Defense Department officials testified Feb. 26 before the Senate Armed Services Committee's personnel subcommittee on the relationship between military sexual assault survivors and the subsequent development of suicide and post-traumatic stress disorder.
Dr. Karen S. Guice, principal deputy assistant secretary of defense for health affairs, was joined by Jacqueline Garrick, director of DOD's suicide prevention program, and Nathan Galbreath, senior executive advisor for DOD's Sexual Assault Prevention and Response Office.
"We know from civilian population research that sexual assault is associated with an increased risk of suicidal ideation, attempts and completions," Guice said. "Furthermore, this association appears to be independent of gender.
"Sexual assault is also associated with mental health conditions such as depression, anxiety and PTSD," she continued. "Likewise, these mental health conditions are associated with suicidal ideation, attempts and completions."
Guice said for military populations, the evidence is less well defined than that in the civilian population.
"Between 2008 and 2011," she said, "the number of individuals who attempted or completed suicide and reported either sexual abuse or harassment in DOD ranged from six to 14 per year -- or 45 in total."
Only nine of those individuals also had PTSD, Guice said, an association similar to prior studies in civilians.
"The data does not, however, describe causation, the nature of the association, its directionality or potential influence of additional comorbidity factors," she said.
DOD has a variety of research initiatives, Guice said, directed to better understand the range of issues associated with suicide, including risk factors, the impact of deployment and possible precursors.
Guice also addressed DOD's services and programs available to trauma survivors.
"Sexual assault survivors are at an increased risk for developing sexually transmitted infections, depression, anxiety and PTSD," Guice said. "[These are] conditions that can have a long-lasting effect on well-being and future functioning, and can precipitate suicidal thought."
To address these and other potential risks, she said, DOD has policy, guidelines and procedures in place to provide access to a structured, competent and coordinated continuum of care, and support for survivors of sexual trauma.
This is regardless of whether the survivor is male or female, Guice said, or whether the sexual assault occurred prior to joining the military or during service, and it doesn't matter if the manifestations are physical or emotional.
Guice noted this continuum begins when the individual seeks care and extends through the transition from military service to the Veterans Affairs health care system or care in their communities.
"DOD has issued comprehensive guidance on medical management for survivors of sexual assault for all military treatment facilities and service personnel who provide or coordinate medical care for sexual assault survivors," she said.
Guice said this guidance also includes the requirement that the care is "gender-responsive, culturally competent and recovery-oriented."
Any sexual assault survivor who goes to a military treatment facility is treated as a medical emergency," she added.
"Treatment of any and all immediate life-threatening conditions takes priority," Guice said. Survivors are offered testing and prophylactic treatment options, and women are advised of the risk for pregnancy and information on emergency contraception, she said.
Before being released from treatment, Guice noted, survivors are provided referrals for additional medical services, behavioral health evaluation and counseling tailored to the patient's preferences for care.
"In locations where DOD does not have the needed specialized care," she said, "including emergency care within a given military treatment facility, patients are referred to providers in the local community."
Guice said Dr. Jonathan Woodson, the assistant secretary of defense for health affairs, issued a memorandum last spring to the services on reporting compliance with these standards.
"The services returned detailed implementation plans," she said. "The first of a yearly reporting requirement is due this summer from each of them."
DOD also has an in-transition program, Guice said, designed to meet the needs of service members who transition from active duty to civilian life. "This program assigns service members to a support coach to bridge between health care systems and providers," she said.
Guice reaffirmed the department's commitment to assisting sexual assault survivors and lauded the committee for examining this "very important issue."
"Our policies within DOD are designed to ensure that all trauma survivors, and particularly those subjected to sexual assault, have access to a full range of medical and behavioral health programs to optimize recovery," she said, "and that their transition from military service to civilian life is supported."