Military Sexual Trauma during Deployment to Iraq and Afghanistan: Prevalence, Readjustment, and Gender Differences
Katz, Lori S., Cojucar, Geta, Beheshti, Sayeh, Nakamura, Erin, Murray, Michelle, Violence and Victims
This study examines military sexual trauma (MST) in men and women deployed in the wars in Iraq and Afghanistan. A diverse sample of 470 (408 men and 62 women) completed anonymous self-report questionnaires. Seventy-seven reported MST: 51 (12.5%) men and 26 (42%) women. MST was significantly related to symptoms and readjustment and most strongly with intimacy problems. Of those with MST, 73% also reported exposure to war-related stressors. Gender differences revealed that women reported a higher prevalence of MST, but men were more likely to endorse MST with multiple war-related stressors. However, no gender differences were found on reports of symptoms, posttraumatic stress disorder (PTSD), or readjustment. Implications of these results are discussed.
Keywords: military sexual trauma; conflicts in Iraq and Afghanistan; OIF/OEF; gender differences
This study investigates the prevalence of military sexual trauma (MST) using anonymous data collection methods, in a diverse sample of men and women who served in the wars in Iraq and Afghanistan, otherwise known as Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), and the associated reports of symptoms and psychosocial readjustment. The Department of Veterans Affairs (VA) defines MST as
sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of the victim, or the relationship to the perpetrator.
Historically, reports have shown consistent high rates of MST (Goldzweig, Balekian, Rolon, Yano, & Shekelle, 2006; Suris & Lind, 2008). A review of 21 studies found MST rates of sexual harassment from 55% to 70% and rates of sexual assault from 11% to 48% among women Veterans (Goldzweig et al., 2006). A review of 25 studies found MST rates of sexual assault ranging from 20% to 43% among women Veterans (Suris & Lind, 2008). One of the 25 studies reported a lower rate (0.4%), and another study reported a higher rate (71%).
However, MST is not solely a woman's issue, although the prevalence among men appears to be much lower than for women, and there are fewer studies on men who report MST. Kimmerling, Gima, Smith, Street, and Frayne (2007) reviewed a large national sample of Veterans and found approximately 22% of women and 1% of men screened positive for MST. In the Suris and Lind (2008) review, eight studies included men. Seven reported MST rates between 1% and 4%. One study examining male participants who were being screened for posttraumatic stress disorder (PTSD) reported a 12% prevalence of MST. None of the studies reviewed by Suris and Lind (2008) included verbal sexual harassment or unwanted sexual advances that have been associated with higher rates of MST (Goldzweig et al., 2006). Murdoch, Polusny, Hodges, and O'Brien (2004) examined the prevalence of MST among men and women seeking VA disability benefits for PTSD. Among the men, 6.5% of combat Veterans and 16.5% of noncombat Veterans reported MST or postservice sexual assault. Among women, 69% of combat Veterans and 86.6% of noncombat Veterans reported MST or postservice sexual assault. Sexual assault was defined as someone attempting to or successfully forcing the victim to have sex against his or her will.
Sexual assault during times of war is also not a new phenomenon. A study on women deployed in the Persian Gulf War found that 8% reported assault, 31% reported physical harassment, and 61% reported verbal harassment (Wolfe, Brown, & Bucsela, 1992).
However, only four studies to date have examined MST among those deployed in OEF/OIF (Dutra et al., 2011; Haskell et al, 2010; Katz, Bloor, Cojucar, & Draper, 2007; Kimmerling et al, 2010). The Katz et al. (2007) study examined 18 women seeking services at a VA medical center and found a 56% prevalence of MST. Those with MST had a higher endorsement of symptoms and higher clinician ratings of distress. Kimmerling et al. (2010) studied prevalence of MST among 125,729 OIF/OEF Veterans using the centralized medical records of the Veteran's Health Administration. They found 15.1% of women and 0.7% of men reported MST when they were screened by health care professionals at their respective VA medical centers. Haskell et al. (2010) examined 1,129 electronic VA medical records (1,032 men, 197 women) and found that female Veterans were more likely to screen positive for MST (14% vs. 1%, p < 0.001) and depression (48% vs. 39%, p = .01) and less likely to screen positive for PTSD (21% vs. 33%, p = .002) than male Veterans. The fourth study examined exposure to combat experiences and military sexual harassment in a sample of 54 active duty women. They found that nearly half of the sample endorsed both stressors, and this was related to depressive and PTSD symptoms.
