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Try out PMC Labs and tell us what you think. Learn More. The issue of MST, therefore, is an important one to address adequately, especially for female veterans who are screened through the VHA system. Only half of VHA hospitals adopted screening 6 years after the policy change. Having a history of MST ificantly increases the risks of developing mental health disorders, including posttraumatic stress disorder PTSDmajor depressive disorder, generalized anxiety disorder, and suicidal ideation.
Female veterans have increased sexual dysfunction and dissatisfaction, which is heightened with a history of MST. Research has identified unique gender-specific concerns such as female-only mental health groups. Those who agreed to participate attended any 1 of 5 focus groups. Prior to initiation of the focus groups, the investigators generated a focus-group script, including specific questions or probes to explore treatment, unmet needs such as other health conditions the veteran associated with MST that were not being addressedand recommendations for care improvement.
Subjects granted consent privately prior to conduction of the focus group. Each participant completed a basic demographic age, race, ethnicity and clinical history including pain conditions and therapy received for MST. These Ladies want real sex MD Taneytown 21787 were evaluated with descriptive statistics, including means and frequencies. Murphy VA Medical Center campus in a private conference room and were moderated by nonmedical research personnel experienced in focus-group moderation. Focus groups were recorded and transcribed. An iterative process was used with revisions to the script and probe questions as needed.
The de-identified transcripts were ed to the web-based qualitative engine Dedoose 6. Using grounded theory, the codes were grouped into themes and subsequently organized into emergent concepts. Between January and June5 focus groups with 17 participants were conducted; each session lasted about 3 hours. Many females were using alternative therapies for treating pain conditions associated with MST Table 2.
Focus-group participants noted improved therapies offered by the VA but challenges obtaining health care:. Participants also noted that, along with screening improving the system, dedicated female staff and service connection Ladies want real sex MD Taneytown 21787 important:. This male-dominated sense also incorporated a feeling of being misunderstood by a system that has traditionally cared for male veterans:.
And we know we need to recognize that men have their issues, and women will have their issues. Ongoing efforts to have female-only spaces, therapy groups, and support networks were encouraged by all 5 focus groups. Because there are barriers to seeking care the overarching method for coping with the effects of MST was isolation. Overcoming the isolation was essential to seeking any care. Participants reported years of living alone, avoiding social situations and contexts, and difficulty with basic tasks because of the isolation. Additionally, feeding the isolation were other maladaptive behaviors, such as alcoholism, weight gain, and anger.
Participants reported that successful treatment of MST must include treatment of other maladaptive behaviors and specific provider-behavior changes. The need for provider-level support and validation likely stems from the sense that many females expressed that MST was their fault.
As one participant said. I froze. I just froze and put up with it, so I feel like jeez it was my fault. Somehow I am responsible for this. Over and over and over. That is the most important thing that us females need to know. Because that is such a relief and that opened up so much more. At all of the focus groups, female veterans reported that physician validation of the assault was essential to healing. When providers communicated validation, the women experienced the most improvement in symptoms. A variety of modalities was recommended as helpful in coping with symptoms associated with MST.
One female noted her therapy dog allowed her to get her first Papanicolaou Pap smear in years:. Last time, up here, they let me bring my little dog, which was extraordinarily helpful for me. For others, more traditional therapy such as prolonged exposure therapy or cognitive behavioral therapy, was helpful. From these concepts, and the specific suggestions female veterans provided for improvement in care, we developed a pictorial conceptual framework of the Ladies want real sex MD Taneytown 21787.
In this framework, isolation is perpetuated by mental health, lack of support both from society and the VAand self-doubt. Patient recommendations to break this cycle based on focus-group coding could disrupt the cycle of isolation Figure. This qualitative study of the quality of MST treatment with specific suggestions for improvement shows that the underlying force impacting health care in female survivors of MST is isolation. In turn, that isolation is perpetuated by personal beliefs, mental health, lack of support, and the VHA culture.
While there was improvement in VHA care noted, female veterans offered many specific suggestions—simple ones that could be rapidly implemented—to enhance care. Many of these suggestions were targeted at provider-level behaviors such as validation, goal setting, knowledge both about the military and about MSTand support. work showed that tangible ie, words, being present support rather than broad social support only generally helps reduces posttraumatic stress symptoms.
Schumm and colleagues also found that high social support predicted lower PTSD severity for inner-city women who experienced both child abuse and adult rape. Our finding that female MST survivors desire verbal support from physicians may point to the inherent sense that validation helps healing, demonstrated by this meta-analysis.
Importantly, the focus group participants did not specify the type of physician psychiatrist, primary care provider, gynecologist, surgeon, etc who needed to provide this support. Thus, we believe this suggestion is applicable to all physician interactions when the history of MST comes up. Physicians may be unaware of their profound impact in helping women recover from MST. This validation may also apply to survivors of other types of sexual trauma. A second simple suggestion that arose from the focus groups was the need for broader options for MST therapy. Current data on the locations female veterans are treated for MST include specialty MST clinics, specialty PTSD clinics, psychosocial rehabilitation, and substance use disorder clinics, showing a wide range of settings.
While it may not be possible to offer every resource at every VHA facility, partnering with community services may help fulfill this veteran need. There are several inherent weaknesses in this study. The female veterans who agreed to participate in the focus group may not be representative of the entire population, particularly as survivors may be reluctant to talk about their MST experience. The participants in our focus groups were most commonly 2 decades past the MST and their experience with therapy may differ from that of women more recently traumatized and engaged in therapy.
However, the fact that many of these females were still receiving some form of therapy 20 years after the traumatic event deserves attention. Recall bias may have affected how female veterans described their experiences with MST treatment. We did not inquire about the timing of therapy and whether they sought VA care first, followed by community care, or vice versa.
Finally, although the data were analyzed separately by 3 investigators, biases in data analysis may arise with qualitative methods. Strengths of the study included the inherent patient-centered approach and ability to analyze data not readily extracted from patient records or validated questionnaires.
Additionally, this qualitative approach allows for the discovery of patient-driven ideas and concerns. Our focus groups also contained a majority of minority females including Hispanic and American Indian populations that are frequently underrepresented in research. Our data show there is still substantial room for improvement in Ladies want real sex MD Taneytown 21787 therapies and in the physician-level care for MST. While each treatment experience was unique, the collective agreement was that multimodal therapy was beneficial.
However, the isolation that often comes from Ladies want real sex MD Taneytown 21787 makes accessing care and treatment challenging. Author disclosures. The authors report no actual or potential conflicts of interest with regard to this article. The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc.
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Female Veterans’ Experiences With VHA Treatment for Military Sexual Trauma