Institutional Betrayal and Closeness Among Women Veteran Survivors of Military Sexual Trauma: Associations with Self-Directed Violence and Mental Health Symptoms

ABSTRACT

Institutional betrayal is defined as harm caused by an institution to an individual in the context of trust and dependence. High institutional betrayal is associated with poorer health outcomes, and high levels of trust, dependence, or identification with the institution (institutional closeness) may exacerbate the negative effects of institutional betrayal. While military sexual trauma is prevalent among women Veterans and associated with high rates of institutional betrayal, studies of the impact of military sexual trauma-related institutional betrayal have been limited in size and scope and have not examined the potential role of institutional closeness. We conducted a secondary analysis of national survey data collected from women Veterans who screened positive for military sexual trauma (n = 229). Hierarchical logistic and linear regression were used to examine associations between predictor variables (institutional betrayal, institutional closeness, and their interaction) and outcomes of interest and adjusted for age, education, and military sexual assault history. Institutional betrayal was associated with increased odds of suicidal ideation and suicide attempt during or following military service, as well as more severe symptoms of depression and posttraumatic stress disorder (PTSD). Institutional betrayal was not associated with non-suicidal self-injury or lifetime substance misuse. Counter to hypotheses, institutional closeness did not moderate relationships between institutional betrayal and mental health symptoms or self-directed violence. Results underscore the necessity of preventing and addressing institutional betrayal among women Veterans who experience military sexual trauma.

KEYWORDS:

• Institutional betrayal
• military sexual trauma
• women
• veteran
• suicide attempt

Acknowledgments

The authors would like to thank all of the women Veterans who participated in this study. The authors would also like to acknowledge and thank Alexandra Schneider and Christin Miller for their contributions to the initial sampling frame, survey programming, and data cleaning. Preliminary results were presented at the 2021 American Psychological Association Conference.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ “When you were in the military, did you ever receive unwanted, threatening, or repeated sexual attention (for example, touching, cornering, pressure for sexual favors, or inappropriate verbal remarks, etc.)? When you were in the military, did you have sexual contact against your will or when you were unable to say no (for example, after being forced or threatened or to avoid other consequences)?”.

² Suicidal ideation was assessed with the question: “Have you ever had thoughts of killing yourself?” Suicide attempt was assessed with the question: “Have you ever made an actual attempt to kill yourself in which you had at least some intent to die?” NSSI was assessed with the question: “Have you ever purposely hurt yourself without wanting to die (for example, cutting or burning)?”

³ Age was significantly associated with depressive symptoms (r = −.22, p < .001), PTSD symptoms (r = −.26, p < .001), suicidal ideation (t = 3.55, p < .001), and NSSI (t = 4.05, p < .001), but not suicide attempt (t = 1.40, p = .16) or substance use (t = 1.32, p = .19). Education was significantly associated with depressive symptoms (F = 2.92, p = .035), but not PTSD symptoms (F = 1.90), suicidal ideation (χ² = 3.21), suicide attempt (χ² = 2.05), NSSI (χ² = 2.64), or substance use (χ² = 1.66) (p’s > .05). Military sexual assault history was significantly associated with depressive symptoms (t = 4.87, p < .001), PTSD symptoms (t = 6.02, p < .001), suicidal ideation (χ² = 14.57, p < .001), suicide attempt (χ² = 6.55, p < .05), and NSSI (χ² = 13.25, p < .001), but not substance use (χ² = .36, p > .05). Race was not significantly associated with any outcomes of interest, including depressive symptoms (F = .99), PTSD symptoms (F = 1.91), suicidal ideation (χ² = 3.28), suicide attempt (χ² = 3.54), NSSI (χ² = 1.22), and substance use (χ² = 2.31) (all p’s > .05). Ethnicity also was not significantly associated with any outcomes of interest, including depressive symptoms (t = 1.31), PTSD symptoms (t = .56), suicidal ideation (χ² = .28), suicide attempt (χ² = .24), NSSI (χ² = .11), or substance use (χ² = .07) (all p’s > .05).

⁴ Results were similar when re-running analyses with substance misuse as a continuous variable (i.e., significant associations between institutional betrayal, institutional closeness, and their interaction with substance use were not detected).

Additional information

Funding

This material is based upon work supported in part by the Department of Veterans Affairs (VA) and the VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention. The views expressed are those of the authors and do not necessarily represent the views or policy of the VA or the United States Government.