title: Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care.
abstract: OBJECTIVE
  This study examines the differential impact of military, civilian adult, and childhood sexual assault on the likelihood of developing posttraumatic stress disorder (PTSD). It also examines the relationship of military sexual assault (MSA) to service utilization and health care costs among women who access services through Veterans Affairs (VA).
  
  
  METHODS
  A convenience sample of 270 veteran women receiving medical and/or mental health treatment at the VA North Texas Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS) and categorized into a sexual assault group using the Interview of Sexual Experiences (ISE). A chart review was also conducted to determine the frequency of diagnoses among the women. Data regarding health care utilization was obtained from self-report using the Utilization and Cost Patient Questionnaire (UAC-PQ) and VA administrative records.
  
  
  RESULTS
  Compared with those without a history of sexual assault, women veterans were 9 times more likely to have PTSD if they had a history of MSA, 7 times more likely if they had childhood sexual assault (CSA) histories, and 5 times more likely if they had civilian sexual assault histories. An investigation of medical charts revealed that PTSD is diagnosed more often for women with a history of MSA than CSA. CSA was associated with a significant increase in health care utilization and cost for services, but there was no related increase in use or cost associated with MSA.
  
  
  CONCLUSIONS
  Women veterans have differential rates of PTSD due to sexual assault, with higher rates found among those assaulted while on active duty. Although women with MSA are more likely to have PTSD, results suggest that they are receiving fewer health care services.
authors.affiliation: Department of Veterans Affairs, Research Service, North Texas Health Care System, Dallas, Texas 75216, USA. alina.suris@med.va.gov
authors.forename: Alina
authors.initials: A
authors.lastname: Surís
authors.forename: Lisa
authors.initials: L
authors.lastname: Lind
authors.forename: T Michael
authors.initials: TM
authors.lastname: Kashner
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Borman
authors.forename: Frederick
authors.initials: F
authors.lastname: Petty
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008016:Life Change Events; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011902:Rape / Q000523:psychology*; D012307:Risk Factors; D017406:Sexual Harassment / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data