Dichter ME, Wagner C, True G. Women veterans’ experiences of intimate partner violence and non-partner sexual assault in the context of military service implications for supporting women’s health and well-being. J Interpers Violence 2016 Sep 20.
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Objective. To understand how the experience of intimate partner violence and non-partner sexual assault (IPV/SA) in women in the military intersects with military service.
Design. Qualitative interviews conducted as part of a larger study focused on experiences of IPV/SA and health care needs and preferences among women veteran patients.
Setting and participants. Participants were 25 women veterans from all branches of the service, ages 22 to 58 years (mean 44.6), who were patients at the Veteran’s Medical Center in Philadelphia, PA. The sample was diverse: 56% self-identified as black or African American, 20% as white or Caucasian, 16% as Hispanic or Latina, and 8% as “other” or multiple race/ethnicity.
Interviews. Researchers conducted face-to-face interviews using a semi-structured interview guide to gather in-depth narratives related to the participants’ lives in the military and their experiences of IPV/SA. The Military Occupational Mental Health Model was used as a framework to understand the experience of IPV/SA within the cultural context of the military and how that context influences health and well-being. The model considers the unique context of the military, including the importance of the values of mission over individual well-being, hierarchy and subordination, leadership, and unit support, as well as what resources are made available.
Data analysis. The authors followed an inductive approach informed by grounded theory, with the goal of identifying themes and a unifying theory empirically grounded in the interview data. First, 2 members of the research team conducted independent, close readings of each transcript and applied open coding, then compared their coding to identify common patterns across transcripts. Through this process, they developed and refined a codebook to define a set of codes and guide application of codes to text. Research team members conducted line-by-line coding of each transcript, based on the codebook definitions. Then the authors read all coded text and met to discuss patterns within and between transcripts, leading to identification of 2 core categories pertaining to the relationship betweenIPV/SA and military service, as well as several subthemes within each core category.
Main results. The 2 core categories identified had both positive and negative influences. The first was the “experience of IPV/SA affects participation in military service, including entering and leaving military service,” and included the subthemes of coercion by the perpetrator to enter or leave military service, effects on service and work performance such as physical and mental health problems that interfered with their ability to do their job, and survival strategies that had negative repercussions on the woman’s career. The second was the “military context shapes responses to, and coping with, experiences of IPV/SA,” and included the subthemes of military sanction for IPV (but not sexual assault) if both partners were in the military, lack of accountability for and protection of service member perpetrators due to the value of unit support, military service as an opportunity to escape through relocation, even preferring a combat zone over home, and resistance to seeking help because of expectations of invulnerability related to the warrior identity.
Conclusion. The military context can provide personal and occupational resources for women who experience IPV/SA, but the institutional (ie, chain of command reporting) and cultural context can constrain women’s ability to access resources and support, negatively affecting outcomes.
Intimate partner violence (IPV) is a widespread public health problem in the United States and women in the military are no exception. According to Black and Merrick , 36.3% of active duty women experienced sexual violence in their lifetime and 39.7% experienced IPV. Violence has significant health, economic, and social consequences for women in all settings, including serious short- and long-term physical and mental health problems, economic hardship, isolation, and decreased quality of life [2–5]. Women who experience IPV/SA in any setting face challenges in protecting themselves, overcoming violence, and seeking justice, however, the context in which the violence occurs can significantly influence the individual experiences of women. This study used a qualitative approach to understand how it is experienced by service women in the context of the military.
As the authors note, military culture can both facilitate and hamper women’s recovery from the physical, psychological, and economic sequelae of IPV/SA. The rigid hierarchal structure of the military and the expectation that one supports the unit and fellow soldiers above all else makes it very difficult for women to disclose IPV/SA and seek and receive protection and justice. On the other hand, military training and service provides women with the skills and means to be independent and to physically distance themselves from the perpetrator. However, the comment of one woman that facing bombs in Iraq was preferable to facing the violence at home should serve as a reminder of how devastating IPV/SA is and suggests that victims do not think there are effective institutional deterrents or protection available to them.
As the authors note, this was a small convenience sample of women at one VA medical center. This qualitative study provides a beginning understanding that should be expanded on with multisite quantitative research with large samples. Sexual assault in the military has been recognized as a significant problem, particularly for women but also for men. We need to continue to study this problem from many different perspectives to determine how to prevent violence and to ensure all victims get the resources and effective services they need.
Applications for Clinical Practice
This study has implications for all health care providers, as active duty and veteran service women seek care outside as well as within the VA. An important finding that has direct application to practice in all settings is the influence of the warrior identity. The warrior identity has been widely acknowledged as a barrier to seeking help for depression or PTSD in service men returning from combat but not as much in service women and not in the context of IPV/SA. It is important that providers consider warrior identity in assessing and treating women for IPV/SA. Not only can this affect disclosure and prevent a victim from seeking help, but the expectation that they should have been invulnerable and strong may increase feelings of self-blame and worsen psychological distress.
—Karen Roush, PhD, RN
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