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Perceived Barriers to Care and Provider Gender Preferences Among Veteran Men Who Have Experienced Military Sexual Trauma: A Qualitative Analysis

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  • VA San Diego Healthcare System; University of California San Diego

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Research suggests that there may be unique barriers to accessing care among men who have experienced sexual trauma. The primary goal of the current research was to elucidate potential barriers to accessing military sexual trauma (MST)-related care for male veterans. A secondary goal was to explore whether veterans have preferences regarding the gender of clinicians providing MST-related care. Qualitative analyses were used to examine data collected from semistructured interviews conducted with 20 male veterans enrolled in Veterans Health Administration care who reported MST but who had not received any MST-related mental health care. Veterans identified a number of potential barriers, with the majority of reported barriers relating to issues of stigma and gender. Regarding provider gender preferences, veterans were mixed, with 50% preferring a female provider, 25% a male provider, and 25% reporting no gender preference. These preliminary data suggest that stigma, gender, and knowledge-related barriers may exist for men regarding seeking MST-related care. Interventions to address potential barriers, such as outreach interventions and providing gender-specific psychoeducation, may increase access to care for male veterans who report MST. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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Perceived Barriers to Care and Provider Gender Preferences Among
Veteran Men Who Have Experienced Military Sexual Trauma:
A Qualitative Analysis
Jessica A. Turchik
National Center for PTSD, VA Palo Alto Health Care System,
Palo Alto, California and Stanford University Medical School
Caitlin McLean
National Center for PTSD, VA Palo Alto Health Care System,
Palo Alto, California
Samantha Rafie
National Center for PTSD, VA Palo Alto Health Care System,
Palo Alto, California and Palo Alto University
Tim Hoyt
Madigan Army Medical Center, Ft. Lewis, Washington
Craig S. Rosen
National Center for PTSD, VA Palo Alto Health Care System,
Palo Alto, California and Stanford University Medical School
Rachel Kimerling
National Center for PTSD, VA Palo Alto Health Care System,
Palo Alto, California
Research suggests that there may be unique barriers to accessing care among men who have experienced
sexual trauma. The primary goal of the current research was to elucidate potential barriers to accessing
military sexual trauma (MST)-related care for male veterans. A secondary goal was to explore whether
veterans have preferences regarding the gender of clinicians providing MST-related care. Qualitative
analyses were used to examine data collected from semistructured interviews conducted with 20 male
veterans enrolled in Veterans Health Administration care who reported MST but who had not received
any MST-related mental health care. Veterans identified a number of potential barriers, with the majority
of reported barriers relating to issues of stigma and gender. Regarding provider gender preferences,
veterans were mixed, with 50% preferring a female provider, 25% a male provider, and 25% reporting
no gender preference. These preliminary data suggest that stigma, gender, and knowledge-related barriers
may exist for men regarding seeking MST-related care. Interventions to address potential barriers, such
as outreach interventions and providing gender-specific psychoeducation, may increase access to care for
male veterans who report MST.
Keywords: military sexual trauma, veterans, men, barriers, sexual assault
Approximately 1.1% of male veterans receiving services at
Veterans Health Administration (VHA) have reported experienc-
ing military sexual trauma (MST; Kimerling, Gima, Smith, Street,
& Frayne, 2007). MST is a Department of Veterans Affairs (VA)-
specific term that refers to threatening sexual harassment or sexual
assault that occurred during military service (U.S. Code, Title 38,
§1720D). Although only a small percentage of men report MST,
the total number of men and women within VHA who have
reported MST since 2002 are very similar (Kimerling et al., 2007).
Male veterans who endorse MST are more likely to be diagnosed
with a number of mental health and physical health problems
compared with those without MST (Kimerling et al., 2007;Ki-
merling et al., 2010;Turchik et al., 2012) and are therefore a
special population with a potentially high need for VHA services.
To promote access to care among those who report MST, universal
MST screening and mandated free treatment for MST-related
This article was published Online First September 17, 2012.
Jessica A. Turchik and Craig S. Rosen, National Center for PTSD,
VA Palo Alto Health Care System, Palo Alto, California and Depart-
ment of Psychiatry and Behavioral Sciences, Stanford University Med-
ical School; Caitlin McLean and Rachel Kimerling, National Center for
PTSD, VA Palo Alto Health Care System, Palo Alto, California; Sa-
mantha Rafie, National Center for PTSD, VA Palo Alto Health Care
System, Palo Alto, California and Pacific Graduate School of Psychol-
ogy, Palo Alto University; Tim Hoyt, Department of Psychology,
Madigan Army Medical Center, Ft. Lewis, Washington.
We thank Jenny Hyun, PhD, MPH, Julie Karpenko, MSW, and
Joanne Pavao, MPH, for their helpful feedback on the qualitative
coding and Meghan Saweikis, MS, for her programming assistance.
This work was supported in part by the VA Advanced Fellowship
Program in Mental Illness Research and Treatment, VA Office of
Academic Affiliations, National Center for Posttraumatic Stress Disor-
der, and the VA Palo Alto Health Care System. The views expressed are
those of the authors and do not necessarily reflect the official policy or
position of the Department of Veterans Affairs, the Department of
Defense, or the United States Government.
Correspondence concerning this article should be addressed to Jessica A.
Turchik, VA Palo Alto Health Care System, 795 Willow Road (324-
PTSD), Menlo Park, CA 94025. E-mail: jessica.turchik@va.gov or
jturchik@stanford.edu
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychological Services In the public domain
2013, Vol. 10, No. 2, 213–222 DOI: 10.1037/a0029959
213
health issues have been implemented within VHA (U.S. Depart-
ment of Veterans Affairs, 2010). However, despite screening and
eligibility to receive free treatment for both male and female
veterans, research has found gender differences in the use of
mental health care related to MST. A recent study of veterans from
the Afghanistan and Iraq conflicts using VHA services found that
men were less likely to receive MST-related outpatient services
and received less intensity of services in the 12 months after
screening compared with female veterans (Turchik, Pavao, Hyun,
Mark, & Kimerling, 2012). National data of all screened veterans
within VHA show that within fiscal year 2010 only 38% of men
versus 54% of women who screened positive received MST-
related mental health care (Office of Mental Health Services,
2011). The reasons for this gender difference are unclear, but these
findings suggest that there may be gender-specific barriers to
service use for men who report MST that warrant further investi-
gation.
If gender differences do exist in access to MST-related mental
health care, the first important step would be to identify potential
barriers to receiving care for male survivors. Although no research
has examined barriers to MST-related care, there are a multitude of
potential barriers to accessing general mental health care services.
These barriers can conceptually be divided into three overarching
categories: individual background characteristics (e.g., age, gen-
der, insurance status), institutional and logistical barriers (e.g., wait
time for appointments, cost, transportation), and stigma-related
beliefs (e.g., feeling that symptoms are embarrassing, not wanting
to talk about problems, concerns about others finding out about
treatment; Ouimette et al., 2011;Vogt, 2011). Recent research has
found that stigma and personal belief–related variables are impor-
tant barriers for many veterans seeking mental health services
(e.g., Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009;
Vogt, 2011). It is possible that there may be issues specific to
sexual trauma that result in barriers not typically captured by most
measures of general mental health barriers. Further, given that
MST is a stressor, not a diagnosis, the barriers to MST care may
be more heterogenous than those for a specific disorder such as
PTSD.
Stigma-related barriers may be particularly salient for those
seeking MST-related care, as fears of not being believed, belief in
rape myths (e.g., rape victims secretly enjoy being assaulted),
self-blame, embarrassment, and shame are common among sexual
assault victims of both sexes (e.g., Ahrens, 2006;Gibson & Leit-
enberg, 2001;Isely & Gehrenbeck-Shim, 1997). In making sense
of a sexual assault, survivors may alter or deny the incident (e.g.,
“it wasn’t a big deal”), shift blame onto themselves (e.g., “I
provoked the rape,” “I must be a bad person if this happened to
me”), and/or change their beliefs about the world (e.g., “it’s a
dangerous world,” “men cannot be trusted”), which may lead to
stigma, negative affect, and interpersonal functioning difficulties
(e.g., Hollon & Garber, 1988;Resick & Schnicke, 1993). Studies
of female sexual assault survivors have found that stigma-related
barriers, such as feelings of shame and beliefs that others would
not believe them, were common reasons why women did not report
an assault (Ahrens, 2006;Miller, Canales, Amacker, Backstrom, &
Gidycz, 2011;Zinzow & Thompson, 2011). Given that sexual
violence is more commonly perpetrated against women and his-
torically sexual violence has been viewed as a women’s issue
(Robertson, 2010), researchers have suggested that stigma-related
barriers (e.g., shame, fears of disbelief) may be particularly salient
for male survivors (Sable, Danis, Mauzy, & Gallagher, 2006). For
instance, Sable et al. (2006) found that college students perceived
gender differences in how important certain barriers would be in
determining whether male or female victims reported a sexual
assault. The stigma-related barriers examined in the study (i.e.,
“shame, guilt, embarrassment,” “concerns about confidentiality,”
“fear of being judged as gay,” and “fear of being believed”) were
judged as being more important for male victims.
