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Some people, I believe, will never go unless they are referred to go by their command. They’ve either been in the Army too long, or they themselves see it as a weak gesture to go. They personally will never go get mental health [treatment], regardless of what’s happened in their life or on deployment, they will not go get help” (--study participant, Zinzow et al., 2013).
History of sexual trauma is common among military personnel, with over one-third of female service members and veterans reporting lifetime history of sexual assault (Zinzow, Grubaugh, Monnier, Suffoletta-Maierle, & Frueh, 2007). Sexual trauma is associated with a variety of mental health problems, including posttraumatic stress disorder, depression, and substance use (Kilpatrick, Resnick, Ruggiero, Conoscenti, & McCauley, 2007; Zinzow et al., 2012). Despite significant treatment needs, only a minority of sexual assault victims seek mental health treatment. For military personnel who have been sexually assaulted, stigma and fear of repercussions if the assault is disclosed could keep the service member from getting the help they might need.

These concerns have led researchers to ask questions about what factors influence treatment-seeking behavior among sexual assault victims. Armed with this knowledge, programming can be designed to improve help-seeking and wellness among service members who have experienced traumatic events. These programs can have a potential positive impact on unit cohesion and readiness, with an overall reduction in mental health problems.

With these questions in mind, our research team sought to identify the factors associated with mental health service use in a sample of 927 Army soldiers who reported current mental health problems (Zinzow et al., in press). In this study, we specifically focused on the 113 soldiers with sexual assault histories.  We found that one-third of sexual assault victims did not seek treatment, and of those who sought treatment, one-third dropped out before completion. Why? The most frequently reported barriers to care included concerns about being treated differently by others, negative beliefs about medications, and logistical issues. In particular, self-reliance, or a desire to take care of problems on one’s own, was significantly associated with a lower likelihood of seeking treatment. These perceptions can be encouraged by a military culture that emphasizes the need to “tough out” distressing emotions in order to accomplish unit missions (Zinzow et al., 2013). Although we were expecting that influences on help-seeking might be different for soldiers who had been sexually assaulted than for those who had not been assaulted, we found no differences between the groups.

Factors that were associated with an increased likelihood of treatment-seeking included positive beliefs about treatment and being encouraged by others to seek treatment. Even though it might seem like those who had more severe mental health symptoms would be more likely to seek treatment for them, surprisingly, symptom severity did not affect treatment seeking. This suggests that soldiers may not recognize when their symptoms warrant medical attention. Our research with soldiers indicates that they often wait until symptoms are severe before seeking treatment (Zinzow et al., 2013).

More sexual assault victims with mental health problems sought informal support for their problems than sought professional mental health treatment. Although these findings point to soldiers’ reluctance to seek out formal intervention, they also highlight the important role of family and friends in providing support. It is therefore critical to educate family, friends, and unit members on how to recognize mental health symptoms and how to encourage treatment-seeking among those who could benefit.

Based on these findings, we have several suggestions for anyone trying to lower the barriers to mental health care for soldiers. Given similarities between sexual assault victims and non-victims, these suggestions apply to soldiers needing treatment for a variety of mental health issues. First, educational programs should focus on how soldiers can recognize the need for treatment, either in themselves or in others. Second, the benefits of treatment should be explained. Third, it is particularly important to challenge the belief that soldiers should handle mental health problems without assistance. Emphasizing the benefits of early risk recognition, as well as addressing the negative stereotypes of behavioral health interventions, could help shift this thinking. Finally, the support of unit members, leaders, and significant others should be enlisted.

In line with these recommendations, we have developed and evaluated a training program to facilitate treatment-seeking in active duty soldiers. This program focused on improving knowledge of mental health treatment, decreasing stigma, and improving unit support for treatment-seeking. We used video testimonials from soldiers who successfully sought treatment and from providers who described the treatment process. Interactive exercises identified treatment benefits, provided information regarding when to seek treatment, and challenged negative beliefs about treatment-seeking.

Preliminary findings suggest that the program led to an immediate improvement in attitudes towards mental health treatment. We also found that the training led to an increase in supportive behaviors towards soldiers with mental health concerns in the three months following the program (Britt et al., in progress).  Such programs can help prevent chronic health conditions in military personnel with trauma histories, and thus improve the readiness of their units. 

Discussion Questions

  1. Why don’t soldiers with sexual assault histories seek mental health treatment?
  2. What can be done to encourage help-seeking in this population?

JTS Reference Article:
Zinzow, H. M., Britt, T. W., Pury, C. L., Jennings, K., Cheung, J. H., & Raymond, M. A. (2015). Barriers and Facilitators of Mental Health Treatment‐Seeking in US Active Duty Soldiers With Sexual Assault Histories. Journal of traumatic stress, 28(4), 289-297.

About the Author:

Zinzow-faculty-photo4.jpgDr. Heidi Zinzow is an Associate Professor of Psychology and Licensed Clinical Psychologist at Clemson University. She conducts research on risk factors for trauma-related mental health problems. She also evaluates clinical interventions and prevention strategies for trauma victims, with particular emphasis on sexual violence and military populations.


Britt, T., Pury, C., & Zinzow, H. (in preparation). The effects of unit training to increase support for mental health treatment seeking in active duty soldiers. 

Kilpatrick, D. G., Resnick, H. S., Ruggiero, K. J., Conoscenti, L. M., & McCauley, J. (2007). Drug-facilitated, incapacitated, and forcible rape: A national study. Charleston, SC: Medical University of South Carolina, National Crime Victims Research & Treatment Center.

Zinzow, H. M., Britt, T. W., Pury, C. L., Jennings, K., Cheung, J. H., & Raymond, M. A. (2015). Barriers and Facilitators of Mental Health Treatment‐Seeking in US Active Duty Soldiers With Sexual Assault Histories. Journal of traumatic stress, 28(4), 289-297.

Zinzow, H., Britt, T., Pury, C., Raymond, M. A., McFadden, A., & Burnette, C. (2013). Barriers and facilitators of mental health treatment seeking among active-duty army personnel. Military Psychology, 25, 514-535. doi: 10.1037/mil0000015

Zinzow, H., Grubaugh, A., Monnier, J., Suffoletta-Maierle, S., & Frueh, B.C. (2007). Trauma among female veterans: A critical review. Trauma, Violence, & Abuse, 8(4), 384-400.
Zinzow, H., Resnick, H., Amstadter, A., & McCauley, M., Ruggiero, K., & Kilpatrick, D. (2012). Prevalence and risk of psychiatric disorders as a function of variant rape histories: Results from a national survey of women. Social Psychiatry and Psychiatric Epidemiology, 47, 893-902. DOI: 10.1007/s00127-011-0397-1