Transcript: Dr. Margaret Bell’s testimony on the VA’s handling of military sexual assault, PTSD & suicides

Partial transcript of testimony of Dr. Margret E. Bell, Director for Education & Training, National Military Sexual Trauma Support Team, Department of Veterans Affairs, on the VA’s handling of post traumatic stress disorders and suicides of service members who suffered military sexual assault. The hearing before the Senate Armed Services Subcommittee on Personnel was held on Feb. 26, 2014:

Good morning, Chairman Gillibrand, Ranking Member Graham, and members of the subcommittee. Thank you for the opportunity to discuss the intersection of two very important issues involving our service members and veterans, namely military sexual trauma and suicide.

We just heard the incredibly moving stories of the two veterans that testified, who have struggled very much with the issues that we’re discussing today, and I very much appreciate their willingness to come today and really bring some of the data that I’m about to speak about to life and make it more real for us today.

The stories they’ve shared really underscored the importance of the issues I’d like to review in my comments, which is what research and empirical literature tell us about the health impact of military sexual trauma as well as the relationship between trauma, military sexual trauma, and suicide specifically.

Military sexual trauma – also known as MST – is an experience, not a diagnosis or mental health condition.

And as with other forms of trauma, there are a variety of reactions that veterans can have after experiencing MST. The type, severity, and duration of a veteran’s difficulties will all vary based on factors like the nature of the MST experienced, the reactions of others at the time and afterwards, and whether the veteran had a prior history of trauma.

Although the struggles that men and women have after MST are similar and may overlap in some ways, there can also be gender-specific issues that they may deal with.

The impact of MST can also be affected by race, ethnicity, religion, sexual orientation, and other cultural variables.

Our veterans are remarkably resilient after experiencing trauma, but unfortunately, some do go on to experience long-term difficulties after experiencing MST.

VA medical record data indicate that in fiscal year 2012, post traumatic stress disorder and depressive disorders were the mental health diagnoses most commonly associated with MST. Other common diagnoses were other anxiety disorders, bipolar disorders, substance use disorders, and schizophrenia and psychotic disorders.

Veterans who experienced MST often also struggle with physical health conditions and other problems such as homelessness.

With regard to suicide, research has shown that trauma in general is associated with suicide and suicidal behavior. This is true for both civilian and military populations.

But if we focus on sexual trauma specifically, data from civilian studies have found an association between sexual victimization and suicidal ideation, attempted suicide, and death by suicide. These relationships remain even after you control for mental health conditions, like depression or PTSD.

Although less work has been done examining the link between sexual trauma and suicide among veterans specifically, the data that exist show a pattern similar to the studies of civilians that I just reviewed, that is studies and VA administrative data show that sexual trauma during military service is associated with suicide attempts as well as death by suicide, and this association also holds even after accounting for mental health symptomotology.

Treatment approaches always need to be tailored to the specific needs of the individual veteran and to take into account not only the co-morbid health conditions but also the veteran’s treatment and broader psycho-social history, his or her current life context, and his or her individual preferences.

Regarding treatment for veterans with PTSD specifically, a specific research base has accumulated identifying exposure-based cognitive behavioral therapies, such as cognitive processing therapy and prolonged exposure as effective treatments for post-traumatic stress disorder.

Cognitive processing therapy and prolonged exposure in particular were originally developed for the treatment of sexual assault survivors with PTSD and they have particularly strong evidence base in this area.

Although these therapies should be considered the first choice approach to treatment of sexual assault survivors with PTSD, some veterans may benefit from an initial focus on coping skills development before getting these emotionally demanding treatments.

This sort of phase-based approach can help augment their strategies for managing the emotional distress that may be brought up during completion of the cognitive behavioral treatment.

Psycho education about PTSD and the impacts of sexual assaults can also be an important component of treatment.

Madam Chairman, VA is committed to ensuring that our veterans get the help that they need to recover from experiences of MST. I really appreciate having the opportunity to speak about some of the research in this area today as well as thank you for your support in these important issues, and I’m prepared to respond to any questions you may have.


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