Background/Rationale: Each year, approximately 20% of female and 1% of male Veterans seen in VHA care have reported military sexual trauma (MST), a VA-defined term that refers to unwanted and threatening sexual harassment or sexual assault that occurred during military service. In fiscal year 2011, this translated into approximately 65,000 female and 53,000 male Veterans across VHA. Veterans who report MST are at significantly greater risk for a wide range of mental health diagnoses as compared to Veterans who have not experienced MST. While VA is mandated to annually monitor screening and treatment for MST, there is no currently available data that can address whether access to MST-related mental health care (MST MH care) is sufficient. Research suggests that Veterans may be underutilizing MST MH care, and that this may be particularly so for male Veterans. A recent study of OEF/OIF Veterans with a positive MST screen found that men were significantly less likely to utilize MST MH care than female Veterans in the year following screening, and that men utilized significantly fewer services than women. Further research is needed to examine whether Veterans have adequate access to MST MH care as no studies have examined Veterans' knowledge of, perceived need for, or barriers to these services. Objectives: The research objectives of the proposed CDA-2 project are to quantify the gender disparity in access to MST care, examine factors related to access to MST MH care, and pilot an intervention designed to reduce the gender disparity and promote access to care. These goals will be accomplished in three subsequent phases. In Phase 1, we will quantify the gender disparity in utilization and access, and examine the gender disparity by mental health diagnosis. In Phase 2, a number of factors (stigma, knowledge) will be examined in relation to whether they are related to access to MST care and then whether these significant factors account for the gender disparity in access to MST MH care. Finally, in Phase 3, the significant access factors from Phase 2 will be used to adapt an existing intervention designed to promote access to care. The training objectives of the proposed CDA-2 include formal and informal training in 1) key health services research areas: access and health disparities; 2) the use of and analysis of large healthcare administrative databases; 3) survey research methodology; 4) the design, evaluation, and implementation of interventions, and 5) professional development skills, such as grantsmanship and working in partnership with VA policy and operations offices. Methods: Research objectives will be achieved through 3 major avenues: 1) analysis of VA national administrative data (Phases 1 and 2), 2) linking VA administrative data to a nationwide mail survey that addresses perceived need and potential barriers to MST MH care among a representative sample of Veterans with positive MST screens (Phase 2); and 3) adapting, conducting, and evaluating an intervention to promote access to MST MH care (Phase 3). This intervention will be conducted at the local VA site in partnership with the MST Support Team, and will be used to provide feasibility data for wider intervention efforts. Potential Impact: By achieving the research aims of the proposed award, this research will provide valuable information about Veterans' access to MST MH care and will be used to used to inform an intervention to promote access to care and eliminate gender disparities among this vulnerable population. The current work is consistent with current priorities of HSR&D and the research priorities set by the VA Women's Health Research Agenda focusing on promoting access to care among vulnerable populations and reducing health disparities. This research will lead to the submission of an IIR, as well as other subsequent intervention and implementation work focused on increasing access to mental health care.
Veterans who experience military sexual trauma (MST) are at significantly greater risk for a wide range of mental health diagnoses as compared to Veterans who have not experienced MST. These Veterans represent a vulnerable population with a potentially high need for VHA services. While VA is mandated to annually monitor screening and treatment for MST, there is no available data that can address whether access to MST- related mental health care (MST MH care) is sufficient. Specifically, while utilization rates are documented, the extent to which Veterans are receiving adequate amounts of MST MH care is unknown, as no studies have examined Veterans' knowledge of, perceived need for, or barriers to these services. Research suggests that Veterans who experience MST may be underutilizing MST MH care, and that this may be particularly true for male Veterans. The proposed study will examine access factors related to MST MH care and pilot an intervention aimed to reduce the gender disparity and promote access to care for these Veterans.
