摘要：Objectives. We explored qualitatively US servicewomen’s experiences with and perceptions of military sexual trauma (MST), reporting, and related services. Methods. From May 2011 to January 2012, we conducted 22 telephone interviews with US servicewomen deployed overseas between 2002 and 2011. We analyzed data thematically with modified grounded theory methods. Results. Factors identified as contributing to MST included deployment dynamics, military culture, and lack of consequences for perpetrators. Participants attributed low MST reporting to negative reactions and blame from peers and supervisors, concerns about confidentiality, and stigma. Unit cohesion was cited as both a facilitator and a barrier to reporting. Availability and awareness of MST services during deployment varied. Barriers to care seeking were similar to reporting barriers and included confidentiality concerns and stigma. We identified several avenues to address MST, including strengthening consequences for perpetrators. Conclusions. We identified barriers to MST reporting and services. Better understanding of these issues will allow policymakers to improve MST prevention and services. Military sexual trauma (MST) refers to sexual assault or repeated, threatening sexual harassment during military service. 1 In the 2012 Workplace and Gender Relations Survey of Active Duty Members, 6.1% of active-duty women reported unwanted sexual contact in the previous year, a significant increase over the 4.4% reporting in 2010, 2 and approximately 16 times the estimated 0.37% annual incidence of sexual assault among the general population of US women aged 18 to 34 years between 2005 and 2010. 3 Two review studies estimated an overall MST prevalence of 20% to 45%, with variations attributed to differing MST definitions, data collection methods, and sample populations; rates were consistently higher among women than men. 4,5 In a 2011 representative survey of active-duty military personnel, 21.7% of women and 3.3% of men reported unwanted sexual contact since joining the military by someone in the military 6 ; because this survey was only among active-duty personnel, the total prevalence of MST among servicemembers over their full military career is likely higher because of the longer exposure time. Despite efforts to prevent and address MST, high prevalence and low reporting persist; the Department of Defense received only 3374 reports in 2012 of an estimated 26 000 active-duty members experiencing unwanted sexual contact. 2 There are little data on MST during deployment; however, research suggests the incidence remains high. In a 2006–2009 study of 7251 soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom, 12% of women (66 of 554) and 0.5% of men (32 of 6697) reported experiencing MST during their deployment. 7 The unique circumstances of deployment may have an impact on reporting and accessibility of services. Military sexual trauma is associated with numerous poor mental and physical health outcomes. Women who experience MST are more likely to have depression, posttraumatic stress disorder, difficulty readjusting after deployment, eating disorders, alcohol abuse, and other mental health comorbidities compared with those who have not experienced MST. 4,5,8–13 Survivors of MST also report more physical health symptoms and medical comorbidities, such as pelvic pain, menstrual problems, headaches, and chronic fatigue, and have poorer overall health functioning and health satisfaction. 4,5,13 In addition, the unique context of the military, which often requires servicewomen to work in close quarters with their perpetrators after abuse, may affect the severity of MST symptoms. 4 Although there is a growing body of literature on MST prevalence and associated health outcomes, there is little qualitative exploration of women’s experiences with MST and the determinants of reporting and uptake of services, particularly during deployment. We were unable to find any studies providing an in-depth exploration of military women’s perceived barriers and facilitators to reporting MST and accessing MST-related services. To fill this gap in the literature, we conducted in-depth interviews with servicewomen who had been deployed overseas between 2002 and 2011 about their experiences with and perceptions of MST prevalence, reporting, and services.
