The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior

Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans

Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.

Using Military Screening Questions to Anonymously Recruit Post-9/11 Era Service Members and Veterans Using Online Survey Methods

INTRODUCTION

The ability to collect data on posttraumatic reactions following military sexual trauma is impacted by data collection methods, such that under-reporting can occur when data are believed to be identifiable. This may be especially true for topics that are sensitive, including sexual trauma. Ensuring participation from service members using non-identifiable methods is challenging when service history cannot be confirmed. The COVID-19 pandemic complicated data collection due to contact and social distancing requirements and limitations. To attempt to overcome these challenges, this study utilized an anonymous survey delivered by Qualtrics, Inc. with military validation checks that served as a screening mechanism. The purpose of the current report is to describe the development and use of military validation questions to recruit a sample of military sexual assault survivors using an anonymous survey.

MATERIALS AND METHODS

Qualtrics, Inc., a data collection software company, was contracted to collect data on military service members and veterans who reported military sexual assault. We developed and piloted four validation checks regarding military knowledge, which had to be answered correctly before participants could engage in the survey. This information was common to those who have served but uncommon to civilians, ensuring, to the best of our ability, that those responding were or had been service members. An incorrect response to any of the validation checks resulted in termination from the study. The probability of guessing correctly all four items was 0.16%.

RESULTS

The current study collected data on 200 women and 200 men, all of whom reported military sexual assault. Data collection took approximately 6 weeks to complete. The validation checks resulted in screening out 1,450 potential participants who provided fraudulent responses. The average cost per participant, which included recruitment costs and participant payment, was $20. Given the histories of military sexual assault, the cohort reported high rates of probable positive screens for posttraumatic stress disorder (PTSD), suicide risk, and moderately severe depression, as well as other interpersonal challenges that are typically reported by those exposed to sexual assault, suggesting our validation checks were effective in recruiting the desired sample. Though not an original goal of our recruitment efforts, 9.75% (n = 39) of our sample identified as a sexual orientation other than heterosexual, including gay, bisexual, questioning, or "other."

CONCLUSIONS

Use of Qualtrics, Inc. to incorporate validation checks helped us to be more reasonably confident that we were collecting data from military service members who reported military sexual assault. While the probability of a person without current or past military service passing the validation checks was low, it was not impossible. An unanticipated benefit of this platform was the short duration of time it took to complete data collection; the sample was collected within about 6 weeks. This platform may be a good option for investigators who cannot collect face-to-face data.

Illusory posttraumatic growth is common, but genuine posttraumatic growth is rare: A critical review and suggestions for a path forward

Over the last 2.5 decades, trauma researchers have increasingly become interested in posttraumatic growth (PTG) - the concept that some people experience growth as a result of trauma exposure. I begin by reviewing extant research on PTG, with a focus on measurement and conceptual issues. Expanding on arguments made by others, I distinguish between three forms of PTG, 1) perceived PTG, which is an individual's beliefs about their own PTG, 2) genuine PTG, which is veridical growth following adversity, and 3) illusory PTG, which is motivated fabrications of PTG. Perceived PTG is extremely common, as over half of individuals exposed to a potentially traumatic event (PTE) report moderate or greater levels of PTG. I review evidence that most self-reports of PTG are greatly exaggerated and argue that perceived PTG is mostly illusory PTG. I propose five reasons for the disconnect between perceived PTG and genuine PTG, including design flaws in the current measurements, emotional biases that favor perceived PTG, the inherent appeal of PTG, cultural expectations, and problems of definition. I then review the empirical evidence concerning the prevalence rate of genuine PTG, coming to the bold conclusion that the occurrence of genuine PTG is very rare, contradicting current fundamental beliefs about PTG. I recommend researchers focus on the key areas of measurement and etiology of genuine PTG, which are necessary to create interventions that foster genuine PTG. I conclude by outlining a path to steer the scientific progression of PTG back in the right direction.

Sexual Violence in Military Service Members/Veterans Individual and Interpersonal Outcomes Associated with Single and Multiple Exposures to Civilian and Military Sexual Violence

Sexual harassment and violence is a grave public health concern and risk for revictimization increases following initial exposure. Studies of sexual revictimization in military samples are generally limited to women and are focused on rates of posttraumatic stress disorder (PTSD), with no examination of how revictimization relates to interpersonal outcomes, such as relationship or sexual satisfaction. The current study addressed these gaps in a sample of 833 women and 556 men service members/veterans. Self-reported outcomes of PTSD, depression, suicidal ideation, sexual function, and relationship satisfaction were compared across those reporting exposure to sexual harassment and violence before the military only (i.e., pre-military), during the military only (i.e., military sexual harassment and violence [MSV]), before and during the military (i.e., revictimization), and to no exposure. More than half of women (51.14%, n = 426) reported revictimization and only 5.79% (n = 28) of men reported revictimization. Among women, those reporting MSV or revictimization tended to report higher PTSD, depression, and suicidal ideation relative to pre-military sexual violence and no sexual violence exposure. No interpersonal outcomes were significantly different among these sexual violence groups. Among men, revictimization was associated with higher PTSD, depression, and sexual compulsivity. PTSD and depression were also higher among those reporting MSV only. No effects were found for premilitary sexual trauma exposure only or relationship satisfaction for either group. Findings highlight the particularly bothersome nature of MSV, whether it occurred alone or in tandem with premilitary sexual violence. Findings also show unique gender differences across outcomes, suggesting interventions following sexual harassment and violence may differ for men and women.