Further, while some barriers may be important to sexual assault
survivors of both sexes, other barriers may be unique to men. For
instance, researchers have suggested that concerns related to mas-
culinity, sexual orientation, and gender role expectations may be
unique for male sexual assault survivors (Davies, 2002;Turchik &
Edwards, 2012). Traditional gender role norms, which specify that
men are expected to live up to a heterosexual masculine ideal and
possess traits such as toughness, aggressiveness, and dominance
(Herek, 1986;Hosoda & Stone, 2000), are incongruent with the
social perception of sexual assault victims as feminine, weak, and
defenseless (Cahill, 2000). Society’s stereotype of sexual assault
victims does not fit with this socially constructed idea of heterosexual
masculinity, and endorsement of rape myths such as “men cannot be
sexually assaulted” and “only gay men can be sexually assaulted” is
common (Turchik & Edwards, 2012). Such stereotypical, and often
inaccurate, beliefs about gender, sexuality, and masculinity may make
it particularly difficult for men to elicit support and seek services for
sexual trauma.
These beliefs are likely even more prevalent in a male-
dominated environment such as the military where men are ste-
reotypically expected to be hypermasculine, physically strong, and
heterosexual. Such beliefs affect not only those who have experi-
enced sexual assault, but to the full range of MST experiences,
from sexual harassment to rape. For instance, research suggests
that men may experience more negative mental health effects from
sexual harassment during military service than women (Street,
Gradus, Stafford, & Kelly, 2007), and it may be that these gender
role issues may make the experience especially toxic and psycho-
logically distressing for men. Further, men in the military who do
not fit this rigid masculine gender role may be particularly likely
to be targeted in the military environment, as sexual harassment
has been conceptualized as a means to punish and control both
men and women who do not behave in accordance with these
gender roles (Franke, 1997). Although there is evidence suggesting
that there may be unique issues for male sexual victims in seeking
help, no research has examined perceived treatment barriers
among male sexual trauma survivors or in relation to accessing
VHA MST-related care. Although two studies have examined
factors that influenced mental health service use among commu-
nity men who experienced sexual assault, both studies focused
only on assault-related variables (i.e., type of assault, physical
injury, and type of perpetrator) not trauma survivors’ beliefs
(Masho & Alvanzo, 2010;Monk-Turner & Light, 2010).
Given the gendered nature of sexual trauma, many clinicians
believe that the gender of the provider may affect whether a sexual
assault victim will choose to begin or continue to receive services.
In fact, the VHA Handbook (U.S. Department of Veterans Affairs,
2008) strongly encourages providers to make sure patients’ pro-
vider gender preferences are taken into account when treating
MST survivors. However, no known research has examined pro-
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214 TURCHIK ET AL.
vider gender preferences among men who have experienced sexual
trauma. One descriptive study of 40 community men who had
experienced sexual assault were asked if having a female re-
searcher contact them via phone made it easier for them to partic-
ipate (Walker, Archer, & Davies, 2005). Almost half of the men
(47.5%) reported that it made it easier, 32.5% reported that it was
a little easier, and 20% reported that it made no difference given
that they did not meet in-person with the researcher; none of the
participants reported that having a male researcher would have
made it easier. Although this study suggests that men who report
MST may prefer female providers, it is impossible to generalize
the results to a treatment context. Information regarding men’s
provider gender preferences, if any, will aid in service delivery
interventions for those who have experienced MST, and provide
additional knowledge and awareness of gender issues relevant to
this population.
Sexual violence of men, including men’s service use for sexual
trauma, has been understudied (Davies, 2002;Hoyt, Rielage, &
Williams, 2011;Ratner et al., 2003). Qualitative research can
provide a greater understanding of male survivors’ experiences
and is needed in this important area (Martsolf et al., 2010). The
primary goal of the current study was to gain a better understand-
ing of perceived barriers to accessing MST-related care for male
veterans. Some barriers may be unique to men who have experi-
enced MST and may not be represented in current measures or
discussions about mental health care barriers. Obtaining patient-
centered and gender-specific information is the first step to iden-
tify any potential barriers to care. Further, given the gendered
nature of MST, a secondary goal was to specifically explore men’s
preferences concerning the gender of health care providers offer-
ing MST-related services. The current study uses qualitative meth-
ods to gather valuable knowledge about men’s perceived barriers
and preferences so that future studies can build off these findings
in moving forward the agenda to examine and address barriers to
care for men who report MST.
Method
Participants
Interviews were conducted with 21 English-speaking male vet-
erans; however, one participant was excluded from the final sam-
ple as he denied any occurrence of an MST experience, leaving a
final sample of 20 veterans. The participants were an average age
of 62 years, and the majority was White, served in the Army, and
served during the Vietnam War era. Detailed demographic char-
acteristics for the final sample are presented in Table 1. Whereas
none of the sample had any MST-related mental health care
because this was an exclusion criterion, 20% had received MST-
related medical care within the previous 2 years. Further, 30% of
the participants had received at least one visit related to a mental
health disorder in the past 2 years. The sample for this study was
identified using VHA administrative data. Criteria for inclusion in
the study were being a male veteran, having screened positive for
MST, having received at least one VHA outpatient encounter in
FY 2009 or FY 2010 at VA Palo Alto Health Care System, and
having not received any MST-related mental health care from VA
Palo Alto Health Care System since FY 2006 when VA began
tracking MST-related care. The MST screen is part of VHA’s
electronic clinical reminder and is comprised of the following two
items: “While you were in the military: (a) Did you receive
uninvited and unwanted sexual attention, such as touching, cor-
nering, pressure for sexual favors, or verbal remarks?; (b) Did
someone ever use force or threat of force to have sexual contact
with you against your will?” An affirmative response to either
question is coded as a positive screen.
Participants were excluded if they did not have a valid mailing
address or if their medical diagnoses indicated they were legally
blind and/or had a severe hearing impairment. A total of 317 men
met these eligibility criteria, and men who lived within 25 miles of
the facility were targeted from this group for recruitment for the
current study given that they would need to drive to our interview-
ing site. There were a total of 99 men who had mailing addresses
within 25 driving miles and participants were randomly selected as
the sampling frame, with a goal of recruiting from that pool until
we obtained 20 participants. Mailings were sent in subsequent
waves with 50 randomly selected veterans being sent two or three
letters of invitation. Two individuals were dropped because of
inaccurate mailing addresses. Of the 48 remaining, 21 participated
in the interview, 17 did not respond, eight declined, and two
contacted us to participate after recruitment was completed.
Independent-samples ttests and chi-square analyses were run to
assess any differences between those who were sent recruitment
materials and those who were not, and between those who re-
Table 1
Participant Characteristics (n20)
n(%)
Age in years, MSD 62.20 12.85
Race/ethnicity
White 16 (80)
Black 1 (5)
Hispanic 2 (10)
Asian/Pacific Islander 1 (5)
Marital status
Married 9 (45)
Never married 4 (20)
Divorced/separated/widowed 7 (35)
Military branch
Air Force 2 (10)
Army 12 (60)
Navy 2 (10)
Marines 4 (20)
Era
Korean War 5 (25)
Vietnam War 11 (55)
Post Vietnam 2 (10)
Persian Gulf War/OEF/OIF 2 (10)
Years served in the military
1–2 7 (35)
3–4 6 (30)
5–8 4 (20)
93 (15)
Served in combat zone or theater 9 (45)
Years using VHA services
1–10 6 (30)
11–30 6 (30)
318 (40)
Note. MST Military Sexual Trauma; OEF/OIF Operation Enduring
Freedom/Operation Iraqi Freedom; VHA Veterans Health Administra-
tion.
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215
BARRIERS TO SEXUAL TRAUMA–RELATED CARE
sponded to the mailings and those who did not. No differences
were found across age, race/ethnicity, and marital status between
these groups (all ps.05).
