Introduction: Military Sexual Trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, PTSD, and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although research has found individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, lacking are evaluations of interventions that combine multiple CIH modalities or specifically in populations of at-risk female Veterans with history of suicidal ideation or behavior. Thus, this quality improvement project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female Veterans with MST. Materials and Methods: Female Veterans (N=38) with and without a history of MST participated in an ongoing multimodal CIH intervention. Programming took place over multiple 4-week long cohorts during which Veterans engaged in meditation and mindfulness, physical exercise, nutrition, and motivational curricula. Mental health symptoms and other factors related to suicide risk were assessed before and after program participation, using measures including the PTSD Checklist for DSM-5 (PCL), Perceived Stress Scale (PSS), Beck Anxiety Scale (BAS), Beck Depression Inventory II (BDI), Patient Health Questionnaire (PHQ-9), Measure of Current Status (MoCS), Pittsburgh Sleep Quality Inventory (PSQI), and the Defense and Veterans Pain Rating Scale (DVPRS). These measures were assessed for baseline differences between those with vs. without MST, pre-post intervention differences, and with ANCOVA for pre-post group differences accounting for baseline score. Results: Most participants reported a history of MST (68%), with those endorsing MST also having significantly worse baseline scores for depressive symptoms (PHQ-9 and BDI; p = 0.0402 and 0.0360 corresponding), PTSD symptoms (PCL; p =0.0360), perceived stress (PSS; p = 0.0254), and sleep quality (PSQI; p= 0.0121) than those without MST. No significant baseline differences were found for hopelessness (BHS), perceived coping ability (MoCS), anxiety (BAS), and pain (DVPRS). Significantly greater improvement in depressive symptoms (PHQ-9 and BDI; p = 0.0156, p = 0.0211), and perceived stress (PSS; p = 0.0351) was found in comparison of the MST vs. no MST group but not for the other scales; findings were no longer significant after accounting for baseline group differences across these measures. Finally, in the subset of Veterans with histories of suicide ideation or attempt, medium to large treatment effects were found for all measured outcomes (Cohen's |d| > .54). Conclusions: The results of this quality improvement project add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptoms related MST and extend these findings to female Veteran populations at-risk for suicide. Additionally, they lend initial weight to the ability of treatments integrating multiple CIH interventions to have similar positive impacts to the singular interventions typically studied.

The authors have declared no competing interest.

Fatemeh Haghighi, PhD is a recipient of the VA CSR&D Research Career Scientist Award; CX002074, and her work is supported by CX001728, CX001395, BX003794 & RX003818 at the James J. Peters VA Medical Center.

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The RWC quality improvement program evaluation described in this paper was reviewed and determined by the Institutional Review Board of the VA hospital to be exempt from IRB review, and it was approved by the Quality Improvement Executive Committee of the James J. Peters VA Medical Center.

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