did not. CONCLUSIONS: There appears to be excellent access to mental health care among Veterans with a perceived need for MST-related mental health treatment. However, treatment beliefs that represented negative perceptions of care may serve as barriers to engagement. Interventions targeting negative perceptions of care during early encounters could help promote subsequent engagement.


Subject(s)
Military Personnel , Sex Offenses , Stress Disorders, Post-Traumatic , Veterans , Female , Humans , Male , Mental Health , Military Personnel/psychology , Sex Offenses/psychology , Sexual Trauma , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , United States/epidemiology , Veterans/psychology
20.
J Gen Intern Med ; 37(Suppl 3): 825-832, 2022 09.
Article in English | MEDLINE | ID: mdl-36042078

ABSTRACT

Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U.S. Department of Defense to establish a 90-day Independent Review Commission on Sexual Assault in the Military (IRC) to assess the department's efforts and make actionable recommendations. As servicemembers discharge from the military, effects of military sexual trauma (MST) are often seen in the Veterans Health Administration (VA). In response to an IRC inquiry about VA MST research, we organized an overview on prevalence, adverse consequences, and evidence-based treatments targeting the sequelae of MST. Women are significantly more likely to experience MST than their male counterparts. Other groups with low societal and institutional power (e.g., lower rank) are also at increased risk. Although not all MST survivors experience long-term adverse consequences, for many, they can be significant, chronic, and enduring and span mental and physical health outcomes, as well as cumulative impairments in functioning. Adverse consequences of MST come with commonalities shared with sexual trauma in other settings (e.g., interpersonal betrayal, victim-blaming) as well as unique aspects of the military context, where experiences of interpersonal betrayal may be compounded by perceptions of institutional betrayal (e.g., fear of reprisal or ostracism, having to work/live alongside a perpetrator). MST's most common mental health impact is posttraumatic stress disorder, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.


Subject(s)
Depressive Disorder, Major , Military Personnel , Sex Offenses , Stress Disorders, Post-Traumatic , Veterans , Female , Humans , Male , Military Personnel/psychology , Sex Offenses/psychology , Sexual Trauma/diagnosis , Sexual Trauma/epidemiology , Sexual Trauma/therapy , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , United States/epidemiology , Veterans/psychology
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