RAND researchers conducted three evidence reviews focused on sexual assault and sexual harassment in adults. The first review focuses on psychotherapy interventions for victims in military settings, the second focuses on barriers and facilitators to accessing care, and the third focuses on associations between victims and three mental health conditions: posttraumatic stress disorder, depression, and substance use disorders.

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Psychological Harms and Treatment of Sexual Assault and Sexual Harassment in Adults

Systematic and Scoping Reviews to Inform Improved Care for Military Populations

by Julia Rollison, Joachim O. Hero, Katie Feistel, Armenda Bialas, Owen Hall, Rosemary Li, Sarah Weilant, Jody Larkin, Coreen Farris, Kristie L. Gore

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Research Questions

  1. What are the effects of psychological interventions for adult victims of military or workplace sexual assault and/or harassment?
  2. What are the barriers and facilitators for service members who are—or were—victims of sexual assault and/or harassment to accessing and remaining in treatment for the psychological sequelae of sexual assault and/or harassment?
  3. What are the associations between mental health conditions (i.e., PTSD, depression, and substance use disorders) and experiences of sexual assault and/or harassment in adulthood?

Victims of sexual assault and sexual harassment often experience a variety of psychological outcomes and mental health symptoms related to posttraumatic stress disorder (PTSD), depression, anxiety, substance abuse, suicidal ideation, and self-harm. Sexual trauma also might affect careers. Despite a need to address these harms, some service members have reported that connecting to health care or mental health services following sexual assault or sexual harassment can be difficult—in part because of a lack of leadership support. Given these persistent challenges, the Psychological Health Center of Excellence identified an urgent need to better understand research that is pertinent to sexual assault and sexual harassment during military service so that the U.S. Department of Defense and the military services can improve the health care response for service members. RAND researchers investigated and synthesized relevant research in three topic areas: (1) the effectiveness of psychotherapy treatments designed for adult victims of sexual assault or sexual harassment in military settings; (2) barriers faced by U.S. military members to accessing and remaining in mental health care settings; and (3) associations between sexual assault or sexual harassment and mental health conditions.

Key Findings

Available evidence showed that psychotherapy interventions were effective in reducing PTSD and depression symptoms among adult victims of sexual assault in military settings

  • Although effect sizes ranged from medium to large, the evidence was limited in scope and quality.
  • This finding applied across all treatment modality groupings for outcomes related to both PTSD and depression, including trauma-focused, skills-based, multisystem, and control therapies.
  • Although the number of studies in this review was limited, all studies were conducted within the past ten years, signaling emerging interest in research on the effectiveness of psychotherapy interventions for victims of sexual assault in the military.

The majority of the barriers and facilitators to accessing and remaining in care were classified at the individual level

  • Perceptions of stigma and shame and fears or concerns about how victims might be viewed by coworkers, leaders, or even providers were prominent factors that influenced seeking treatment.
  • Logistical factors (e.g., issues with scheduling appointments, challenges in getting time off work, inadequate transportation, challenges in arranging child care) were also stressed.

There was evidence of an association between reported experiences of sexual assault and the risk of diagnosis of PTSD, depression, and substance use disorders

  • The strongest support for the association was between reported experiences of sexual assault and PTSD.
  • Associations between experiences of sexual assault were as strong among military populations as among civilians.

Recommendations

  • In tests of psychotherapy treatments, researchers should conduct more randomized control trials with control groups that receive no treatment to help mitigate bias concerns.
  • Future research should examine the interactions between the traumatic experiences that military populations typically experience and those from sexual assault to better understand the impacts and clinical implications of layered traumas.
  • Stakeholders should consider ways to address identified barriers to better connect victims to services and help them remain engaged in mental health care to improve treatment outcomes and experiences of care.
  • There is a need for more-precise and -consistent definitions and measurement of experiences of sexual assault, sexual harassment, and sexual trauma, including severity and timing of those experiences.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methodology

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategies

  • Appendix B

    Evidence Tables

Research conducted by

This research was sponsored by PHCoE and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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