背景:服兵役期间的性侵犯和/或性骚扰(军事性创伤(MST))可能会产生医疗和心理健康后果。大多数MST研究都集中在育龄妇女身上,关于MST对更年期和衰老相关健康的长期影响知之甚少。
目的:检查MST与中年女性退伍军人更年期和心理健康结果的关系。
方法:横断面。
方法:年龄在45-64岁的女性退伍军人在2019年3月至2020年5月期间在北加州的退伍军人事务部(VA)医疗保健部门注册。
方法:标准化VA筛查问题评估MST暴露。结构化项目问卷评估血管舒缩症状(VMS),阴道症状,睡眠困难,抑郁症状,焦虑症状,和创伤后应激障碍(PTSD)症状。多变量逻辑回归分析基于临床相关的更年期和心理健康症状阈值,检查了MST与结局之间的关联。
结果:在232名参与者中(年龄=55.95±5.13),73%报告MST,66%报告了VMS,75%的人报告了阴道症状,36%的人符合中度至重度失眠的标准,几乎一半的人有临床上显著的精神健康症状(33%的人有抑郁症状,49%的焦虑,27%可能的PTSD)。在调整年龄的多变量分析中,种族,种族,教育,身体质量指数,和更年期状态,MST与VMS的存在相关(OR2.44,95%CI1.26-4.72),阴道症状(OR2.23,95%CI1.08-4.62),临床显着抑郁症状(OR3.21,95%CI1.45-7.10),焦虑(OR4.78,95%CI2.25-10.17),和可能的PTSD(OR6.74,95%CI2.27-19.99)。当军事性侵犯和骚扰被分类时,结果没有差异,除了军事性侵犯还与中度至重度失眠相关(OR3.18,95%CI1.72-5.88).
结论:MST暴露在中年女性退伍军人中很常见,并显示出与临床上重要的更年期和心理健康症状的强烈和独立的关联。研究结果强调了基于创伤的护理方法的重要性,这些方法承认MST在整个生命周期中对退伍军人妇女健康的作用。
BACKGROUND: Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health.
OBJECTIVE: Examine associations of MST with menopause and mental health outcomes in midlife women Veterans.
METHODS: Cross-sectional.
METHODS: Women Veterans aged 45-64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020.
METHODS: Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds.
RESULTS: Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26-4.72), vaginal symptoms (OR 2.23, 95% CI 1.08-4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45-7.10), anxiety (OR 4.78, 95% CI 2.25-10.17), and probable PTSD (OR 6.74, 95% CI 2.27-19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72-5.88).
CONCLUSIONS: Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women\'s health across the lifespan.