Unfortunately, all of these studies have serious limitations in that their samples were limited to those willing to report MST to health care professionals knowing that it would be recorded in their medical records or while on active duty service. In other words, there is a selection bias for those who were willing to endorse MST under these conditions.
In addition, the variability of prevalence rates among the various studies may be due to several factors: (a) how MST was defined (e.g., completed forced sexual relations/ assault vs. a broader definition including verbal sexual harassment and unwanted sexual advances), (b) the vulnerability of the population chosen (e.g., homeless Veterans, those receiving inpatient substance abuse treatment, or those seeking disability benefits for PTSD), and (c) the level of privacy associated with the assessment (e.g., taking an anonymous survey vs. being screened by one's medical care provider and maintaining an ongoing relationship and having the response recorded in one's medical record for other health care providers to view).
Nonetheless, the aggregate of these studies show an overwhelmingly high prevalence rate of MST that is concerning on multiple levels including the increased risk of developing PTSD (American Psychiatric Association [APA], 1994). Rape victims, in general, are considered to be the largest single group suffering from PTSD (Steketee & Foa, 1987). It has been estimated that 33%-57% of women who have been raped, at some point after the incident, develop PTSD (Kilpatrick, Saunders, Veronen, Best, & Von, 1987). Those who have incurred PTSD from sexual trauma have more symptoms across nearly all body systems and report higher levels of poor health behaviors (e.g., smoking, substance abuse) and twice as many physician visits than nonvictims (Koss & Heslet, 1992; Koss, Koss, & Woodruff, 1991; Skinner, John, & Hampson, 2000).
In addition to PTSD, MST is associated with a host of other concerns such as the impact it could have on one's military career, fear of reoccurrence, or retaliation if it is reported while continuing active duty service (Kimmerling et al., 2007). Because the military is both a living and work environment, victims may have to continue to interact with their perpetrators rendering victims virtually captive (Katz, 2009; Kimmerling et al., 2007). Victims may need to rely on their perpetrators or friends of their perpetrators in combat, for health care, promotions, or simply to do their jobs. Unit cohesion has been shown to be a vital component of maintaining solidarity among fellow service members (Martin, Rosen, Durand, Knudson, & Stretch, 2000); however, victims may choose to remain silent about their exposure to MST or even encouraged to do so to maintain unit cohesion, or their complaints may simply be ignored (Kimmerling et al., 2007). Victims of sexual trauma can be judged as being weak, ineffective in protecting themselves, or somehow blamed for inviting or causing the sexual trauma (Madriz, 1997). This promotes a sense of shame and isolation. Furthermore, there is a stigmatization associated with service members seeking mental health services that could be an additional burden and reason for MST victims to avoid reporting or seeking treatment (Hoge et al., 2004).
MST during OEF/OIF presents unique circumstances because not only does the sexual trauma occur while in the military but also it happens while deployed in a war with a high potential of being exposed to other war-related stressors for both men and women. Although Fontana and Rosenheck (1998) found sexual trauma to be four times as influential as war stress in the development of PTSD, no studies to date have examined the specific additive effects of experiencing both sexual trauma and being exposed to the effects of combat or other war stressors and its impact on psychological adjustment.
Another limitation of previous research on MST is that the studies have focused solely on medical and psychological symptoms and have not included psychosocial functioning across various domains (e.g., social, intimacy, and career) with a reliable and valid instrument. This study includes the Post-Deployment Readjustment Inventory (PDRI; Katz, Cojucar, Davenport, Pedram, & Lindl, 2010) for a more comprehensive view of the impact of MST on postdeployment readjustment for those with and without symptoms of PTSD.
