Stigma and Expected Retaliation Drive Suicide Among Military Sexual Trauma Survivors

A new study finds that for sexual trauma survivors in the military, self-stigma and anticipated enacted stigma for seeking help are associated with suicidal ideation.

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Newly published research in the journal Psychology of Violence highlights how stigma against reporting sexual assault in the military leads to heightened suicidal ideation amongst military sexual trauma (MST) women survivors. The results of this cross-sectional, convenient-sampled study suggest that both self-stigma and anticipated enacted stigma from unit leaders for seeking help for MST were associated with suicidal ideation.

Military sexual trauma can be “instances of unwanted sexual attention and pressure, as well as threatened or actual sexual assault, during military service.” Statistics suggest an alarming prevalence of MST, with one out of every three veterans (33%) and one out of every twelve (8.4%) actively serving military personnel reporting MST. The study authors, led by psychologist Rebecca Blais, draw attention to the severity of this issue:

“Those who experience MST are at elevated risk for a broad range of mental health, physical health, and adverse psychosocial outcomes, including posttraumatic stress disorder, depression, alcohol misuse, and sexual dysfunction…Additionally, women MST survivors are more likely to experience suicidal ideation … suicide attempts … and suicide mortality.”

The goal of the research was to examine further the relationship between suicidal ideation and different types of MST-related stigma. Previous research suggests that such stigma is a core factor that may negatively affect MST survivors by acting as a barrier against seeking help.

The researchers utilized a self-reported dataset from previous research in the Women’s Health Study from 2015-2016. By using the participants’ measured suicidal ideation, MST experience, and stigma, Blias and her team aimed to test the following two hypotheses:

  • More intense MST experiences, such as sexual assault (as opposed to unwanted sexual attention or harassment), will be associated with higher stigma.
  • The more one anticipates stigmatization from unit leader, the higher one’s self-stigma is likely to be, as well as one’s frequency of suicidal ideation.

Participants who were included in the current study were all of the age of consent or above, had experience with military service, or were currently serving. Through a self-reported survey, data regarding their suicidal ideation, the presence of MST experiences, and stigma (self-stigma, predicted perceived stigma from superiors) were collected to run through statistical analyses.

The results were in line with both hypotheses. The researchers report:

“The association between MST and suicide was indirect, through the effects of stigma. In particular, exposures to MST were associated with higher perceived stigma from unit leaders, which was, in turn, associated with higher self-stigma. Self-stigma was also associated with higher suicidal ideation.”
“We observed that the effect of assault MST and anticipated enacted stigma was stronger than the effect of harassment MST and anticipated enacted stigma, and the effects of self-stigma were weakened. Collectively, findings support the notion that type of MST is differentially related to stigma and suicide experiences and anticipated enacted stigma may be a more powerful correlate of suicidal ideation.”

In other words, there are multiple associations at play in the indirect connection between MST and the high suicidal ideation of survivors. A history of MST is associated with higher anticipated enacted stigma from superiors, which is associated with higher self-stigma, which is associated with higher suicidal ideation (hypothesis 2). Because of this, survivors with an MST history have higher levels of stigma (hypothesis 1) and hence a higher frequency of suicidal ideation. However, for survivors of more intense MFT experiences (such as sexual assault), the association between anticipated enacted stigma and suicidal ideation was far stronger, and the association between self-stigma and suicidal ideation was weaker. Hence, Blias and her team points to anticipated enacted stigma from unit leaders as a better potential indicator for suicidal ideation amongst MST survivors.

There are a few limitations of this study design to consider. First, study was conducted cross-sectionally (meaning data were collected and analyzed only for one time-point) and does not illustrate temporal changes in the variables. Second, the way that MST was assessed, through simple ‘yes’ and ‘no’ questionnaires, fails to provide the context of the MST history. Lastly, the sample is collected from only women who are predominantly white (76%).

Further studies using samples that represent diversity in race, culture, and sex while comparing their experiences and stigma may provide broader implications for developing clinical interventions for MST survivors.

Nevertheless, the current study suggests that reducing self-stigma and stigma perceived by unit leaders is imperative to reduce suicidal ideation amongst MST women survivors. In the military culture of silence and retaliation regarding sexual assault, an initiative to change toxic and entrapping environments is necessary for suicide prevention. This study, among others, highlights the need for veterans to be in conditions where they not only feel less stigmatized in seeking help but also feel free to talk about their experiences in order to reduce suicide rates in this population.

 

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Blais, R. K., Cruz, R. A., Hoyt, T., & Monteith, L. L. (2023). Stigma for seeking psychological help for military sexual trauma is associated with more frequent suicidal ideation among women service members and veterans. Psychology of Violence. Advanced online publication. https://doi.org/10.1037/vio0000461 (Link)

2 COMMENTS

  1. I will once again point out that fearing retaliation from one’s peers or superiors for reporting abuse is not STIGMA. It is DISCRIMINATION, plain and simple. The person is not ashamed of reporting, s/he is AFRAID of the consequences of reporting the event, and for very concrete and real reasons. They are being treated in a violent and threatening manner for seeking justice. VERY different from the concept of “stigma,” if it ever actually does apply to any kind of violent victimization such as rape or sexual assault.

    • You are absolutely correct, Steve. Thank you. Those who are seeking justice in regards to sexual abuse – even of our innocent children – “are being treated in a violent and threatening manner for seeking justice” by so called “mental health professions,” whose DSM “bible” is “invalid.”