Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
Center for Health Services Research, Uniformed Services University, Bethesda, MD 20814, USA.
Mil Med. 2023 Jul 22;188(7-8):1609-1614. doi: 10.1093/milmed/usac175.
Reports of sexual assault (SA) in the U.S. Military have increased in recent years. Given the deleterious effects of military SA, there remains a need for large-scale studies to assess SA-related health care utilization among active duty service members (ADSMs). The present study, therefore, utilized Military Health System (MHS) data to determine the prevalence of SA-related care, sociodemographic characteristics of ADSMs receiving said care, and the type of provider seen during the initial SA-related health encounter.
Utilizing the MHS Data Repository and Defense Enrollment Eligibility Reporting System, all ADSMs from the Air Force, Army, Navy, and Marine Corps during fiscal years (FY) 2016-2018 were identified. Those with an International Classification of Diseases diagnostic code related to SA during the study period were isolated. Descriptive statistics and multivariable logistic regression analyses were conducted. The study was exempt from human subjects review.
A total of 1,728,433 ADSMs during FY 2016-2018 were identified, of whom 4,113 (0.24%) had an SA-related health encounter. Rates of SA-related health care encounters decreased each FY. Women (odds ratio [OR] = 12.02, P < .0001), those in the Army (reference group), and enlisted personnel (OR = 2.65, P < .0001) were most likely to receive SA-related health care, whereas ADSMs aged 18-25 years had lower odds (OR = 0.70, P < .0001). In addition, higher odds of SA-related care were observed among those identifying as American Indian/Alaskan Native (OR = 1.37, P = .02) and "Other" race (e.g., multiracial) (OR = 4.60, P < .0001). Initial SA-related health encounters were most likely to occur with behavioral health providers (41.4%).
The current study is the first large-scale examination of health care usage by ADSMs in the MHS who have experienced SA. Results indicated that rates of SA-related care decreased throughout the study period, despite the increasing rates of SA documented by the DoD. Inconsistent with previous research and DoD reports indicating that younger ADSMs are at the highest risk for SA, our study observed lower rates of SA-related care among those aged 18-25 years; additional research is warranted to determine if there are barriers preventing younger ADSMs from seeking SA-related health care. Behavioral health providers were most frequently seen for the initial SA-related encounter, suggesting that they may be in a unique position to provide care and/or relevant referrals to ADSMs who have experienced SA. The present study provides key insights about the prevalence of SA-related care within the MHS, not yet reported in previous literature, which could help inform MHS screening practices. The strengths of the study are the inclusion of the entire active duty population without the need for research recruitment given the utilization of de-identified TRICARE claims data. The study is limited by its use of health care claims data, general SA International Classification of Diseases codes as a proxy indicator for military SA, and lack of data on ethnicity. Future research utilizing MHS data should examine mental health outcomes following the documentation of SA and disruptions in SA-related care due to SARS-CoV-2.
近年来，美国军方报告的性侵犯（SA）事件有所增加。鉴于军事 SA 的有害影响，仍需要进行大规模研究，以评估现役军人（ADSM）中与 SA 相关的保健服务利用率。因此，本研究利用军事医疗系统（MHS）数据来确定与 SA 相关的护理的流行率、接受此类护理的 ADSM 的社会人口学特征，以及在最初的与 SA 相关的健康接触期间看到的提供者类型。
利用 MHS 数据仓库和国防登记入选系统，确定了 2016 财年至 2018 财年空军、陆军、海军和海军陆战队的所有 ADSM。在研究期间，对与 SA 相关的国际疾病分类诊断代码进行了隔离。进行了描述性统计和多变量逻辑回归分析。该研究获得了人类受试者审查豁免。
在 2016 财年至 2018 财年期间，共确定了 1728433 名 ADSM，其中 4113 名（0.24%）有与 SA 相关的健康接触。每财年与 SA 相关的保健服务接触率都有所下降。女性（比值比[OR] = 12.02，P <.0001）、陆军（参考组）和 enlisted 人员（OR = 2.65，P <.0001）最有可能接受与 SA 相关的保健服务，而 18-25 岁的 ADSM 则可能性较低（OR = 0.70，P <.0001）。此外，与 SA 相关的护理的可能性更高，见于认定为美国印第安人/阿拉斯加原住民（OR = 1.37，P =.02）和“其他”种族（例如多种族）（OR = 4.60，P <.0001）的人。最初与 SA 相关的健康接触最有可能与行为健康提供者发生（41.4%）。
目前的研究是对经历过 SA 的 MHS 中 ADSM 健康服务使用情况的首次大规模检查。结果表明，尽管国防部记录的 SA 发生率不断增加，但与 SA 相关的护理率在整个研究期间有所下降。与以前的研究和国防部报告表明，年轻的 ADSM 面临最高的 SA 风险不一致，我们的研究观察到 18-25 岁年龄组的 SA 相关护理率较低；需要进一步研究以确定是否存在阻止年轻 ADSM 寻求与 SA 相关的保健服务的障碍。行为健康提供者是最初与 SA 相关的接触中最常看到的，这表明他们可能处于独特的位置，为经历过 SA 的 ADSM 提供护理和/或相关转介。本研究提供了关于 MHS 中与 SA 相关的保健服务的流行率的关键见解，这在以前的文献中尚未报道，这可能有助于为 MHS 筛查实践提供信息。该研究的优势在于纳入了整个现役人员，而无需进行研究招募，因为使用了去识别的 TRICARE 索赔数据。该研究的局限性在于使用了健康护理索赔数据，一般的 SA 国际疾病分类代码作为军事 SA 的代理指标，以及缺乏关于种族的数据。未来利用 MHS 数据的研究应检查记录 SA 后的心理健康结果以及由于 SARS-CoV-2 而中断与 SA 相关的护理。