In this study, it was hypothesized that (a) both men and women would report prevalence rates of MST similar to the levels of previous findings (e.g., women = 20%-43%, men = 1%-4%) based on the most recent review article (Suris & Lind, 2008), (b) MST as well as war-related stressors of being injured or witnessing others injured or killed would be significantly related to symptoms of PTSD and psychosocial readjustment difficulties, (c) a significant portion of those who reported MST while deployed in OEF/OIF would also have reported exposure to other war-related stressors, and (d) when statistically controlling for the effects of exposure to war-related stressors, MST would continue to be associated with symptoms and psychosocial readjustment difficulties.
Five hundred and seventy-seven questionnaires were distributed to postdeployed OEF/ OIF service members and 496 were received back. Twenty-six were not included because of incomplete data (e.g., they missed more than half of the items on at least one of the questionnaires). The final sample consisted of 470 participants, 408 (86.8%) men and 62 (13.2%) women. This sample is consistent with the proportion of women for this population. It is estimated that women comprise 10.5% of the troops deployed in OEF/ OIF (Hoge, Auchterlonie, & Milliken, 2006). Similarly, approximately 11% of OEF/OIF Veterans enrolled at the VA Long Beach Healthcare System are women. Thus, although there were few women in this study, it is in a representative proportion of the population.
The sample was ethnically diverse: 46 (9.8%) African American, 54 (11.5%) Asian, 186 (39.6%) Hispanic, 131 (27.9%) White, 46 (9.8%) other or mixed ethnic groups, and 7 (1.5%) did not answer this question. The sample also represented all branches of service: 183 (38.9%) Army, 26 (5.5%) Navy, 7 (1.5%) Air Force, 122 (26.0%) Marines, 2 (0.4%) Coast Guard, 69 (14.7%) National Guard, and 58 (12.3%) Reserves; 3 participants did not respond to this item (see Table 1 for a summary of sample demographics).
The average age was 30.56 years old (range = 20-57 years, SD = 8.41), and the average length of deployment was 12.81 months (range = 1-72 months, SD = 6.95).
General Information Form. Five questions were used from a general information form assessing (a) age, (b) gender, (c) length of deployment, (d) ethnicity, and (e) branch of service.
War Stressors. Participants completed five items assessing exposure to three war stressors: MST, being injured, and witnessing others injured or killed. These questions were chosen as broad experiences that could happen to men and women in various jobs during deployment (e.g., not just direct combat). The questions for MST were the following: (a) "Did you experience unwanted verbal comments of a sexual nature (pressure for dates, threats, catcalls)?" (b) "Did you experience unwanted physical sexual advances (unwanted touching, grabbing, cornering)?" and (c) "Were you sexually assaulted, attempted, or completed rape (forced sex, or agreed to have sex out of fear)?" The data was coded as a binary variable where presence of MST was coded as a "Yes = 2" and absence coded as "No = 5 ." Questions assessing war stressors were the following: (a) "Were you injured?" and (b) "Did you witness others injured or killed?" These items were scored as a binary variable where presence of the war stressor was coded as a "Yes = 2" and absence of the stressor was coded as a "No = 1."
Post-Deployment Readjustment Inventory (Katz et al., 2010). The PDRI is a 36-item inventory that includes a global scale of readjustment (all items) and six subscales: career challenges, social difficulties, intimate relationship problems, health concerns, concerns about Iraq, and PTSD symptoms. Respondents are asked, "How true is each item since your return from deployment?" on a 5-point Likert-type scale, where 1 = not at all true and 5 5 extremely true. Higher scores indicate higher levels of readjustment difficulties. The PDRI has high internal reliability and convergent validity (Katz, Cojucar, Davenport, Clark, & Williams, 2012; Katz et al., 2010).
