Sexual Assault Victimization and Mental Health Treatment, Suicide Attempts, and Career Outcomes Among Women in the US Army.
To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling for nonrandom victimization exposure.



We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes.



Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval [CI] = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2).



Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Anthony J
AJ
Rosellini
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Amy E
AE
Street
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Robert J
RJ
Ursano
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Wai Tat
WT
Chiu
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Steven G
SG
Heeringa
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
John
J
Monahan
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
James A
JA
Naifeh
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Maria V
MV
Petukhova
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Ben Y
BY
Reis
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Nancy A
NA
Sampson
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Paul D
PD
Bliese
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Murray B
MB
Stein
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Alan M
AM
Zaslavsky
Anthony J. Rosellini, Wai Tat Chiu, Maria V. Petukhova, Nancy A. Sampson, Alan M. Zaslavsky, and Ronald C. Kessler are with the Department of Health Care Policy, Harvard Medical School, Boston, MA. Amy E. Street is with the National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston. Robert J. Ursano and James A. Naifeh are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD. Steven G. Heeringa is with the Institute for Social Research, University of Michigan, Ann Arbor. John Monahan is with the School of Law, University of Virginia, Charlottesville. Ben Y. Reis is with the Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School. Paul D. Bliese is with the Darla Moore School of Business, University of South Carolina, Columbia. Murray B. Stein is with the Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, and VA San Diego Healthcare System, San Diego.
Ronald C
RC
Kessler
D000328:Adult; D019548:Crime Victims / Q000523:psychology*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008889:Military Personnel / Q000523:psychology*; D057216:Propensity Score; D012307:Risk Factors; D012742:Sex Offenses / Q000523:psychology* / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology