Rationale and objective: The proposed research is designed to produce new useful information about predictors of exposure to military sexual trauma (MST), the effects of MST on post-traumatic stress disorder (PTSD) and a wide range of other outcomes, potentially modifiable factors that reduce the impact of MST on PTSD and other adverse outcomes, and modifiable factors that interfere with or increase the chances of a Soldier with emotional problems caused by MST seeking treatment for these problems. Although some research already exists on all these issues, there are serious gaps in this research that will be addressed by the unique dataset we will use in the research proposed here, increasing the chances that our work will yield new and useful insights that can be used by intervention program planners.

Who will be helped and how? The proposed research will involve analysis of the Army Study to Assess Risk and Resilience in Servicemembers (A-STARRS), the largest epidemiological study of mental health risk and resilience ever conducted among US Army personnel. A-STARRS is a Collaborative Agreement between the National Institute of Mental Health and a multi-site team of academic collaborators along with the US Army. Although the main focus is on Army suicide, a great deal of data exists that can also address other topics, including MST. Army STARRS has three separate surveys administered between early 2011 and mid-2013: 54,000 New Soldiers (New Soldier Survey, NSS) surveyed in Reception Battalion, 39,000 Soldiers surveyed across all other duty assignments (including in theatre) exclusive of training (All Army Survey, AAS), and a panel survey of 10,000 Soldiers surveyed shortly before deployment and again 6 months after redeployment (Pre-Post Deployment Survey, PPDS). Neurocognitive tests and blood samples are collected in conjunction with NSS and PPDS, in which administrative data from 30 different Army administrative data systems are collected both retrospectively and prospectively for all survey respondents who grant permission in all three surveys.

Analysis of these surveys will be carried out for fact-finding purposes: to document how big the problem of MST is; to see if we can improve our understanding of the predictors of exposure to MST so as to help develop educational and other interventions to reduce MST occurred; to study modifiable factors that seem to reduce the adverse psychological effects of MST so as to use this information in designing ameliorative interventions; and to find why Soldiers with emotional problems caused by MST often fail to reach out for professional help so as to gain insights that might help reduce these barriers to help-seeking. As it is designed as a fact-finding study, the work proposed here will not help study participants directly, although we do provide participants with information and assistance to seek professional help for the emotional problems they report to us. The main objective, instead, is to gather information that can increase the effectiveness of existing and future interventions. You can't fix a problem without understanding it, and our research is designed to increase understanding.

What are the potential clinical applications, benefits, and risks? The potential applications of the study results will be many and varied. We will try to develop risk equations that include our understanding of exposure to MST. We want to be careful not to blame victims, but we also know that some types of MST are much more likely to occur to certain people than others depending on their circumstances. If we can increase our understanding of these risk factors, we might be able to target high-risk people and situations for intensive preventive interventions that could help reduce the incidence of MST. We also know that some people who experience MST make better emotional adjustments than others for reasons having to do with their access to social support and a wide variety of other coping resources and vulnerabilities. Increasing our understanding of these risk and resilience factors could be valuable in helping us develop more effective ways to help MST victims adjust. Finally, we know that many people who experience MST fail to seek treatment out of embarrassment or fear of repercussions or misinformation. A-STARRS contained detailed information about these kinds of barriers to treatment that we want to examine in order to gain insights that might help us increase the number of MST victims to seek professional help for the emotional problems they experience in the wake of MST.

What is the projected time it may take to achieve a patient-related outcome? The study timeline is for 36 months, but we believe that useful insights will begin to emerge within the first 6 months of the study and will continue to grow throughout the study period. Our intention is to write reports of results as they emerge so as to make them available for practical implementation as soon as possible.