Posttraumatic Stress Disorder Checklist-Military Version (PCL-m; Weathers, Huska, & Keane, 1991). This 17-item inventory has items consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) criteria for PTSD. Items are answered on a 5-point Likert-type scale, where 1 = not at all and 5 = extremely. A general measure of PTSD is indicated by the sum of the items in the scale, whereby a higher score is related to a higher level of PTSD. The scale has good reliability based on test-retest reliability (r = 0.96 at 2-3 days and r 5 0.88 at 1 week; Blanchard, Jones-Alexander, Buckley, & Forneris, 1996) and internal consistency (a = .94 and .97; Blanchard et al., 1996; Weathers, Litz, Herman, Huska, & Keane, 1993). The PTSD Checklist (PCL) also correlates positively with the Mississippi PTSD Scale (convergent validity r = 0.85 and 0.93; Weathers et al., 1993).
Brief Symptom Inventory (BSI; Derogatis, 2000). This is a widely used 18-item instrument to measure symptoms of psychological distress. Items are answered on a 5-point Likert-type scale, where 0 = not at all and 4 = extremely. A general distress score is computed by summing across items with higher scores indicating higher level of psychological distress. The BSI has been shown to have strong psychometric properties (e.g., internal consistency, a = .89; Derogatis, 2000). It also has good convergent validity with the 90-item version of the Symptom Checklist (r = 0.91-0.96; Asner-Self, Schreiber, & Marotta, 2006).
Postdeployed service members were recruited at VA enrollment fairs comprising 60% of the sample. Recruitment was at the following locations: the VA Long Beach Healthcare System, Los Alamitos (Joint Training Center for reservists of all branches) and Irvine and Bandini Army bases. The participants at these fairs were not necessarily seeking treatment at the VA but were enrolling to secure their VA benefits. The authors were invited to attend these fairs but agreed not to ask participants about the study until after they completed their VA paperwork. It was estimated that 10% of the attendees at these events agreed to participate in this study. Nonparticipants stated they couldn't because they had to go back to training (e.g., didn't have the time), were tired after spending 4-5 hours taking assessments (e.g., overwhelmed by paperwork), and only a few stated they were not interested. Participants were also recruited at the VA Long Beach Healthcare System in patient waiting rooms (e.g., waiting for appointments, lab results, or pharmacy) or walking around the medical center. The number recruited from the VA waiting rooms was approximately 40% of the sample. Several nonparticipants said they would like to participate but had appointments and didn't have time.
The study was explained to potential participants and those who agreed were given an informed consent form and a packet of questionnaires consisting of a general information form, the PDRI, the BSI, and the PCL-m. To ensure anonymity, participants were asked to place their signed consent forms in one envelope and their completed questionnaires in another. This design reassured participants that their name or any identifying information was not associated with their responses, and therefore, nobody would know their responses to the questionnaire and none of the responses would be in their medical chart. This was to help postdeployed troops feel more comfortable about answering questions about their experience. However, about halfway through data collection, we were granted a waiver, so participants did not have to complete an informed consent form. The VA Internal Review Board (IRB) continued to approve and monitor the data collection, data storage, and all aspects of doing research with human subjects. No differences were found on rates of MST from the two data collection procedures, so we combined the data. The average time for completing the questionnaires was about 30 minutes.
Because numerous analyses were conducted on this data set, to avoid spurious positive findings and to be able to draw meaningful conclusions, the alpha level of significance was set at p < .01 for all of the analyses.
Differences on demographics were examined. No differences were found for rates of MST between White and non-White participants, x2(1) = 1.54, p = .22. No differences were found for rates of MST between the Army, 26 (14%); Marines, 19 (16%); National Guard/Reserves, 20 (16%); and Navy, Air Force, and Coast Guard combined, 12 (34%); x2(3) = 7.13, p = .07. There were no differences between age and length of deployment between men and women (age, t = 0.37, p = .71; length of deployment, t = 20.22, p = .83) or between those with and without MST (age, t = 0.15, p = .89; length of deployment, t = 1.34, p = .18).
Prevalence of Military Sexual Trauma
Of the 470 participants, 77 (16%) reported experiencing MST while deployed in OEF/OIF, 23 (5%) reported sexual assault or rape, 54 (11.5%) reported unwanted physical advances, and 67 (14%) reported verbal sexual harassment. Of the 77 who screened positive for MST, 51 (12.5%) were men, and 26 (42%) were women. Specifically, 18 (4%) men and 5 (8%) women reported physical sexual assault or rape; 33 (8%) men and 21 (34%) women reported unwanted physical advances; and 45 (11%) men and 22 (36%) women reported verbal sexual harassment (see Table 2 for summary of MST prevalence rates).