Interviews
During the consent process for each interview, all participants
were told that they were selected for the study because they had
endorsed an unwanted sexual experience in the military during VA
screening. A brief definition of MST was provided (“sexual ha-
rassment or sexual assault that may have occurred during a veter-
an’s military service”; “unwanted sexual experiences in the mili-
tary”) and if participants had any questions about this, the actual
items from the screener were presented. It was also explained that
to increase participants’ comfort and facilitate disclosure during
the interviews, we would not ask any direct questions about the
person’s own MST experience although they were welcome to talk
about it if they wished. Each in-person semistructured interview
lasted approximately 45 minutes and consisted of three parts: (1)
general demographic, military history background, and VHA
health care use questions; (2) questions about their knowledge of
what services were available for MST, opinions on what obstacles
some men may encounter when seeking services for MST, and
whether they believe the gender of the provider is important and;
(3) questions about two different MST brochures that participants
were asked to review at the end of the interview. Only results from
the first two sections of the interview are reported in the current
study.
Demographics. Participants were first asked questions con-
cerning their age, geographic location, marital status, branch of
the military served in, years of military service, if they served
in a combat zone, when they began using VHA, how frequently
they use VHA services, and how satisfied they have been with
the services.
MST care knowledge, potential barriers, and provider gen-
der preferences. After the demographic questions were com-
pleted, the interviewers then defined the term MST and asked if the
participant would feel comfortable with the use of that term within the
remaining questions. In one case, a veteran felt more comfortable with
the term “military sexual experiences” and this was used during his
interview questions. A set of open-ended questions regarding MST
were then asked, including: Do you know if there are any VA services
available for veterans who report military sexual trauma?; What
kinds of barriers do you think men may experience in seeking treat-
ment for those experiences?; Do you think that male veterans would
feel more comfortable talking to either a male or female VA provider
about military sexual trauma, or the same? Other questions included
asking about their thoughts on what VHA or VHA providers might do
to facilitate reporting and treatment, and whether they believe gender
is important in whether a survivor seeks treatment services. Given the
semistructured nature of the interview, the interviewers asked addi-
tional follow-up questions as appropriate. All questions were asked in
an indirect manner to increase comfort for participants and facilitate
disclosure; however, many veterans spontaneously expressed how
they themselves felt about many of the issues that were discussed.
Procedure
The current research was approved by the Stanford University
Institutional Review Board. The present paper reports on data
collected in the first phase of a larger ongoing pilot project aimed
at examining the impact of a mail-based outreach intervention on
MST-related service utilization. As described earlier, eligible vet-
erans were contacted via mail to invite them to participate in an
in-person interview. These mailings provided details about the
study and how to contact the research team with questions or
concerns, to opt out of the study, and to set up an interview.
Participants were able to schedule an interview or contact the
research team by phone or through the mail. Veterans received up
to three letters from the research team (see Participant section for
further detail). The interviews were conducted separately by two
female research assistants (one bachelor’s level and one master’s
level). Both were trained by a doctoral level clinical psychology
researcher through discussion of relevant research articles on sex-
ual trauma, conducting mock interviews with researcher feedback,
in-person observation of initial participant interviews, and same-
day consultation and debriefing after each interview. At the be-
ginning of each interview, participants provided signed informed
consent and read and signed a HIPAA form. During the consent
process, the participants were informed that they were contacted
due to having a positive MST screen, given a brief description of
MST, and were shown the original MST screening item questions
if they had any questions about the screening. Interviews were
audiotaped with signed permission from the participants; all but
one participant allowed audiotaping and this participant’s inter-
view was recorded by hand. At the conclusion of each interview,
participants were given a resource list with information about how
to schedule a VHA appointment, find out more information about
local VHA services, contact their local MST Coordinator (advo-
cate who helps veterans find and access MST-related VHA ser-
vices and programs, state and federal benefits, and community
resources), and use the VA Veterans Crisis Line (confidential
toll-free hotline, online chat, or text that is available to veterans
and their friends and family to discuss troubling issues with
qualified VA responders 24 hours a day, 7 days a week). Partici-
pants were compensated for their time with a $40 gift card.
Data Analysis
Frequencies and the comparison of the demographics between
responders and nonresponders were conducted using Predictive
Analytics SoftWare (PASW), version 18.0 for Windows. The
interviews were transcribed, reviewed, and entered into ATLAS.ti
software, version 6.2.25 (ATLAS.ti Scientific Software Develop-
ment GmbH, 2011) by the research team. A grounded theory
approach was used for qualitative data analysis (Glaser & Strauss,
1967;Strauss & Corbin, 1998). Grounded theory focuses on the
process of generating theory rather than testing theory. This ap-
proach provides a set of steps and procedures to systematically
code and make sense of data without predetermined hypotheses.
After data collection, the qualitative data are coded into themes;
the themes are then grouped into similar categories from which an
overall theory is formed. From this final theory hypotheses can be
determined. More specifically, we used the following process to
determine categories. During the data collection phase, the re-
search team met after each interview to discuss themes that arose
during the interview. After data collection, a two-person coding-
team, the first and third authors, independently identified provi-
sional codes, and the second author reviewed codes when there
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216 TURCHIK ET AL.
were discrepancies. The provisional codes were for themes related
to barriers to seeking mental health care for services related to
MST directly from the interview data, beginning with breaking the
text into discrete parts for open coding. After open coding, axial
coding focused on clustering interrelated codes to develop a hier-
archy for grouping data, such as the large overarching categories
(e.g., Stigma-Related Barriers) and subcategories (e.g., embarrass-
ment/shame). We considered a group of similar codes to constitute
a theme if at least three participants (15%) mentioned the issue.
We continued to define broader groups of similar concepts and to
identify patterns between these broad groups both within-subjects
and between-subjects. After the initial coding by the authors, three
additional experts on MST were consulted for code review and
their feedback was used to revise and finalize the coding. The
results below are based upon this final stage of analysis.
Results
Barriers to MST-Related Care
Barriers were coded into three overarching categories: (1)
Stigma-Related Barriers, (2) Gender-Related Barriers, and (3)
Knowledge Barriers. A total of 13 subcategories, or themes, were
identified within these three larger categories. Stigma-Related
Barriers were the most noted in the current study, with all veterans
reporting at least one Stigma-Related Barrier. See Table 2 for the
percentage of veterans who discussed barriers within each of these
categories and subcategories. In order to facilitate disclosure, most
of the interview questions were phrased indirectly, such as “How
do you think men would feel . . ..” However, many veterans
spontaneously reported how they personally felt or acted, which is
reflected throughout the veterans’ quotes.
Stigma-related barriers. This category included issues re-
garding veterans’ personal discomfort or internalized beliefs about
seeking care for MST, and concerns about social perceptions and
consequences. Most of these barriers appeared to be directly re-
lated to the sexual nature of the trauma rather than concerns about
help seeking in general.
Not wanting to talk about problems. Many veterans re-
ported that men would not want to talk about their problems or
share their feelings with a professional. While this is a common
general help seeking barrier, these men noted this would be espe-
cially so if they were seeking care for sexual trauma. Many men
reported they would rather forget about an assault or handle it on
their own than talk to someone else about it. Although men did not
say what might happen if they did disclose to someone, these men
appear to share a belief that if such experiences happen to a man
they should not be admitted to others. Such concerns are consistent
with rape myths such as “men cannot be sexually assaulted” and
“men should be able to handle their own problems.”
Veteran 1. They don’t want to talk about it, and try to forget about it,
and that’s it.
Veteran 10. Men don’t want to admit that they had sexual trauma
attacks. So it’s very hard because you don’t know how to go about it.
[. . .] Definitely don’t want to admit it.
Veteran 11. I would think that among most men [who have experi-
enced MST] the biggest barrier would be that they wouldn’t want to
report it in the first place because it’s something that they should be
able to take care of themselves.
Embarrassment/shame. Participants reported that men who
experience MST would feel marked feelings of shame and embar-
rassment. Like many sexual trauma survivors, they noted that these
feelings would contribute to men not wanting to talk about MST
experiences.
Veteran 1. I guess they might be embarrassed . . . same reason why a
woman wouldn’t want to go on the stand against a rapist because of
embarrassment.
Veteran 10. I guess being ashamed. Not just being ashamed, but also
being laughed at.
Veteran 18. The embarrassment. People don’t want to admit that
they’ve actually went through with the act or it happened to them. Or
were that naïve to have gotten into a situation.
