Physical and Psychological Health Following Military Sexual Assault
Recommendations for Care, Research, and Policy
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- What do the available data show about the incidence and prevalence of military sexual assault?
- What is known about appropriate care for victims in the immediate aftermath of a sexual assault?
- How do DoD recommendations for care compare to civilian guidelines?
- What additional avenues need to be explored?
Awareness of military sexual assault — sexual assault of a servicemember — has been increasing within the Department of Defense (DoD). The DoD is striving to improve this situation, but unique conditions of life in the military may make response to these events more difficult than within the civilian sector. This paper reviews the prevalence of sexual assault among servicemembers, victim responses in the immediate aftermath of a sexual assault, barriers to disclosure, victim needs, and DoD efforts to provide necessary resources to victims. The authors review civilian guidelines for the care of physical injuries, response to STI/HIV and pregnancy risk, forensic services, advocacy and support services, and formal mental health care. They then review DoD directives, forms, and guidelines for sexual assault victim care, revealing that these generally are consistent with civilian guidelines. However, little is known about the fidelity with which these DoD recommendations are implemented. The authors close with recommendations for future research to support the DoD's commitment to a culture free of sexual assault, including a comprehensive, longitudinal epidemiological study of military sexual assault, a needs assessment of disclosed and undisclosed military victims, an evaluation of the training enterprise, and an evaluation to document the extent to which DoD directives requiring immediate, evidence-based care for military victims are being implemented with fidelity.
- In 2010, servicemembers filed 3,158 reports of sexual contact crimes. In response to a confidential survey question, 4.4 percent of female and 0.9 percent of male servicemembers reported experiencing unwanted sexual contact in the previous year.
- Sexual assault victims experience a number of negative outcomes including physical injuries, risk of STIs/HIV and pregnancy, and increased risk for post-traumatic stress disorder and other psychological health problems.
- DoD has implemented new routes of reporting in an effort to increase disclosure. In the year following implementation, reports of military sexual assault grew by 30 percent, perhaps due to this effort. Most victims, however, choose not to disclose, which may be due to concerns about confidentiality, feeling uncomfortable, not wanting others to know, and fear of retaliation.
- Civilian guidelines for victim care prioritize treatment of physical injuries and the assessment and management of sexually transmitted illnesses and pregnancy, provide guidance for conducting physical exams, recommend advocate support to help victims navigate the system of care, and recommend evidence-based treatment of mental health problems should they develop. DoD recommendations for care of servicemember victims are generally consistent with, or in many cases, drawn from civilian guidelines. Little is known about the fidelity with which DoD recommendations are implemented.
- High-quality epidemiological data should be collected to establish baseline incidence of military sexual assault with which to (1) track future changes in incidence and disclosure, (2) better target prevention and intervention programs, and (3) document risk of sexual assault among servicemembers relative to civilians.
- The needs of undisclosed victims of military sexual assault need to be studied to (1) better understand the barriers and facilitators' of disclosure, (2) improve efforts to increase the likelihood of disclosure, (3) develop strategies to protect victims from being penalized for disclosing an incident, and (4) appropriately scale services to meet the needs of victims who may not have disclosed in the past.
- An outcome evaluation of servicewide training to increase awareness of military sexual assault and reporting options should be considered.
- DoD guidelines for the care of military sexual assault victims appear to be well-matched to civilian recommendations for care. The next step in the process will be to evaluate the extent to which the care that victims actually receive matches DoD directives for the care they ought to receive.