Institutional betrayal and help-seeking among women survivors of
                        military sexual trauma.

Monteith, Lindsey L.; Holliday, Ryan; Schneider, Alexandra L.; Miller, Christin; Bahraini, Nazanin H.; Forster, Jeri E.

doi:10.1037/tra0001027

Cited by 27 publications

(18 citation statements)

References 50 publications

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“…It is possible that discrimination, sexual harassment, and sexual assault, which is unfortunately overrepresented among female active duty personnel and veterans, 41,42 dissuade female veterans from seeking care in an institution (i.e., the VHA) that is viewed as an extension of the DoD. For instance, Monteith et al found that the construct of institutional betrayal was significantly predictive of women veteran MST survivors to endorse lower willingness to seek care from the VHA versus non‐VHA health care sources 43 . Previous research suggests that sexual minority female veterans are more likely than heterosexual female veterans to report histories of violence victimization 6 .…”

Section: Discussionmentioning

confidence: 99%

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Hahn

Burkitt

Kauth

et al. 2022

Health Services Research

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Objective This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non‐LGBTQ+ veterans. Data Sources and Study Setting Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules. Study Design We used survey‐weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non‐LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state. Data Collection Methods Study data were gathered via computer‐assisted telephone interviews with probability‐based samples of adults aged 18 and over. Data are publicly available. Principal Findings Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non‐LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non‐LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex‐stratified analyses, fewer female LGBTQ+ veterans than female non‐LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed. Conclusions Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.

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Section: Discussionmentioning

confidence: 99%

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Hahn

Burkitt

Kauth

et al. 2022

Health Services Research

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“…Additionally, women Veterans are more likely to have trauma histories than non-Veterans, [ 13 ] and are at a higher risk of experiencing military sexual trauma (MST) than their men counterparts. [ 37 ] Women Veterans who have survived MST are less likely to seek treatment through the VHA, despite their eligibility, partly due to feelings of institutional betrayal – i.e., poor institutional response to MST may lead survivors to seek healthcare in civilian settings as opposed to identifying as a Veteran for the purposes of receiving healthcare through the VHA [ 37 ]. This may contribute to our findings that some providers believe they encounter few women Veterans with hazardous substance use.…”

Section: Discussionmentioning

confidence: 99%

“…However, given the critical gap in the current literature, these findings can nonetheless help us advance the conceptual thinking around screening and hazardous substance use identification. Although we strategically targeted providers since screening and identification are systems-level issues, expanding this work to include more of the patient voice is warranted [ 37 ]. Future work to improve hazardous substance use screening and identification should further consider Veteran perspectives.…”

Section: Limitationsmentioning

confidence: 99%

Provider perceptions of challenges to identifying women Veterans with hazardous substance use

Giannitrapani

Holliday

Dawson

et al. 2022

BMC Health Serv Res

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Background Approximately one-third of women Veterans Health Administration (VHA) users have substance use disorders (SUD). Early identification of hazardous substance use in this population is critical for the prevention and treatment of SUD. We aimed to understand challenges to identifying women Veterans with hazardous substance use to improve future referral, evaluation, and treatment efforts. Methods Design: We conducted a secondary analysis of semi-structured interviews conducted with VHA interdisciplinary women’s SUD providers at VA Greater Los Angeles Healthcare System. Participants: Using purposive and snowball sampling we interviewed 17 VHA providers from psychology, social work, women’s health, primary care, and psychiatry. Approach: Our analytic approach was content analysis of provider perceptions of identifying hazardous substance use in women Veterans. Results Providers noted limitations across an array of existing identification methodologies employed to identify women with hazardous substance use and believed these limitations were abated through trusting provider-patient communication. Providers emphasized the need to have a process in place to respond to hazardous use when identified. Provider level factors, including provider bias, and patient level factors such as how they self-identify, may impact identification of women Veterans with hazardous substance use. Tailoring language to be sensitive to patient identity may help with identification in women Veterans with hazardous substance use or SUD who are not getting care in VHA but are eligible as well as those who are not eligible for care in VHA. Conclusions To overcome limitations of existing screening tools and processes of identifying and referring women Veterans with hazardous substance use to appropriate care, future efforts should focus on minimizing provider bias, building trust in patient-provider relationships, and accommodating patient identities.

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“…One recent study of women veterans that did address barriers in the context of suicide prevention found that a history of military sexual assault was associated with lower willingness to use VHA care for mental health symptoms [41]. Relatedly, MST-related institutional betrayal may deter women veterans from seeking specific types of VHA care [42]. Given the association between institutional betrayal and suicide attempts [43], preventing and addressing institutional betrayal may be particularly important to increasing healthcare engagement and preventing suicide.…”

Section: Reducing Barriersmentioning

confidence: 99%

Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization

Monteith

Holliday

Dichter

et al. 2022

Curr Treat Options Psych

Self Cite

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Purpose of Review There is growing concern regarding suicide among women veterans, who have experienced an increase in suicide rates that has exceeded that reported for other US adult populations. Recent research has bolstered understanding of correlates of suicide risk specific to women veterans. Yet most existing suicide prevention initiatives take a gender-neutral, rather than gender-sensitive, approach. We offer clinical considerations and suggestions for suicide prevention tailored to the needs, preferences, and experiences of women veterans. Discussion is framed around the White House strategy for preventing suicide among military service members and veterans.Social Determinants of Health (R Holliday, Section Editor)Recent Findings Considering high rates of trauma exposure among women veterans, we propose that a trauma-informed lens is essential for taking a gender-sensitive approach to suicide prevention with this population. Nonetheless, research to inform evidence-based assessment and intervention remains largely focused on veteran men or gender-neutral. Integral next steps for research are posited. Summary Extant research provides an initial foundation for beginning to understand and address suicide among women veterans in a gender-sensitive, trauma-informed manner. Additional research that is specific to women veterans or that examines gender differences is critical to ensure women veterans receive optimal, evidence-based care to prevent suicide.

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Institutional betrayal and help-seeking among women survivors of military sexual trauma.

Cited by 27 publications

References 50 publications

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Provider perceptions of challenges to identifying women Veterans with hazardous substance use

Preventing Suicide Among Women Veterans: Gender-Sensitive, Trauma-Informed Conceptualization

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