When comparing prevalence rates of MST between men and women, women reported significantly higher rates of total MST, x2(1) = 34.0, p < .001; unwanted physical advances, x2(1) = 35.2, p < .001; and verbal sexual harassment, x2(1) = 26.3, p < .001 compared to men. However, the rates of sexual assault or rape did not differ between men and women, x2(1) = 1.5, p = .2.
Prevalence of War-Related Stressors
Variables of being injured and witnessing others injured or killed had the following respondent frequency: 221 (47%) reported being injured (199 [49%] men, 22 [36%] women) and 307 (65%) reported witnessing (282 [69%] men, 25 [40%] women). This suggests that a high proportion of this sample was exposed to war-related stressors. Comparing men and women, men reported more witnessing, x2(1) = 19.7, p < .001 but not being injured, x2(1) = 3.8, p = .05 compared to women.
Military Sexual Trauma and War-Related Stressors' Relationship to Symptoms and Readjustment
As hypothesized, MST was significantly associated with symptoms and readjustment (BSI: r = 0.14, p < .01; PDRI: r = 0.16, p < .001). With respect to PTSD, there was a discrepancy between results of the PCL-m and the PTSD subscale on the PDRI. Specifically, a statistically significant association was not found between MST and the PCL-m (r = 0.11, p = .02), but it was found based on the PTSD subscale of the PDRI (r = 0.15, p < .001). Of the three types of MST (assault, unwanted advances, and verbal sexual harassment), only verbal sexual harassment was significantly related to symptoms and readjustment (BSI: r = 0.15, p < .01; PDRI: r = 0.18, p < .001). Although in the hypothesized direction, the lack of an association between assault and unwanted advances and symptoms and readjustment is most likely due to the small sample size (see Table 3 for summary of results).
War-related stressors of being injured and witnessing others injured or killed were also significantly associated with symptoms, PTSD, and readjustment difficulties (BSI, PCL-m, and PDRI with injured: r = 0.33, 0.26, 0.31, p < .001; with witnessing: r = 0.25, 0.26, 0.28, p < .001, respectively). MST, being injured, and witnessing others injured or killed were significantly related to all PDRI subscales-career, health, intimacy, social concerns, concerns about deployment, and PTSD (see Table 3 for summary of results).
Military Sexual Trauma and Exposure to Multiple War-Related Stressors
Of the 77 who reported MST, 21 (27%) reported MST alone without war-related stressors of witnessing others injured or killed or being injured, whereas 56 (73%) of the sample reported MST and these war-related stressors: 18 (23%) reported MST with one other war stressor, and 38 (49%) reported MST with both war stressors. Those with MST while deployed were significantly more likely to experience MST and a war-related stressor, x2(1) = 15.91, p < .001. A variable of MST with multiple war-related stressors was created where MST alone = 1, MST and one war event = 2, and MST with two war events = 3. MST with multiple war-related stressors was significantly correlated with symptoms and readjustment suggesting that exposure to multiple war-related events may have a cumulative effect (with BSI, PCL-m, and PDRI: r = 0.17, 0.14, 0.19, p < .001, respectively). As hypothesized, MST during deployment in OEF/OIF is for a significant majority, not an isolated stressor but rather one of multiple war-related stressors. In addition, men were more likely to have multiple war-related stressors compared to women, t(75) = 3.22, p < .01.
Military Sexual Trauma and Unique Readjustment Patterns When Controlling for War-Related Stressors
When statistical controlling for the effects of being injured and witnessing others injured or killed, MST continued to reveal significant relationships with psychosocial readjustment (e.g., intimacy, PDRI global, social concerns, and concerns about deployment: r = .17, p < .001, .14, .13, .12, p < .01, respectively). Similar to previous results, MST was not associated with the PCL-m in this partial correlation, whereas the PTSD subscale on the PDRI was (PCL-m: r = 0.10, p < .05; PDRI- PTSD subscale: r = 0.13, p < .01) and not significantly associated with symptoms but in the hypothesized direction (BSI: r = 0.12, p < .05). Thus, when controlling for other war stressors, MST in its own right appears to be a significant contributor to psychosocial readjustment, particularly for issues with intimacy.