Privacy/confidentiality concerns. A related concern to feel-
ing embarrassed or ashamed was the fear that other people may
find out that they experienced MST or were in treatment for sexual
trauma. Veterans reported that they would want to be extra cau-
tious about disclosing MST, seeking services, or taking informa-
tion related to MST because of concerns related to privacy.
Veteran 11. Because people you know, if they were having problems
over something like that, they would probably wouldn’t want every-
one to know.
Veteran 16. Probably a lot of information would get out there that he
wouldn’t want to get out.
Veteran 17. I wouldn’t want to take it [printed information about
MST] because what if someone sees it.
Self-blame. Participants also reported that veterans may
blame themselves for the assault and this would limit help-seeking.
This is consistent with evidence that following a sexual assault
Table 2
Perceived Barriers (n20)
n(%)
Stigma-related barriers 20 (100)
Not wanting to talk about problems 13 (65)
Embarrassment/shame 12 (60)
Privacy/confidentiality 4 (20)
Self-blame 4 (20)
Not important or serious enough 7 (35)
Sensitivity and reactions of a provider 6 (30)
Fear that they won’t be believed 3 (15)
Gender-related barriers 19 (95)
Men less affected than women 5 (25)
Masculinity 11 (55)
Sexuality/sexual orientation 9 (45)
Provider gender preferences 15 (75)
Knowledge barriers 19 (95)
Lack of knowledge about service availability 19 (95)
Financial concerns regarding services 3 (15)
Note. MST Military Sexual Trauma; VHA Veterans Health Admin-
istration.
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217
BARRIERS TO SEXUAL TRAUMA–RELATED CARE
many survivors believe that “I provoked the assault,” “I must be a
bad person if this happened to me,” and “If only I would have done
______, this would not have happened.” Such thoughts contribute
to beliefs that there must be something deficient, “dirty,” or wrong
with them for allowing the harassment or assault to happen to
them.
Veteran 1. They always would think it’s them that’s the cause of it. It
wasn’t the other guy.
Veteran 8. That there is something wrong with them. So if they’re
seeing themselves as heterosexual and somebody traumatized them
sexually that could put them in a place where they were feeling guilty
like a child that is sexually molested and takes it personally that there
is something bad about them.
Veteran 21. If you fail to react “hostilely” it was your fault ....And
the barrier that if I’m assaulted that I must be ipso facto inadequate for
the military because I didn’t kill the son of a bitch the moment they
look cross-eyed at you. So the solution to sexual assault is to adopt the
antisocial behavior in the first place.
Not important or serious enough. In addition to potentially
blaming themselves, veterans reported thinking that the trauma is
not serious enough to warrant treatment, or that other people would
not take their experience(s) seriously. Veterans indicated that
except for perhaps the most severe of sexual traumas (e.g., a
violent rape), one should just deal with it because others would not
think it was serious. Military culture, particularly the emphasis on
hypermasculinity and resilience, appeared to reinforce such be-
liefs; men may be thinking about sexual assault in contrast to
stressors more commonly associated with military experience,
such as combat exposure.
Veteran 1. If they were almost raped, or approached to be raped, they
would just shrug it off.
Veteran 11. And I think that if they asked for assistance, let’s say that
I asked for assistance from even my buddy or something. . . . You
know, he might just kind of laugh at me, well, what’s the matter with
you, you can’t handle that yourself, you know . . . Uh, they might not
be taken seriously enough . . . they [other people] say, no big deal.
Sensitivity and reactions of providers. Many veterans
noted potential concerns about how the provider may react to
hearing about the trauma, and participants noted a range of
potential reactions or attitudes providers may have when hear-
ing about MST. Veterans predicted that some providers may
intentionally avoid the topic or display negative reactions, such
as shock, disgust, confusion, or assume the veteran to be
homosexual.
Veteran 4. It all depends on where you go. [. . .] Well, especially in
nonliberal staff that they, you know you’re in the Midwest, and in
San Francisco probably half your class might be homosexual or a
large percentage of it. As opposed to if there were homosexuals out
in Oklahoma they might not be telling people. And I think just your
basic attitude your basic liberal attitude has uh people accept other
differences and other people uh more so.
Veteran 10. Because all he [the Provider] has to do is just laugh a little
bit and that changes a lot.
Veteran 12. If you were an MD and I had a problem, I would tell in
10 minutes if I’ve offended you [by telling the trauma]. And if I
offended you, I’d just shut up.
Veteran 15. I think they’d [providers’ reactions] probably be nega-
tive. . .. Yeah, that’s probably why people keep it to themselves if it
happens or when it happens.
Fear that they won’t be believed. Another concern was that
a veteran may not want to talk about MST or seek treatment
because they are afraid they would not be believed that the MST
occurred. Some veterans specifically referenced the provider’s
potential disbelief, while others more broadly stated that people in
general would be unlikely to believe them.
Veteran 17. If the doctor ignores the claim, you have to deal with that.
Veteran 19. I guess doubts about whether they’ll be helped or heard
. . .. This is a lot of guess work, but I’m guessing that people would
think that they weren’t believed or that they exaggerated or imagined
something.
Gender-related barriers. This category included barriers re-
lated to issues concerning gender, including masculinity, sexual
orientation, and provider gender. While most of these barriers
relate to stigma, these barriers were separated because of the
explicit references to gender issues and appear to be a result of an
interaction of stigma and stereotypical gender role beliefs.
Men less affected than women. Some men made gender
comparisons between how a man and woman would react to being
sexually assaulted. Participants noted that men should be less
emotionally affected by an assault than women because men are
tougher and more able to handle experiences. Therefore, some men
noted that men would be less likely to deserve or need treatment
for sexual trauma. Such thoughts are consistent with the male rape
myth that “women are more affected by sexual assault” and
traditional gender role beliefs concerning that men should be tough
and rational, while women are weak and emotional.
Veteran 4. Um maybe it was like that because women are . . . they’re
the fairer sex, well you know they aren’t as masculine, strong, and
they’re at a disadvantage there and their incidences might . . . have
been more of a trauma.
Veteran 14. Women and men have different emotional feelings. And
they would affect them probably differently. More so the women, I
think. [. . .] Cause they’re . . . cause less men are affected than women.
Masculinity. More than half of veterans noted that issues
related to masculinity and “male pride” would serve as a barrier to
them wanting to disclose or seek services related to MST. Men felt
that admitting to having experienced MST would detract from
their masculinity. Similar to the perceptions that men are less
affected by trauma than women, these concerns seemed to be
rooted in gender role beliefs and male rape myths (e.g., a tough
man could not be sexually assaulted).
Veteran 2. Um like it’s challenging their masculinity, or something,
for them to open up about something that happened to them.
Veteran 6. How can I tell somebody this affected me, you know?
‘Cause typically as a man, being in the military I’ve gotta be reserved
and maintain that manhood.
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218 TURCHIK ET AL.
Veteran 12. They uh, no, I, no they would not feel comfortable at all
. . . because it takes away their macho.
Veteran 13. I think as long as it has to do with the men’s pride . . . you
know, be a man, and stuff it.
Sexuality/sexual orientation. Many men brought up issues
related to sexual orientation, homophobia, and sexuality. While
divided on personal viewpoints, most men noted that men, whether
homosexual or heterosexual, may not want to disclose because
their sexual orientation might be questioned. Such beliefs fall in
line with the male rape myth that “only gay men are sexually
assaulted.” Military culture appeared to exacerbate such beliefs;
several men shared their thoughts on the “Don’t Ask, Don’t Tell”
policy (legal policy in effect from 1993 to 2011 that prohibited
homosexual or bisexual servicemembers from openly expressing
their sexual orientation) and how it might relate to disclosing or
seeking services for MST.
Veteran 2. They probably don’t bring it up because maybe it involves
another male and they don’t want to be considered homosexual, if
they’re not homosexual.
Veteran 7. The fear that I believe is common among or, if not
common, is prevalent among American heterosexual men is that they
will be, is that they might be homosexual or that they might be
perceived as homosexual.
Veteran 15. I know there are new attitudes toward sexuality now in
the military, that “Don’t Ask, Don’t Tell” is gone, [but] the people are
still treating it like it’s there. It kind of was [there] before they made
it a rule. . . . Possibly afraid of being accused by their coenlisted men
of being gay. There was that stigma that just because I’m talking to a
gay person, they think I might be gay.
Provider gender preferences. Veterans reported that the gen-
der of the provider may serve as a barrier. However, veterans were
mixed on provider gender preferences, with 50% preferring a
female provider, 25% a male provider, and 25% reporting no
gender preference (p.05).
