The role of contextual factors and social support on PTSD among sexual assault survivors: Findings from the Millennium Cohort Study.

Sexual assault may be especially harmful during military service, and contextual factors may influence post-assault outcomes. However, military contextual factors have not been widely examined in a large population-based military sample. This study examined whether experiencing sexual assault during military service, compared to prior to entering the military, was associated with probable PTSD, and explored contextual factors linked with PTSD. Participants were US service members who enrolled in the Millennium Cohort Study between 2020 and 2021 who self-reported sexual assault. Probable PTSD was assessed using the PTSD Checklist. Models were adjusted for the recency and frequency of assault, as well as prior trauma, including child sexual abuse and combat exposure. Logistic regression was used to estimate unadjusted and adjusted odds ratios and 95 % confidence intervals. Among 8119 participants reporting sexual assault, 4968 (61.2 %) experienced assault during military service. Prevalence of probable PTSD was higher among those assaulted during service (31.4 %) compared with those assaulted as civilians (19.9 %). Contextual factors associated with higher odds of probable PTSD included assaults that occurred at military schools or temporary duty stations, by a spouse or significant other, and by someone in the same command or of higher rank. Perceived social support from friends, family, and the military was associated with lower likelihood of probable PTSD. These findings highlight how some contextual factors may increase PTSD risk and underscore the protective role of social support. Results may help inform both prevention and response strategies within military settings.