As presented, significantly more women reported MST than men and a significantly higher percentage of men reported witnessing others injured or killed and more likely to have experienced MST with multiple war-related stressors than women; however, there were no gender differences on reports of symptoms, PTSD, or readjustment difficulties.
The prevalence of MST among OEF/OIF postdeployed service members was at the top of the range of prior studies for women and appears slightly higher for men. This may be because this study included three questions assessing a range of MST behaviors including verbal sexual harassment. Including verbal sexual harassment appears to be critical but sometimes overlooked or minimized in the assessment of MST and neglected in studies on MST that only assess for sexual assault. This study found that verbal sexual harassment was the most prevalent and the strongest predictor of symptoms and readjustment. Verbal sexual harassment can be an ongoing stressor that may be particularly difficult in the military (e.g., work and living environment) as well as while deployed in a war (e.g., creating a hostile environment superimposed on an already stressful environment of war).
The questions used in the Kimmerling et al. (2007) study were similar to the questions used in this study. They found MST rates of 22% for women and 1% for men compared to our findings of 42% and 12.5% for women and men, respectively. The higher results reported in this study may be related to the fact that Veterans from all eras were included in the Kimmerling et al. (2007) study. It is possible that the prevalence of MST is higher in OEF/OIF compared to other conflicts, or maybe men and women are more aware of and more likely to identify incidents of MST as MST and more likely to report MST now compared to the past.
However, the results of this study are also much higher than the findings of the Kimmerling et al. (2010) study, which focused solely on Veterans from OEF/OIF screened by health care providers at VA medical centers (15.1% for women and 0.7% for men compared to our findings of 42% and 12.5% for women and men, respectively). Although the Kimmerling et al. (2010) study had a very large sample size of more than 125,000 respondents, it may be that people are more likely to report MST on an anonymous questionnaire than to health care providers knowing that their answers would be recorded in their medical records. In this study, participants had no secondary gains (e.g., not applying for compensation/benefits), were given no compensation for participating in the study, and were granted anonymity. It is possible that this particular sample had a higher rate of MST compared to other samples, or it may be possible that there is more MST incurred than what is actually reported in VA health care screenings. Nonetheless, postdeployed service members are not likely to spontaneously disclose their MST to health care providers (Acierno, Resnick, & Kilpatrick, 1997; Briere & Zaidi, 1989), but they may be more likely to disclose MST along with various other war events if given a self-report questionnaire with specific items assessing MST. More research is needed to answer these important questions.
Although a significantly higher proportion of women reported MST compared to men, in terms of actual numbers, almost twice as many men reported it compared to women. MST is typically thought of as a "women's issue" and this may bias providers by neglecting to assess for MST or bias men by not wanting to report it. This study highlights additional complicating factors given that most of those who reported MST also had exposure to other war-related stressors and more men compared to women reported multiple war-related stressors. MST for both men and women, and especially men, may be pushed aside to focus on more "heroic" and less stigmatizing events of combat. In many VA medical centers, there are specific clinics designated to treat combat PSTD and separate clinics or a single designated clinician to treat MST. A male combat veteran might seek treatment or be referred to treatment in a combat-stress clinic that may or may not address his issues of MST.
In addition, a war-related injury may necessitate immediate attention, and comparatively, addressing MST would be a lower priority. However, MST, while controlling for the statistical effects of the other war stressors, was related to symptoms and readjustment issues. Therefore, even if MST is not a top priority, if leftuntreated, it could have negative readjustment consequences. It is also possible that the full effects of MST may not surface until later or after immediate pressing needs are resolved. However, if psychosocial readjustment is conceptualized broadly, then ongoing assessments of symptoms and functioning in various domains, including intimacy and social functioning, may help health care providers detect and address the consequences of MST, with the intent to halt a cascade of deleterious effects that can unfold for someone with untreated MST.