Prefer female provider.
Veteran 5. I would prefer a woman, but that’s just me, because I think
they’re more compassionate I guess.
Veteran 8. Especially if they’re homophobic and if they had been
traumatized. Um, they would feel insecure or self-conscious about
sharing that with another man.
Veteran 17. Having a female provider makes it easier for me to share
sensitive information.
Prefer male provider.
Veteran 1. I would say most men would rather talk to a man about that
experience than a woman.
Veteran 2. [I]f they [male victim] talk about if somebody got raped or
something, and they start breaking down crying or something because
it’s a very traumatic event for them, that might even be more embar-
rassing to them that it’s happening in front of a female. So if they were
to cry in front of a male then the doctor can say that’s all right, it’s all
right. May not have the same feelings if a female were around, so I
think they could kind of be stronger in that situation.
Veteran 18. I think they would feel more comfortable speaking with
the same gender. Because the issues . . . a woman knows a woman’s
body, and all those details better than a man would, and vice versa.
Knowledge barriers. Many veterans did not know that spe-
cific MST-related mental health services were offered in VA and
that these services were delivered without copay. As a result, some
logistical barriers related to availability and cost of services were
coded as knowledge-related barriers. A couple participants sug-
gested that more outreach about the availability of the services
may be helpful in making sure that veterans are aware of these
services and how to access them.
Veteran 5. Make sure that it’s available and easy to get to and doesn’t
cost very much, probably free. Scheduling and cost.
Veteran 6. Um, I think they can provide . . . more specific informa-
tion, about its [VHA MST] services . . .. I don’t know, marketing
wise, to be more upfront with it.
Veteran 13. First of all, I didn’t know [about MST services]. I had no
idea anything like that existed.
Discussion
A number of perceived barriers were identified by the men in
the current study as potential reasons why men who are having
difficulties related to their MST may not seek VHA care for MST.
These were grouped into three broad categories: (1) Stigma-
Related Barriers, (2) Gender-Related Barriers, and (3) Knowledge
Barriers. Other researchers examining mental health barriers
among veterans have identified barriers similar to many of the
ones identified in the current study, particularly the Stigma-
Related Barriers (e.g., Ouimette et al., 2011;Vogt, 2011). How-
ever, many of the potential barriers noted by veterans in the current
study are quite specific to sexual trauma and are consistent with
the research findings demonstrating that many victims struggle
with issues such as self-blame, shame, fears about being believed,
and belief in rape myths (Ahrens, 2006;Miller et al., 2011;Sable
et al., 2006;Zinzow & Thompson, 2011). These findings suggest
that future research in this area should draw not only from the
literature on general mental health barriers among veterans but
also from findings on barriers that might be specific to sexual
assault victims. Although the only demographic or background
characteristic noted as a barrier by participants in the current study
was gender, this variable was found to be a common factor
throughout many men’s responses. The Gender-Related Barriers
reported by these men appear to be unique to men and specific to
receiving care for sexual trauma (e.g., issues related to sexuality/
sexual orientation), suggesting that gender-related barriers are
indeed important to male veterans who report MST. These pre-
liminary findings suggest that current measures of mental health
barriers designed to examine general help seeking barriers may not
fully capture some of the potential barriers faced by men who have
experienced MST.
There were a number of Stigma-Related Barriers identified in
the current study, many of which are consistent with a prior study
which found that social stigma-related barriers were the most
salient concerns among veterans with PTSD (Ouimette et al.,
2011). In fact, 100% of veterans in the current study mentioned at
least one stigma-related barrier. Moreover, many of the veterans in
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219
BARRIERS TO SEXUAL TRAUMA–RELATED CARE
the current study specifically discussed the stigma associated with
talking about or seeking services for sexual trauma, suggesting that
men seeking MST-related mental health care may have additional
concerns beyond those typical for someone seeking mental health
treatment for a non MST-related issue. The identified Stigma-
Related barriers are a combination of their own personal discom-
fort (e.g., “embarrassment/shame”) and their concerns about what
others will believe about them (e.g., “fear of not being believed”).
Researchers have noted that such beliefs are common among
sexual trauma survivors and are embedded within our social insti-
tutions (Edwards, Turchik, Dardis, Reynolds, & Gidycz, 2011;
Turchik & Edwards, 2012).
Many veterans expressed concerns about the sensitivity and
reactions of providers. Research suggests that sexual assault sur-
vivors may overestimate the degree to which others endorse neg-
ative or stereotypical beliefs about sexual assault (Paul, Gray,
Elhai, & Davis, 2009). Such concerns are reasonable given that
social stigma and erroneous beliefs about sexual assault are fairly
pervasive in our society (Edwards et al., 2011;Turchik & Ed-
wards, 2012). Survivors may be particularly concerned about the
reactions of mental health providers given the level of trauma
disclosure and increased personal vulnerability that treatment
would entail. Prior research has found that some health care
providers and rape crisis workers endorse male rape myths and
stereotypes about male victims (Donnelly & Kenyon, 1996;An-
derson & Quinn, 2009), with one study focusing on counseling
trainees (Kassing & Prieto, 2003). However, no other research has
examined male rape myth endorsement among mental health pro-
viders. If such negative or stereotyped beliefs exist, they may
prevent providers from proving optimal care to these veterans.
Because sexual trauma affects a small proportion of male patients,
many mental health providers may encounter such patients rarely
and may feel uncomfortable discussing such issues. However, the
VHA is unique in that it performs universal screening of male and
female veterans and provides training about MST to all primary
care and mental health staff. Research is needed to examine the
extent to which these issues impact access to mental health care,
and potential strategies with patients or providers that may pro-
mote access among patients that seek services for sexual trauma.
A second set of potential barriers, Gender-Related Barriers, was
identified and conceptualized as an interaction between stigma-
related concerns and belief in gender role stereotypes. These
barriers were likely salient for male veterans not only because of
the gendered nature of sexual violence, but that many men likely
adhere to gender role stereotypes (e.g., men must be tough) and
believe in rape myths associated with male sexual assault (e.g.,
men cannot be sexually assaulted, victims of sexual assault must
be gay, only a weak man could be assaulted). Many men noted
how being a victim of sexual violence or seeking help for these
issues presented a gender role conflict for men who wanted to be
perceived of as tough, independent, and heterosexual. These bar-
riers may be unique to men who have experienced sexual trauma
and reflect issues not normally captured on traditional measures
examining access to care barriers. While these perceived barriers
are likely similar to those among civilian men, elements of the
military culture could impact such beliefs (e.g., emphasis on hy-
permasculinity, the “Don’t Ask, Don’t Tell” policy). Within VHA,
gender sensitivity and the examination of gender-related issues has
been identified by researchers as an important area of focus (e.g.,
Vogt et al., 2001;Washington, Bean-Mayberry, Riopelle, & Yano,
2011) and these discussions have largely focused on women given
VHA’s historical focus on serving male veterans. The current
results suggest that for some mental health related concerns, such
as sexual trauma, gender-related barriers merit attention for both
men and women. Further research is needed in this area to deter-
mine the nature of gender-related barriers among men and women
and the extent to which gender-tailored interventions are effective
for increasing access to mental health care for sexual trauma.
The Knowledge Barriers identified in this study (i.e., service
availability and cost of services) represent a lack of awareness
about available VHA services and suggests that a focus on infor-
mation concerning MST services may be important. Only one of
our 20 participants reported knowing that MST-related services
were available to male veterans. Given that VHA provides free
care to all veterans who report MST and all VHA facilities provide
MST-related mental health care to men, these Knowledge Barriers,
if widespread, would likely need to be addressed as a first step in
efforts to promote access.
The current study demonstrates that although most men had
provider gender preferences, men are mixed on whether they
would prefer a male or female provider. There is widespread
anecdotal evidence that female patients prefer female providers for
sexual trauma-related care. However there is a surprising lack of
data concerning gender preferences for providers among both men
and women. While these preferences would only represent a bar-
rier if there is a mismatch between the preferred and actual gender
of veterans’ providers, these data suggest that the issue may be
important as the majority of the men in this study did have a
preference. Interestingly, many of the reasons that men gave for
preferring a female provider (e.g., feeling comfortable, concerns
about provider’s view of their sexuality, perceived understanding
of provider) were also indicated by men who preferred a male
provider. The gender preference for MST-related care for male
survivors is not universal and is likely based on a number of
unique factors (e.g., sex of perpetrator, past provider experiences,
sexual orientation, beliefs about male sexual assault), so it is likely
important for providers to ask about any gender preferences a
veteran may have, especially when making referrals, as they may
impact a man’s likelihood to enter or continue treatment. In fact,
VHA Policy (U.S. Department of Veterans Affairs, 2008) encour-
ages respect for patients’ provider gender preferences in the treat-
ment of MST-related conditions. These data suggest this practice
may be an important factor in assuring access to care among this
population.
