MedicalResearch.com Interview with:
Keren Lehavot, PhD
Research Clinical Psychologist
VA Puget Sound Health Care System
Department of Psychiatry & Behavioral Sciences
University of Washington
Medical Research: What are the main findings of the study?
Dr. Lehavot: Alcohol misuse is a significant public health concern among women living in the U.S. Women who have served in the military are a unique population who report relatively high rates of hazardous drinking, and those who identify as lesbian or bisexual (LB) may be at especially high risk for alcohol misuse. While previous research suggests that lesbian or bisexual veterans report higher rates of alcohol misuse than their heterosexual counterparts, mediators that might explain this disparity have not been identified. To that end, we examined the role of civilian and military traumas and mental health symptoms (i.e., depression, post-traumatic stress disorder) in explaining disparities in alcohol misuse between sexual minority and heterosexual women veterans across the U.S. Women veterans were recruited using the Internet to participate in an online, anonymous, national survey.
Findings indicated that lesbian or bisexual veterans scored significantly higher on an alcohol misuse measure than heterosexual women veterans. LB veterans also reported higher rates of childhood trauma, physical victimization in adulthood both during the military and as a civilian, and mental health symptoms, partly accounting for their higher rates of alcohol misuse.
Medical Research: What was most surprising about the results?
Dr. Lehavot: There was only a marginally significant difference in adult civilian sexual assault and no difference in military sexual assault between lesbian or bisexual and heterosexual women veterans. Rates of adult sexual assault were strikingly high among both groups (33-42%). Thus, these variables did not act as mediators that could explain the sexual orientation–alcohol misuse disparity. However, it is essential to note that there were significant indirect effects of military sexual assault on alcohol misuse through depressive and PTSD symptoms for the full sample, suggesting that sexual assault during military service can be an important antecedent for adverse outcomes.
Medical Research: Medical Research: What should clinicians and patients take away from your report?
Dr. Lehavot: The findings suggest that elevated rates of victimization and mental health symptoms partially account for lesbian or bisexual women veterans’ greater alcohol misuse. This reflects a pressing need to address both violence against women and women veterans more broadly, as well as sexual orientation disparities in experiencing such violence. Results also suggest the need for clinicians to assess victimization histories and mental health. An understanding of how increased rates of trauma and mental health symptoms relate to alcohol use disparities for lesbian or bisexual veterans may enhance therapeutic rapport and use of appropriately tailored intervention strategies, such as identifying alternative sustainable coping methods and addressing mood regulation.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Lehavot: The present study advances understanding of alcohol use disparities; however, further testing of explanatory models of alcohol use is needed. Longitudinal designs are critical to examine sequential relationships among variables more accurately. Moreover, while victimization and mental health symptoms are important to address, other factors such as family history of alcohol use, social norms, and stressors unique to lesbian or bisexual veterans may also be key to understanding and ultimately reducing alcohol disparities.