Despite growing public awareness of sexual assault of women during their military service and increased efforts by the Department of Defense to deter sexual crimes and encourage reporting and help-seeking, a Veterans Affairs study suggests most female service members who experience sexual assault are still unlikely to seek post-assault health care, at least in the short term.
The study, published in Medical Care in April 2015, found that fewer than a third of sexually assaulted servicewomen sought such care.
The low numbers are notable, say researchers, because women who experience sexual assault tend to become heavy users of health care resources in the years following their assault.
"There are numerous health consequences associated with sexual assault," says Dr. Michelle Mengeling, an affiliate investigator with VA's Comprehensive Access and Delivery Research and Evaluation (CADRE) team and lead author on the study. "Examples include gynecologic, gastrointestinal, chronic pain symptoms, and sexual dysfunction. There are also mental health outcomes such as PTSD, depression, substance abuse, and anxiety."
While many studies have demonstrated the relationship between trauma, such as sexual assault, and chronic health problems, says Mengeling, this research looked specifically at the factors associated with post-assault care utilization and the reasons servicewomen did not seek care. The goal was to identify the factors that prevent servicewomen from seeking post-assault care.
Research has shown that women in the military experience higher rates of sexual assault than their peers in the general population, with estimates of 30 - 45 percent of servicewomen experiencing military sexual trauma.
For the study, researchers interviewed 1,339 women who were either veterans or were still serving in the military about their experiences with attempted and completed sexual assault. Of the whole group, 207 of the women reported being sexually assaulted during military service.
Of those, only about a third used health care specific to their assault. Roughly a quarter of those who used post-assault care sought both medical and mental health care, and only four servicewomen received both medical and mental health care within six months of the assault.
"Few women got care and few women reported [the assault]," says Mengeling, also an associate research scientist at the University of Iowa. "Sexual assault is widely considered the most serious and traumatic crime possible, short of homicide. One of the first steps in potentially mitigating some of the negative health effects of sexual assault is seeking immediate post-assault medical and mental health care."
Mengeling adds, "Most of the servicewomen said they did not immediately seek care because they were embarrassed, or did not think they needed medical attention." Many also voiced concerns about confidentiality and how seeking care might adversely affect their military careers. However, few said that leadership discouraged seeking medical care or mental health services.
Those who reported the sexual assault were far more likely to receive care. Mengeling says, "This finding was consistent with our prior work showing that few servicewomen made an official report to Department of Defense officials about their sexual assault, and that concerns about confidentiality, being embarrassed, and adverse career impacts were associated with servicewomen's decisions about both seeking post-assault health care and reporting."
Mengeling also points to the importance of sexual assault screening at routine health checkups. Although few servicewomen reported getting post-assault health care, almost all reported undergoing routine annual physical exams. Mengeling suggests providers screen for sexual assault histories in order to provide "trauma-informed care" throughout women's lives.
VA has been conducting universal military sexual trauma screening for both male and female veterans since 2002.
"Most women who have experienced sexual assault don't report or seek post-assault specific care, but they do continue to get health care," says Mengeling. "It is unclear if women's current health care providers are aware of their sexual assault histories. Thus, sensitively inquiring regarding sexual assault histories allows providers to provide appropriate and timely care to address the physical and emotional needs of their patients."