Study Limitations and Future Research
One limitation of this study was a lack of follow-up with those who reported MST. To preserve anonymity, we had no identifying information on the respondents; thus, we were unable to offer services or find out if those with MST sought services and how many specifically for MST.
Another limitation is that only two war stressors were included in this study where in actuality, service members may experience a host of stressful experiences, especially while deployed in combat zones. This may further conceal the acknowledgement and treatment of MST if it is one of many stressful experiences (e.g., combat exposure, interpersonal distress, and circumstances of deployment). For example "killing or indirect killing" has been found to be a significant predictor of mental health symptoms (Maguen et al., 2010). A future study could include a broad assessment of war events such as using the Deployment Risk and Resilience Inventory (King, King, & Vogt, 2003) normed on Persian Gulf War service members or the War Experiences Inventory (Katz et al., 2012) normed on OEF/ OIF service members to examine the relationship of multiple war events and psychosocial readjustment.
A third limitation of this study is that it only assessed a limited amount of information regarding prevalence of MST and associated psychosocial readjustment. More in-depth interviews could reveal information such as how did these events occur; what factors lead people to choose if they would or would not report MST; if they did choose to report it, how was it handled; and what was the perceived consequences regarding MST. For example, in a small pilot study, 10 women were given in-depth interviews about their MST and found that (a) none of the women officially reported the incidents while in the military, (b) those who disclosed the events to military personnel (e.g., coworkers and superiors) or civilians (e.g., friends and families) did not feel they were supported (e.g., either minimized or blamed), and (c) six (60%) reported suicidal ideation and one person (10%) reported a suicide attempt (Huffman, Katz, Cojucar, & Nakamura, 2009). A future study could include more in-depth assessments to garner information about how these events happen, who are the perpetrators, as well as more information about the consequences.
Further implications of this study are vast, from designing treatments that address multiple events (e.g., combat and MST) as well as behavioral symptoms (e.g., intimacy and social anxiety) to simply ensuring that clinicians are addressing MST in those who also were exposed to combat (e.g., MST may be overlooked or minimized by men and women and their families, health care providers, and evaluators). More studies are needed to better understand how and why MST is occurring, as well as how best to address this issue in postdeployed Veterans.
Results of this study suggest that there is a significant prevalence of MST in postdeployed troops from the conflicts in Iraq and Afghanistan for both men and women. The prevalence of MST in this OEF/OIF sample using anonymous questionnaires was even more profound than previous research using routine MST screening by VA health care providers. This study suggests the importance of using various questions to assess MST including verbal sexual harassment because the results for verbal sexual harassment were most prevalent and robust. Results also indicated that most of those who reported MST also reported exposure to other war-related stressors and indicating an additive effect of multiple events. Considering the multitude of studies that have linked MST to higher incidences of physical and mental health problems, it is vital to identify those exposed to MST to provide proper treatment and ultimately, to better serve those who served in OEF/OIF.
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Lori S. Katz, PhD
Geta Cojucar, MA
Sayeh Beheshti, MD
Erin Nakamura, MSW
Michelle Murray, BA
Veterans Affairs Long Beach Healthcare System, California
Acknowledgment. This information was presented in part at the 2009 Annual Meeting of the International Conference on Violence, Abuse, and Trauma, San Diego, California.
Correspondence regarding this article should be directed to Lori S. Katz, PhD, Women's Mental Health Center, VA Long Beach Healthcare System, 5901 East Seventh Street, 116B, Long Beach, CA 90822. E-mail: email@example.com…
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Publication information: Article title: Military Sexual Trauma during Deployment to Iraq and Afghanistan: Prevalence, Readjustment, and Gender Differences. Contributors: Katz, Lori S. - Author, Cojucar, Geta - Author, Beheshti, Sayeh - Author, Nakamura, Erin - Author, Murray, Michelle - Author. Journal title: Violence and Victims. Volume: 27. Issue: 4 Publication date: July 1, 2012. Page number: 487+. © Springer Publishing Company 2009. Provided by ProQuest LLC. All Rights Reserved.
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