Although this study is the first to provide information concern-
ing potential barriers to MST-related care for male veterans, there
are a few important limitations to the current research. Most
notably, the current study consists of data from a sample of only 20
male veterans from one health care facility and may not be gen-
eralizable to other male veterans who have experienced MST and
use VHA care. Many of the interview questions were phrased in an
indirect rather than direct manner (e.g., “How do you think men
would feel . . .” instead of “How do you feel . . .”), which may
have affected their responses and led participants to provide fewer
details about their own experiences; however, this indirect manner
of questioning may have also facilitated disclosure by making
veterans feel more comfortable. In fact, 75% of veterans sponta-
neously noted at least some detail of their own MST experience. It
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220 TURCHIK ET AL.
should be noted that logistical barriers, such as distance from VHA
facility and transportation difficulties, were likely not an issue for
those in the current study given that all lived within 25 miles and
were able to attend the interview appointment but may be impor-
tant for veterans in accessing MST-related care. Barriers and
preferences may be related to factors such as age, time in VHA,
military era, or veterans’ primary VHA facility; however, such
examinations were beyond the scope of the current study. Simi-
larly, we only interviewed men who had not received any VHA
MST-related mental health services, so it is unknown whether the
perceived and actual barriers and preferences of men who have
received services may differ from those who have not. The per-
ceived need for services is an important variable to examine in the
future as many veterans who experience MST do not want or need
services. The current study elucidated potential barriers to care to
inform future research, and further work should also focus on
identifying factors that facilitate access to care for veterans who
report MST.
The current study provides preliminary evidence that barriers
may exist for men seeking MST-related care, and that some of
these barriers may be gender-specific for male veterans. While this
study provides qualitative data on only 20 male veterans who
report MST, these data are consistent with prior research findings
and support the need for further research to examine the gender
disparities in the utilization of MST care. Further quantitative
research is needed to further clarify barriers and preferences that
may impact men’s access and utilization of MST-related services.
Further work in this area should compare barriers between men
and women, as similarities and differences in perceived barriers
can inform interventions to assure access to sexual trauma-related
mental health care. If future research confirms that such barriers
are indeed present for men who have experienced MST, this
information can be used to develop interventions to address these
barriers and increase access to care for these veterans, such as
outreach interventions and providing gender-specific psychoedu-
cation. Lastly, although the current study examines this issue
within the context of VHA, it is likely that many of the potential
barriers identified are also applicable to men seeking treatment
outside this system of care.
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Accepted July 6, 2012
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222 TURCHIK ET AL.
... Despite the prevailing clinical wisdom on gender preferences and VHA policy, only two qualitative, small sample studies researching provider preferences in MST survivors have been published to date. Turchik et al. (2013) interviewed 20 male veterans who had not previously received MST-specific mental health care. Of these, 50% indicated they would prefer a female clinician, 25% preferred a male clinician, and 25% denied a preference. ...
... Prior research with MST treatment seekers shows that, similar to IPV treatment seekers, the gender of the provider is an important concern for patients (Turchik et al., 2013;Turchik, Bucossi, et al., 2014;Turchik, Rafie, et al., 2014). Extant literature suggests male and female MST survivors show a predominant preference for female providers, yet these small sample studies primarily involved qualitative research with veterans not specifically seeking MST-related mental health care. ...
... Approximately half of women and one third of men articulated a preference for female providers. However, our results were only partially consistent with those reported in previous research with smaller samples of veterans who were not seeking MST-specific mental health care (Turchik et al., 2013;Turchik, Bucossi, et al., 2014). Regarding female veterans' preferences, our results roughly parallel Turchik's interviews with women; 50% of veterans in this study requesting female providers in contrast with 67% in Turchick, Bucossi, et al. (2014). ...
... Past research and literature reviews indicated that although there have been high rates of service members and veterans who screened positively for mental health concerns or disorders and would have benefited from MHC, many did not seek it (Sammons, 2005;Ouimette et al., 2011;Reger et al, 2013;Turchik et al., 2013;Acosta et al., 2014;Vogt et al., 2014;Whealin et al., 2014;Pickett et al., 2015;Sharp et al., 2015;Wade et al., 2015;Hernandez et al., 2016;Snyder et al., 2016;VanSickle et al., 2016;Brecht et al., 2017;Porcari et al, 2017;Murray-Swank et al., 2018;Seidman et al., 2018;Winzeler, 2017;Barr et al., 2019;Newins et al., 2019). Common mental health issues included in the above-cited research included anxiety, depression, work-related stressors, PTSD, combat-related stressors, and relationship issues on the home front. ...
... One study discovered that the degree to which veterans saw their military service as an essential element of their self-identity moderated the relationship between their mental functioning and negative attitudes they had toward mental health treatment (Bick, 2016). As with sexually related other-stigma, greater self-stigma and avoidance of MHC were associated with MST (Turchik et al., 2013;Blais et al., 2018;Monteith et al., 2018). In one study, men who experienced sexual trauma reported perceiving self-stigma and avoiding MHC (Turchik et al., 2013). ...
... As with sexually related other-stigma, greater self-stigma and avoidance of MHC were associated with MST (Turchik et al., 2013;Blais et al., 2018;Monteith et al., 2018). In one study, men who experienced sexual trauma reported perceiving self-stigma and avoiding MHC (Turchik et al., 2013). In another study, female veterans who reported experiencing higher self-stigma also shared that they were less likely to disclose their MST during screening (Andresen & Blais, 2018). ...
Thesis
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This archival study utilized descriptive, correlational, and chi-square analyses to examine data from a recent self-report survey of 2,163 military and veteran chaplains (Nieuwsma et al., 2013). Data trends were explored between U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) samples and subsamples, targeting frequencies in populations encountered, perceived mental health problems, and perceived stigma-related and non-stigma-related avoidance of mental health professionals/providers (MHPs). Relationship/ Family stress, work stress, and concern of harm to career or differential treatment from leadership occurred most frequently in DoD subsamples. Avoidance of MHPs was perceived by higher percentages of chaplains who served the DoD than chaplains in the VA sample. A higher average percentage of chaplains who served the Air Force perceived non-stigma-related avoidance of MHPs than did chaplains of other subsamples. Non-stigma-related avoidance of MHPs was perceived by a slightly higher average percentage of VA and DoD chaplains than was stigma-related avoidance. A small correlation was found in the Army sample between “sometimes” perceiving posttraumatic stress in clients and “frequently” encountering veterans who avoid MHPs in order to avoid potential harm to their career. Keywords: stigma, mental health care, chaplains, military, veterans, DoD, VA
... Few past studies have examined preferences for therapist gender, mostly reporting crosssectional findings on small samples from mixed-gender, non-clinical, college populations (Black & Gringart, 2019;Ip et al., 2016;Liddon, Kingerlee, & Barry, 2018;Pikus & Heavey, 1996;Speight & Vera, 2005;Turchik et al., 2013). Across studies, approximately half the respondents typically indicated a preference for therapist gender, with male respondents often reporting a slightly greater preference for female therapists (Black & Gringart, 2019;Liddon et al., 2018;Pikus & Heavey, 1996;Turchik et al., 2013), albeit with some inconsistency (Speight & Vera, 2005). ...
... Few past studies have examined preferences for therapist gender, mostly reporting crosssectional findings on small samples from mixed-gender, non-clinical, college populations (Black & Gringart, 2019;Ip et al., 2016;Liddon, Kingerlee, & Barry, 2018;Pikus & Heavey, 1996;Speight & Vera, 2005;Turchik et al., 2013). Across studies, approximately half the respondents typically indicated a preference for therapist gender, with male respondents often reporting a slightly greater preference for female therapists (Black & Gringart, 2019;Liddon et al., 2018;Pikus & Heavey, 1996;Turchik et al., 2013), albeit with some inconsistency (Speight & Vera, 2005). Both Pikus and Heavey (1996) and DeGeorge, Constantino, Greenberg, Swift, and Smith-Hansen (2013) identified that men who preferred female therapists mostly did so because they felt more comfortable talking to women, because they preferred qualities stereotypically more readily found in women (i.e. ...
