In line with previous studies conducted mostly in the US military [1, 2, 5, 10], MST was a common experience in the French military with substantial implications for mental health. While patterns of sexual aggression were similar for both sexes, most commonly involving repeated sexual comments or unwanted touching, the gender gap was profound, as women were twice as likely as men to report any MST and to experience the most severe forms of sexual stressors. These gender inequalities are pervasive across all settings, including in the general population in France, and in other military settings in the US [12], underscoring the need for gender-transformative interventions to tackle sexual aggression in the workplace.
Consistent with studies conducted in the US, servicemen and women exposed to MST were substantially more likely to express symptoms of depression and to have positive PTSD screening scores [1, 4]. Results also indicate different forms of aggression were associated with different levels of psychological distress mirroring the findings of a study conducted among army reservists in the United States [13], albeit distinguishing more specific events that are less severe, but more commonly and repeatedly experienced, such as sexual comments. These associations remained even after adjusting for a range of potential confounders, including individual as well as workforce characteristics, generally not accounted for in previous studies.
Our results support the continuum of harm framework [24, 25], endorsed by the US Department of Defense, that acknowledges all forms of aggressions rather than SA alone, in an effort to prevent SA. While the frequency of mental health sequelae was higher when forms of aggression were more severe, results also indicate that women exposed to repeated sexual comments alone had higher levels of depressive symptoms, which was not the case for men. Given the prevalence of these forms of sexual stressors, these results support the need to expand the scope of prevention programs to address verbal sexual stressors, not only as a point of prevention of SA, but also to address prevalent mental health conditions related to these forms of harassment. The benefit of these preventive measures expands beyond the sphere of mental health, as harassment and psychological conditions have sexual health implications, including on STI and sexual dysfunctions [26, 27].
Studies exploring sex-differences in psychological distress following sexual harassment report conflicting results, some suggesting no sex-differences [28, 29], while others describe stronger associations among women [30, 31], but don’t include a formal test of interaction. The present study provides evidence of gender disparities as associations between sexual stressors and psychological distress (depressive symptoms and subthreshold PTSD screening scores) were statistically stronger for women compared to men. Gender disparities in MST sequalae are likely due to differences in the nature of MST experiences, social support systems and access to healthcare [11], which were not assessed in the present study. Additional qualitative research is needed to better understand how men and women experience and cope with sexual stressors in the French military context to guide the institutional response. The need to address women’s psychological distress is pressing as they suffer the cumulative burden of being more likely to be exposed to MST, of experiencing more severe forms of MST and of suffering greater psychological sequela from these sexual stressors [11].
These results need to be interpreted with a number of limitations in mind. The MST metrics in the COSEMIL study used fewer items from the SEQ DoD [7], which were adapted to the cultural context [32] and allowed comparisons with the population-based Virage study in France [21]. Unlike the revised SEQ DoD [33], perceived severity of MST events was not investigated, although only repeated events were considered as SH. Likewise, the psychological measures used in this study are based on screening instruments which do not equate with diagnoses of mental health disorders. In addition to measurement concerns, the female sample size was small, despite oversampling of servicewomen, resulting in large confidence intervals. The cross-sectional nature of the study also prevents causal interpretation, although the study’s conclusions are mostly consistent with findings of retrospective cohort studies, in which sexual trauma precedes the onset of mental illness [34]. In addition, the cross-sectional design allows investigation of recent events (MST in the last 12 months) that are not available in retrospective administrative data, all while adjusting for workplace environment,. Finally, unobserved factors, such as other work-related traumatic events, race/ethnicity and childhood adverse events could confound or moderate the associations explored.
Despite these limitations, this study adds to the growing literature on the implications of MST on mental health outcomes in several ways. First, the multidimensional measures of sexual stressors show how common forms of sexism mostly neglected from SA prevention programs specifically affect women’s mental health, increasing the profound gender gap in mental health illness in military populations. Second, unlike most research on MST, the COSEMIL study includes a national probability sample of active-duty personnel, allowing an investigation of mental health sequalae following MST in a representative sample of service members operating in a range of military settings [8]. While a number of studies, mostly using convenience samples or administrative data have reported similar associations in the US military [6], there is little investigation of MST sequalae in other contexts, including Europe, deterring programmatic action to integrate systematic screening and treatment to reduce the health consequences of MST. The study results serve as an impetus for action beyond the US military setting.
