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Combat: Unique Issue

Combat: Unique Issue

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Combat: Unique Issue

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  1. Combat: Unique Issue

  2. Stressor-related Factors • Unique characteristics of a traumatic event that play a role in shaping post-traumatic functioning • These factors may overlap with other traumatic events

  3. Combat-Related Stressors • Type of combat plays an important role in shaping the response • Afghanistan and Iraq are the most sustained combat operations since Vietnam • Increased frequency and intensity of combat exposure

  4. Combat-Related Factors contd. • Persistent danger of guerilla warfare and terrorist activities • Difficulty determining ‘who is the enemy’ • Prolonged periods of vigilance • Rules of engagement that prohibit engaging in spite of the fact that the situation is threatening • Ongoing stress and strain

  5. Combat-Related Factors contd. • High casualty rates (now exceed 4000) • High ratio of wounded to killed so many are exposed to wounded comrades and to seeing their comrades killed • See high rates of civilian casualties including those of women and children • Moral conflict of killing others, including unintended death of civilians

  6. Meaning of War • As the war continues, public support for the war wanes and can affect the perceived support of the service members; • No available research on this topic

  7. What is Military Sexual Assault (MSA)? • Sexual assault that occurs in the military setting • Victims and perpetrators can be male or female

  8. How is MSA Different from Other Types of Sexual Assault? • Military sexual assault occurs in a setting where the victim lives and works, and as a consequence: • Victim may rely on perpetrator for basic needs • Career goals may be disrupted • Victim may experience increased feelings of powerlessness • Anecdotal evidence suggests MSA may be underreported because of fear that: • Report will be ignored • Survivor will be blamed for the assault • There will be negative implications for career

  9. Prevalence of MSA In 1995, the Department of Defense conducted a study of active duty military members. • Findings from this study indicated that in the previous year, MSA had affected: • 6% of women • 1% of men

  10. Consequences of MSA In a study of female VA healthcare users conducted in 1997: • 23% reported MSA at some time during • their military service • MSA was related to a number of health • outcomes, among them: • Mental health problems, including PTSD, depression, and anxiety • Gastrointestinal and pulmonary problems • Chronic fatigue, vision, and hearing problems • Dissatisfaction with sex life (Skinner et al., 2000)

  11. Sexual Assault and PTSD amongReturning Iraq and Afghanistan War Veterans • Reports of sexual harassment and assault perpetrated by fellow military personnel, military leaders, allies, and foreigners have surfaced in the media (Loeb, 2004; Martineau & Wiegand, 2005; “Sexual assaults,” 2005; Siemaszko, 2005) Military members may be coping with additional deployment stressors, in addition to MSA, that increase the risk for negative health consequences • Lack of social support (Vogt, Pless, King, & King, 2005) • Family stress (Blount, Curry, & Lubin, 1992) • Combat and other war-zone stressors (Ritchie, 2001)

  12. Screening for Military Sexual Trauma • Military sexual trauma refers to both sexual harassment and assault experienced during military service • VA mandates universal screening for military sexual trauma • Important elements of the screening process include: • Establishing a comfortable climate for disclosure • Deciding on how screening will be conducted (e.g., as part of social history or on an intake form) • Introducing the line of questioning in a non-judgmental manner • Asking behaviorally-based questions (e.g., Did someone ever use force or the threat of force to have sexual contact with you against your will? [sexual assault])

  13. Screening for Military Sexual Trauma in the VA (cont.) • Response to disclosure of military sexual trauma should include: • Validation/empathy • Education about post-trauma reactions • Assessment of current health and safety status • Assessment of support available to individual • All patients with a sexual trauma history should be offered the option of a mental health referral

  14. Screening for Military Sexual Trauma in the VA (cont.) • When making referral, it is important that the clinician know: • How to present the referral in a way that will maximize its acceptability to patient • Normalize experience • Offer options • Where to send the consult • Local VA’s Military Sexual Trauma Coordinator • Women Veterans Program Manager • Mental Health (For more information, please see the Military Sexual Trauma Quick Reference Guide available through the Employee Education System)