Article
Little empirical data exists regarding men’s preferences for therapist gender, including what predicts these preferences, and the impact they may have on satisfaction with care. To address this, data were drawn from an online survey of Australian men (n = 2002; aged 16–85; M = 43.8 years) reflecting on their preferences for and experiences of mental health treatment. Participants responded to items assessing demographics alongside their preference for therapist gender, reason for this preference and items on masculinity and treatment satisfaction, which were entered into a predictive model. Findings indicated that the majority (60.5%) of respondents did not indicate a preference, while equal proportions preferred male (19.1%) and female therapists (20.4%). Undergraduate-educated, non-heterosexual, and more masculine-identifying men were all more likely to prefer a male therapist. Severely depressed men preferred a female therapist. Finally, seeing a therapist who matched one’s gender preference was a significant predictor of satisfaction with therapy, while feeling less manly in attending therapy mediated this relationship. While the majority of men reported no gender preference for their therapist, for those who do, the underpinnings and implications warrant consideration and discussion. Limitations and clinical and research implications are discussed.
... In this pilot study of chiropractic care, a manually delivered treatment, some participants stated a preference to receive care from a female chiropractor, which currently comprise about 20% of VA chiropractors [17]. Male and female veterans who have experienced military sexual trauma want to choose the gender of their healthcare providers, while many women veterans prefer access to gender distinct clinics and waiting areas [48,[87][88][89]. ...
Article
Full-text available
Background Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP. Methods The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10-week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services. Results Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers). Conclusions This qualitative study highlighted veteran stakeholders’ perceptions of VA-based chiropractic services and offered important suggestions for conducting a full-scale, veteran-focused, randomized trial of multimodal chiropractic care for chronic LBP in this clinical setting. Trial registration ClinicalTrials.govNCT03254719
... Future research should compare childhood sexual trauma, nonmilitary adult sexual trauma, and sexual revictimization in civilian settings. In addition to the stigma of experiencing and reporting sexual trauma in the military, along with institutionalized power dynamics (e.g., chains of command) that may create unique barriers to reporting assault (Turchik et al., 2013) other differences may arise when studying nonmilitary adult sexual trauma rather than MST. ...
Article
Objective: Research to date has not examined how childhood sexual trauma (CST) followed by sexual trauma during military service (MST) relates to posttraumatic stress disorder (PTSD), depression, and suicidality among women and men. Given the strong association between MST in particular, and these serious posttraumatic outcomes, the current study sought to address this gap. Method: The current study compared the mental health concerns of 268 treatment-seeking veterans who were survivors of CST, MST, or both (CST + MST). We hypothesized that MST would be associated with greater severity of symptoms compared with CST and that those who experienced sexual revictimization (CST + MST) would report more severe symptoms than veterans who experienced CST or MST alone. Results: Veteran men presented with significantly higher suicidality but not higher PTSD or depression scores than women. Controlling for gender, MST survivors had significantly higher PTSD and depression symptom severity scores, but not suicidality, than CST survivors. PTSD, depression, and suicidality scores were significantly higher for the CST + MST group than for CST only survivors, but did not significantly differ from survivors of MST alone. Conclusion: Findings support the more severe clinical impact of CST + MST-specific sexual revictimization compared with CST-only among military men and women, but also suggest that MST alone can have negative consequences similar to revictimization. While results point to the need to consider context and trauma history in future trauma research and clinical applications, they should be interpreted in light of our sample demographics, which were representative of the southwest U.S. veteran population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... As such, it is essential that future studies replicate and extend these preliminary analyses regarding the differential stress-buffering effect of MME for men and women who are exposed to military sexual harassment. Although previous literature consistently reports that sexual harassment is more common among female veterans (Portnoy et al., 2018;Street et al., 2009;Wilson, 2018), high levels of stigma, fears about confidentiality, or shame among male veterans may have prevented accurate reporting of severe sexual harassment (Burns et al., 2014;Hoyt et al., 2011;Turchik et al., 2013). Indeed, female veterans are more likely to report military sexual trauma via phone interview (as in the present study) than on self-report questionnaires, whereas men exhibit the opposite trend (Bovin et al., 2019). ...
Article
Objective: Post-9/11 military deployment is commonly reported as stressful and is often followed by psychological distress after returning home. Yet veterans also frequently report experiencing meaningful military engagement (MME) that may buffer detrimental effects of military stressors. Focusing on the under-investigated topic of association of MME with post-deployment psychological adjustment, this study tests gender differences in MME and post-deployment outcomes. Method: This cross-sectional study examined the relationship of MME with deployment stressors, subsequent psychological distress (posttraumatic stress symptoms (PTSS) and depression), and gender among 850 recent-era U.S. veterans (41.4% female). Results: On average, both male and female veterans reported high MME. Greater MME was associated with less PTSS and depression following combat and general harassment, and more depression after sexual harassment. For men only, MME associated with less PTSS after sexual harassment. Conclusions: MME is high among post-9/11 veterans, but its stress-buffering effects depend on gender and specific stressor exposure.
... Age, gender and ethnicity matching were generally not considered sufficient motivations for requesting a specific PMHP or to change PMHP if users had a specific preference in regard to these characteristics in the PMHP. With respect to gender, this finding is consistent with previous studies investigating users' gender preferences 18,19 . As to ethnicity, this results is in contrasts with some studies 20-25 that showed that users tend to prefer therapists of their ethnicity. ...
Article
SUMMARY Objectives It is generally agreed that it is important to take into consideration users’ preferences in the choice of their allocated primary mental health professional (PMHP). Our aim was to explore experiences of users, care givers and psychiatrists on users’ initial choice and request of change the PMHP in Community Mental Health Services (CMHSs). Methods Three focus groups were conducted in March-May 2017 in two CMHSs in Modena, Northern Italy. Transcripts were analyzed using MaxQda 11. Results Six users, 7 psychiatrists and 5 care givers were enrolled. Casual or fixed allocation is commonly performed (so-called “fixed rota”). Lack of empathy and a bad therapeutic relationship seem to be the most important reasons to change the PMHP. Conclusions Neither users nor professionals are generally involved in the initial choice of the PMHP. The availability of evidence-based guidelines for managing users’ request to choose/change the PHMP may improve quality of care. Key words: recovery, choice; primary mental health professional, community mental health, quality of care
Article
Sexual trauma is common and increases the risk for posttraumatic stress disorder (PTSD), substance-use disorders (SUD), and depression among Veterans. Limited research has examined the impact of sexual harassment and assault during deployment on treatment outcomes among Veterans with co-occurring PTSD and SUD. The current study examined the frequency of exposure to sexual harassment and assault during deployment as a predictor of treatment outcomes among a primarily male sample of US military Veterans diagnosed with current PTSD and SUD. A secondary analysis was performed using data from a randomized clinical trial examining the efficacy of Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) compared to Relapse Prevention (RP). Data from 69 Veterans (91.3% male) who were deployed while in the service were analyzed using mixed models to determine whether frequency of exposure to sexual harassment and assault during deployment impacted changes in PTSD symptom severity, percent days using substances, and depressive symptoms during treatment. Over one-third of the sample (36.2%) reported exposure to sexual harassment and/or assault during deployment. Frequency of exposure to sexual harassment and assault during deployment was not a predictor of treatment outcome in any of the models, suggesting a similar response to treatment among those with varying frequency of exposure to sexual harassment and assault during deployment. Veterans with co-occurring PTSD and SUD who have been exposed to sexual harassment and assault during deployment may benefit from integrated trauma-focused treatments and treatments focused on decreasing SUD symptoms.
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Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.
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Military veterans with histories of military sexual trauma (MST) are at risk for several negative mental health outcomes and report perceived barriers to treatment engagement. To inform interventions to promote gender-sensitive access to MST-related care, we conducted an exploratory, multiple-group latent class analysis of negative beliefs about MST-related care. Participants were U.S. veterans (N = 1,185) who screened positive for MST within the last 2 months and reported a perceived need for MST-related treatment. Associations between class membership, mental health screenings, logistical barriers, difficulty accessing care, and unmet need for MST-related care were also examined. Results indicated a four-class solution, with classes categorized as (a) low barrier, with few negative beliefs; (b) high barrier, with pervasive negative beliefs; (c) stigma-related beliefs; and (d) negative perceptions of care (NPC). Men were significantly less likely than women to fall into the low barrier class (27.9% vs. 34.5%). Relative to participants in the low barrier class, individuals in all other classes reported more scheduling, ps < .001; transportation, p < .001 to p = .014; and work-related barriers, p < .001 to p = .031. Participants in the NPC class reported the most difficulty with access, p < .001, and those in the NPC and high barrier classes were more likely to report unmet needs compared to other classes, ps < .001. Brief cognitive and behavioral interventions, delivered in primary care settings and via telehealth, tailored to address veterans' negative mental health beliefs may increase the utilization of mental health treatment related to MST.
