A Narrative Inquiry of Mental Health Treatment: Barriers, Facilitators, and Military Identity Among Female Veterans Who Experienced Military Sexual Assault

Background and Purpose: The rate of military sexual assault (MSA) is as high as 41% among female veterans. While current literature focuses on the rates of MSA, barriers to reporting MSA (e.g. fear of negative career impact), and associations with health and mental health outcomes, female MSA victims’ perspectives on the barriers and facilitators to mental health treatment is largely unexamined. As such, this study examined barriers and facilitators to mental health treatment during military service and once veterans among post-9/11 female veterans who experienced MSA. This study was guided by social identity theory and in-group membership (i.e. military identity), as service members are psychologically and socially interdependent on one another to accomplish the mission while in the military.

Methods: To account for the social and cultural contexts (i.e. military), we used narrative inquiry to understand the experiences of female veterans. Semi-structured, individual interviews were conducted with a purposive sample of female veterans (n = 11) drawn from two larger parent studies (N = 2,646, total sample; n = 366, female veterans). Inclusion criteria included female veterans who served post-9/11 (n = 215), experienced MSA (n = 72), consented to be re-contacted (n = 41), and had valid contact information (n = 37). Two co-coders used thematic analysis to identify emerging themes, with an inductive approach to allow for meaning to come from the narratives. Co-coders reviewed transcripts independently and agreed upon the codebook. Sample characteristics included demographics, military-related variables, and mental health outcomes. PTSD was measured by the PCL and depression was measured by the PHQ-9.

Results: Most female veterans were 31-40 years old, White, and single. Most had served in the Army and for 5-10 years. Three themes emerged that exemplified military identity. The first, “perception of mental health treatment seeking and in-group desirability” highlighted for most of the veterans, the most salient reason to avoid treatment during military service was influenced by how it would be perceived by others within the military and not wanting to impact in-group status. The second, “readiness to disclose MSA and seek mental health treatment” found veterans’ readiness increased once separated from the military system, highlighting the exit from one in-group that hindered treatment into another in-group made up of veterans that encouraged treatment. The final theme “mental health treatment preferences are among other veterans” revealed a majority of the veterans sought treatment as veterans and preferred being in treatment with other veterans.

Conclusions and Implications: As the majority of veterans expressed great concern with utilizing a mental health clinic on an installation during military service, it would be beneficial to evaluate the feasibility of offering long-term, non-acute mental health services for MSA outside of the clinic or off of installations. Providing more options for treatment during military service may help mitigate mental health concerns, as well as enhance victims’ readiness to fulfill the mission. Providers and agencies working with the veteran population are encouraged to utilize veterans to connect veterans to mental health treatment.