No man left behind', Conceptualizing functioning and increasing access to care for male survivors of military sexual trauma

Abstract: Military sexual trauma (MST), or the perpetration of sexual harassment or sexual assault against a member of the military, continues to be a pervasive problem which affects many service members’ mental health (Fillo et al., 2018; SAPRO, 2021; Tannahill, 2020). Research on psychological sequelae and healthcare utilization among this population is limited and has primarily focused on female MST survivors (Monteith et al., 2019; Morris et al., 2014). Paper 1 presents an empirical analysis of sex differences in psychological functioning and patterns of healthcare utilization among survivors of MST. To reduce the influence of confounding variables sixty-one male survivors of MST were 1:1 propensity matched to female MST survivors on duty status, race, age, experiences of military sexual harassment, and experiences of military sexual assault. There were significant differences in PTSD scores and life satisfaction, wherein male MST survivors reported higher PTSD symptomatology and lower life satisfaction than matched female MST survivors. Veteran sex did not significantly predict VA healthcare satisfaction, VA healthcare use, or non-VA (i.e., civilian) healthcare use. Then, 2x2 between subjects factorial analysis of variance (ANOVA) were conducted to examine the influence of gender and mental healthcare access on mental health symptoms reported among MST survivors. There were no significant interaction effects between gender and mental healthcare treatment on mental health outcomes in our sample. However, treatment access was associated with higher PTSD symptoms, lower life satisfaction, and more alcohol use among the sample of MST survivors. Paper 2 presents an integrative literature review focusing on the barriers which prevent male MST survivors from accessing effective healthcare within the Veterans Healthcare Administration (VHA). The VHA is a national institution that operates separately from civilian healthcare, with its own training, mandates, and screening processes (Trivedi et al., 2011). This integrative literature review applies an ecological model of healthcare access (Zinzow et al., 2021) to the VHA. Barriers to accessing healthcare for male MST survivors are outlined at each level of the ecological model. Recommendations for remediating these barriers are provided and include military culture interventions, research initiatives, and policy recommendations for changes to the VA’s organization of MST care.

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