In recent months, sexual harassment and assault in the military has regained the public’s attention. Reports beyond the headlines show sexual violence continues to be a threat to the well-being and health of service members in the U.S. armed forces. For nearly two decades, Michelle Mengeling, PhD, assistant professor in General Internal Medicine has published more than 20 articles on the subject, working alongside psychiatrists Anne Sadler, PhD, and Brian Cook, DO, and epidemiologist James Torner, PhD, among others. They have investigated the risk factors and the health consequences of sexual assault in the military (SAIM). 

Many researchers, including Mengeling, have sounded the alarm, labeling SAIM a public health crisis. SAIM instills lasting impairments on the health and mental wellness of survivors, and Mengeling has found that the repercussions of SAIM can impact survivors for decades following the incident. While survivors experience an emotional and mental toll, SAIM can also harm a survivor’s quality of life, gynecologic health outcomes, sexual function, mental health, health care utilization, and the way they approach substance use.

“These acute and long-term consequences underscore why the primary prevention of sexual violence, starting with zero tolerance, is so important,” Mengeling said. 

Factors in SAIM incidence
Mengeling’s extensive research has focused in part on why and where SAIM occurs. Mengeling’s 2017 American Journal of Public Health publication compared the rates of SAIM in deployed locations versus non-deployed locations. When surveying women in active duty, Mengeling found an estimated 16% of women had experienced SAIM. Although a more substantial proportion of women had experienced SAIM while not deployed, Mengeling says deployed servicewomen still face a higher risk of SAIM.  

“We also found that in deployed locations, Reserve/National Guard servicewomen had higher rates of SAIM than their Active Component peers,” Mengeling said. 

In a different study, Mengeling and team also found that military leadership can be either be a preventive or a risk factor for SAIM. The data, collected from 1,337 servicewomen, compared the frequency of assault and detrimental leadership behaviors, such as allowing peers in the unit to make sexually demeaning comments. Mengeling found that negative leadership behaviors doubled a servicewoman’s risk of being assaulted. 

“When military leadership, commissioned and noncommissioned officers, actively address and enforce zero-tolerance, servicewomen’s risk of sexual violence is decreased,” Mengeling said. 

Barriers to reporting
In a 2014 American Journal of Preventative Medicine, Mengeling examined SAIM reporting trends. This survey aimed to identify the rates at which servicewomen report SAIM incidents and explain why some would choose not to report. Of the 205 servicewomen who experienced sexual assault, only 25% filed an official report. Furthermore, the study found that servicewomen sometimes faced adverse consequences when filing an official SAIM report. 

“These actual and perceived reporting consequences may deter servicewomen from making an official SAIM report while serving in the military,” Mengeling said. The fear of negative consequences were corroborated by her results. “Our research found that 13% of servicewomen who tried to make an unrestricted report said the official did not make an official report,” Mengeling said. “Almost 60% said that their confidentiality was not maintained within the chain of command.” 

Her 2014 study also found that officers were less likely to file a report than enlisted servicewomen, and the incident was more likely to be reported if it occurred on base, on duty, or resulted in a physical injury. 

SAIM experienced by men
“Understanding men’s unique risk and protective factors for sexual assault is an important research area,” Mengeling said. In 2016, the Department of Defense (DoD) reported that only 17% of male survivors reported their assaults. In a 2018 study published in the Journal for Interpersonal Violence, Mengeling and a team of researchers dove deeper into male SAIM reporting and surveyed 34 National Guard and Active Component servicemen.  

The survey group reported a lack of male SAIM awareness, a marginalization of male survivors, and more substantial barriers to reporting the incidents. National Guard servicemembers reported barriers such as a greater stigma because of their status as dual citizen-soldiers, the value of conformity among their reserve, and a lack of confidence in the SAIM-reporting process. For Active Component servicemen, the location of deployment and sex of the victim proved to be barriers. Awareness of these reporting-barriers is important for providers to offer patient-focused care. 

Recommendations for improvement
Mengeling’s research suggests that improving unrestricted reporting, which notifies both the command and law enforcement, may increase SAIM reporting. Restricted reporting, which provides the survivor medical treatment, counseling, and forensic examination but does not open an official investigation into the incident, was rated more positively. However, survivors used unrestricted reporting more often than restricted.

Ultimately, Mengeling has found that military leadership plays a large role in SAIM, and strong leadership could be the key to preventing SAIM occurrence. Since the early 2000s, the DoD has increased its efforts to prevent SAIM occurrence. They established a Sexual Assault Prevention and Response Office and began working with the armed forces, Congress, and national experts to address SAIM. Since then, DoD has developed several new protocols, including reporting options, documenting SAIM with annual reports, developing the Prevention Plan of Action, creating a response to retaliation related to reports of sexual assault, and implementation of the Catch a Serial Offender program. Additionally, they have created support groups and therapeutic programs to aid survivors in their recovery.

In the near future, Mengeling will continue to focus on the health and wellness of veterans as the director of the new Veteran’s Affairs Community Care Research Evaluation Center (CREEK). A policy and data center, CREEK will research the VA’s expanded community care programs and share the findings with the Office of Community Care. By analyzing the implementation of these programs, CREEK, with Mengeling at the wheel, will be able to improve the quality of care provided to our veteran patients at the VA and at University of Iowa Hospitals & Clinics.