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There are many empirically supported treatments available to help sexual assault survivors improve their postassault outcomes. Unfortunately, many survivors do not disclose their assault to others or seek formal treatment services and thus are not able to benefit from these treatments. This study examines the relations between survivors’ perceptions of peer rape myth acceptance (RMA), disclosure behaviors, and psychological well-being. Sixty-four sexually assaulted college undergraduates and 159 of their nonassaulted peers participated in this study. Survivors significantly overestimated their peers’ RMA, and this overestimation predicted posttraumatic symptoms. Contrary to hypotheses, the relation between estimated peer RMA and posttraumatic distress was not mediated by assault disclosure variables. As estimated peer RMA increased, survivors reported disclosing fewer assault details. These findings have implications for both sexual assault survivors and the general population.
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This study examined the frequency and correlates of barriers to reporting sexual victimization to law enforcement. Participants were 127 female undergraduate sexual assault victims who completed self-report surveys. The most frequently reported barriers were “I handled it myself” and “I didn't think it was serious enough.” Factor analysis of the reported barriers items revealed two factors: shame/not wanting others involved and did not acknowledge the event as a crime /handled it myself. Shame/not wanting others involved was positively associated with physical injury, being victimized by a relative, and self-blame. Acknowledgment/handled it myself was negatively associated with being victimized by a relative. Findings suggest that intervention efforts should focus on increasing acknowledgment, decreasing negative reactions to disclosure, and decreasing victims' self-blame.
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ABSTRACT. This cross-sectional study examined the odds of being diagnosed with a sexually transmitted infection (STI) or a sexual dysfunction disorder (SDD) among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) American veterans receiving care in the Veterans’ Health Administration (VHA) in relation to whether or not they have experienced military sexual trauma (MST). Among those veterans who experienced MST, the influence of a diagnosis of posttraumatic stress disorder, a depressive disorder, or a substance use disorder on the odds of being diagnosed with an STI or SDD was also examined. The study utilized nationwide VHA records of 420,725 OEF/OIF male and female veterans who used VHA services in fiscal years 2002 to 2010. Veterans who reported a history of MST were more likely to have a number of STIs and SDDs compared with veterans without a history of MST. Among veterans with MST, the risk for having an STI or SDD increased with the presence of certain mental health diagnoses. Implications for clinical practice and assessment with veterans are discussed.
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Rape myths are one way in which sexual violence has been sustained and justified through history and modern times. However, there has been a dearth of scholarship about rape myths concerning male victims. This paper reviews the historical origins, development, and current manifestations of male rape myths prevalent in Western society. Specifically, we review male rape myths and their origins in the areas of medicine, law, media, the military, and incarcerated settings. The paper also delineates possible means for eradicating male rape myths at the individual, institutional, and societal levels. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Despite the availability of specialty posttraumatic stress disorder (PTSD) care within Department of Veterans Affairs (VA) facilities, many VA patients with PTSD do not seek needed PTSD treatment. This study examined institutional and stigma-related barriers to care among a large diverse group of Vietnam and Iraq/Afghanistan veterans who had been diagnosed with PTSD by a VA provider. A total of 490 patients who had not received VA treatment for PTSD in the previous 2 years (31% response rate) were asked about psychological symptoms and reasons for not using care. Stigma related barriers (concerns about social consequences and discomfort with help-seeking) were rated as more salient (rated in the “slightly” to “moderately” problematic range) than institutional factors (not “fitting into” VA care, staff skill and sensitivity, and logistic barriers; rated in the “not at all” to “slightly” problematic range). Regression analyses revealed that younger age and White females were associated with higher ratings on not fitting into VA health care, whereas non-White males were associated with higher ratings on logistic barriers. PTSD symptoms were positively associated with perceived barriers to care, with the most consistent results observed for PTSD avoidance symptoms. Magnitude of effects was generally small, suggesting the possibility that other factors not assessed in this study may also contribute to perceptions of barriers to care. Future research should attend to the effects of stigma, as well as institutional barriers to care, on VA mental health treatment seeking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In this article, Professor Franke asks and answers a seemingly simple question: why is sexual harassment a form of sex discrimination under Title VII of the Civil Rights Act of 1964? She argues that the link between sexual harassment and sex discrimination has been undertheorized by the Supreme Court. In the absence of a principled theory of the wrong of sexual harassment, Professor Franke argues that lower courts have developed a body of sexual harassment law that trivializes the legal norm against sex discrimination. After illustrating how the Supreme Court has not provided an adequate theory of sexual harassment as sex discrimination, she traces the theoretical arguments advanced by feminist scholars on behalf of a cause of action for sexual harassment under Title VII: 1) it violates formal equality principles; 2) its sexism lies in the fact that the conduct is sexual; and 3) sexual harassment is an example of the subordination of women by men. Professor Franke provides a critique of each of these accounts of sexual harassment, in part, by showing how each is unable to provide an account of whether same-sex sexual harassment should be actionable under Title VII. She argues that flaws in both the theory and the doctrine are amplified in the marginal cases of same-sex harassment. Professor Franke then argues that the discriminatory wrong of sexual harassment, between parties of different or same sexes, should be understood as a technology of sexism. That is, the sexism in sexual harassment lies in its power as a regulatory practice that feminizes women and masculinizes men, renders women sexual objects and men sexual subjects.
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The authors surveyed counselors‐in‐training at counselor education programs nationwide, accredited by the Council for Accreditation of Counseling and Related Educational Programs, to examine trainees' acceptance of rape myths and their willingness to make blame‐based attributions toward a male victim of rape. Results suggested that male counselor trainees with no experience counseling sexually assaulted clients tended to endorse the greatest degree of acceptance of rape myths. Trainees of both sexes thought that a male rape victim who showed no resistance to his attacker should have done so. The authors discuss implications for counselor training and supervision.
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The purpose of the study was to assess sexual assault survivors' nondisclosure motivations, including stigma threat, and their impact on revictimization risk. The authors describe data from a prospective study of 144 female, undergraduate sexual assault survivors, most of whom had been assaulted by acquaintances and only one of whom had officially reported her experience to police. As part of a large-scale investigation, participants described during individual interviews why they had not reported their experiences to law enforcement authorities. Open-ended responses were coded into five reliable content themes, one of which was stigma-motivated nondisclosure, or stigma threat. Results indicated that stigma threat prospectively predicted sexual revictimization during a 4.2-month follow-up period. Moreover, results of mediation analyses suggested that decreased posttraumatic growth during the course of the study accounted for the relationship between stigma threat and survivors' revictimizations. Discussion focuses on advances to the sexual revictimization research (e.g., the importance of assessing subjective/perceptual in addition to objective/factual characteristics of assaults and their social repercussions) and to posttraumatic growth research, with data highlighting for the first time an important health correlate (i.e., sexual revictimization) of sexual assault survivors' perceived (lack of) posttraumatic growth. In addition, recommendations are provided for primary (social-level) prevention as well as for secondary prevention, that is, formal and informal support provided to sexual assault survivors.
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This research examines the effects of gender role stereotypes on the provision of services to adult, noninstitutionalized male victims of sexual assault. Thirty sexual assault crisis providers in a major Southeastern city participated in in-depth interviews focusing on their experiences with male sexual assault victims, their attitudes toward these men, and the services provided by their organizations. Although official reports of male sexual assault victims are relatively uncommon, our research confirms that male victims do exist and that they are more numerous than official statistics indicate. Moreover, our findings suggest that traditional gender role stereotypes, lack of responsiveness to male victims, and gaps in service provision prevent sexually assaulted men from getting the help they need.
Considers the proposition that to be "a man" in contemporary American society is to be homophobic, that is, to be hostile toward homosexual persons in general and gay men in particular. It is argued that homophobia is an integral component of heterosexual masculinity, to the extent that it serves the psychological function of expressing who one is not (i.e., homosexual) and thereby affirming who one is (heterosexual). Further, homophobia reduces the likelihood that heterosexual men will interact with gay men, thereby ruling out opportunities for the attitude change that often occurs through such contact. It is concluded that a long-term strategy for eradicating homophobia must focus on heterosexual masculinity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)