Continuing EducationContinuing EducationMilitary Sexual Trauma: An Update for Nurse Practitioners
Section snippets
Background
Military sexual trauma (MST) is a pervasive and insidious problem among military personnel. MST is defined as sexual harassment or sexual assault that occurs during one’s time in military service. Rates of MST are likely underreported and undetected but are estimated to be as high as 31% among all military personnel, with specific subgroups particularly at risk.1 At-risk populations include gender and sexual minorities, including women and lesbian, gay, bisexual, and transgender (LGBT) persons.2
Screening
For NPs working in the civilian sector, it is critical to universally inquire: “Have you ever served in the military?” This question will aid NPs in identifying military service–related health risk factors, including MST, and may improve the quality of health care delivery.7
Universal screening for MST is required within the VHA; however, there are no ubiquitous, standardized tools designed specifically for the screening of sexual trauma related to military experience. Although a number of
Physical Consequences of MST
Due to chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis secondary to dysregulation in stress response for those with a history of trauma, sustained immune and inflammatory activity can occur in those with a history of MST, which can predispose these individuals to a multitude of chronic health problems.16 Veterans who have experienced MST are at higher risk for cardiovascular disease, plausibly through the increased prevalence of related risk factors, such as obesity,
Mental Health Consequences of MST
MST survivors are at risk for trauma-related disorders, in addition to other mental health problems. More than 56% of women who survive MST meet diagnostic criteria for PTSD.18 In regard to PTSD diagnostic criteria within the context of MST, exposure to sexual violence is accompanied by the following symptom clusters: intrusion symptoms, avoidant symptoms, negative cognitive or affective symptoms, and arousal and reactivity symptoms. See Table 1 for examples of symptoms within each symptom
Psychosocial Consequences of MST
Survivors of MST are at risk for a variety of psychosocial problems, including intimate partner violence (IPV), homelessness, sexual dysfunction, and engagement in risky behaviors. In a study of women, those who experienced MST were more likely to report exposure to IPV within the past year.38,39 IPV, in isolation and when compounded by MST exposure, can increase the risk of economic disparities, including housing insecurity.40 Exposure to MST can predict homelessness upon exit from military
Interventions and Referrals
NPs working across the care continuum must be able to identify MST survivors and provide the necessary interventions and treatment to address physical, mental health, and psychosocial sequelae. Foremost, NPs must be sure to adhere to principles of universal trauma-informed care (TIC). The Department of Veterans Affairs (VA) and DoD emphasize the importance of realizing the prevalence of trauma, recognizing the impact of trauma, responding appropriately to trauma; and promoting resilience
Conclusions
NPs working in both VHA and non-VHA settings are likely to encounter MST survivors. Due to the burden of comorbidities related to MST, NPs must be able to identify and address physical, mental health, and psychosocial consequences to promote optimal outcomes for MST survivors. NPs can use both pharmacological and nonpharmacological interventions to address residual sequelae of MST and should also be able to initiate referrals as appropriate (see Table 2 for VHA and community resources). With
Brayden N. Kameg, DNP, PMHNP-BC, CARN, CNE, is a an assistant professor at the University of Pittsburgh School of Nursing, Pittsburgh, PA. She can be contacted at [email protected].
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Cited by (0)
Brayden N. Kameg, DNP, PMHNP-BC, CARN, CNE, is a an assistant professor at the University of Pittsburgh School of Nursing, Pittsburgh, PA. She can be contacted at [email protected].
Dina Fradkin, BSN, RN is a graduate teaching fellow at the University of Pittsburgh School of Nursing, Pittsburgh, PA.
In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.