Continuing Education
Continuing Education
Military Sexual Trauma: An Update for Nurse Practitioners

https://doi.org/10.1016/j.nurpra.2020.09.010Get rights and content

Highlights

  • Military sexual trauma (MST) is an insidious problem among military personnel.

  • Rates of MST are likely underreported and undetected.

  • MST survivors are at risk for a multitude of health consequences.

Abstract

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 ones’ time in military service. Due to the physical, mental, and psychosocial consequences of MST, all nurse practitioners (NPs) must be able to effectively identify survivors of MST, recognize and address health consequences of MST, and provide appropriate interventions and referrals for MST survivors. The purpose of this report is to provide an overview so that NPs are equipped to effectively care for MST survivors in both Veterans Health Administration (VHA) and non-VHA settings.

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].

References (64)

  • M.M. Yalch et al.

    Influence of military sexual assault and other military stressors on substance use disorder and PTS symptomology in female military veterans

    Addict Behav

    (2018)
  • M.E. Dichter et al.

    Intimate partner violence screening in the VHA: demographic and military service characteristics

    Am J Prev Med

    (2017)
  • A.E. Montgomery et al.

    Recent intimate partner violence and housing instability among women veterans

    Am J Prev Med

    (2018)
  • C.S. Pulverman et al.

    Military sexual trauma and sexual health in women veterans: a systematic review

    Sex Med Rev

    (2019)
  • R.K. Blais et al.

    Specific PTSD symptom clusters mediate the association of military sexual trauma severity and sexual function and satisfaction in female service members/veterans

    J Affect Disord

    (2018)
  • M.J. Friedman et al.

    Considering future pharmacotherapy for PTSD

    Neurosci Lett

    (2017)
  • N. Sugg

    Intimate partner violence: prevalence, health consequences, and intervention

    Med Clin

    (2015)
  • K. Narain et al.

    Access to care and health outcomes among women veterans using veterans administration health care: Association with food insufficiency

    Womens Health Issues

    (2018)
  • K. Hatzimouratidis et al.

    Pharmacotherapy for erectile dysfunction: recommendations from the Fourth International Consultation for Sexual Medicine

    J Sex Med

    (2016)
  • J.L. Combellick et al.

    Trauma and sexual risk: Do men and women veterans differ?

    Womens Health Issues

    (2019)
  • L.C. Wilson

    The prevalence of military sexual trauma: a meta-analysis

    Trauma Violence Abuse

    (2018)
  • K. Beckman et al.

    Military sexual assault in transgender veterans: Results from a nationwide survey

    J Traum Stress

    (2018)
  • S. Gurung et al.

    Prevalence of military sexual trauma and sexual orientation discrimination among lesbian, gay, bisexual, and transgender military personnel: a descriptive study

    Sex Res Social Policy

    (2018)
  • P.S. Calhoun et al.

    The association between military sexual trauma and use of VA and non-VA health care services among female veterans with military service in Iraq or Afghanistan

    J Interpers Violence

    (2018)
  • M.A. Bowman et al.

    Military health history: resources for use at the point of care

    Am Fam Physician

    (2019)
  • Street A, Stafford J. Military sexual trauma: Issues in caring for veterans. National Center for PTSD. October 14,...
  • Intimate partner violence and sexual violence victimization assessment instruments for use in healthcare settings

  • J. McFarlane et al.

    Assessing for abuse during pregnancy: severity and frequency of injuries and associated entry into prenatal care

    JAMA

    (1992)
  • Diagnosis and treatment guidelines on domestic violence

    (1992)
  • L.F. Fitzgerald et al.

    Measuring sexual harassment in the military: The sexual experiences questionnaire (SEQ-DoD)

    Military Psychol

    (1999)
  • M.P. Koss

    Sexual experiences survey—long form victimization (SES-LFV)

    (2006)
  • M.P. Koss et al.

    Revising the SES: a collaborative process to improve assessment of sexual aggression and victimization

    Psychol Women Q

    (2007)
  • 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.

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