A Moderated Mediation Model of Gender, Posttraumatic Cognitions, and Posttraumatic Stress Disorder Symptoms After Military Sexual Assault

Military sexual assault (MSA) is associated with the greatest risk for posttraumatic stress disorder (PTSD) and PTSD severity beyond other trauma types. Sexual revictimization further increases this risk and severity. However, not all who experience MSA revictimization develop PTSD. This suggests there may be a key mechanism that explains the association between MSA and PTSD. Posttraumatic cognitions (PTC), which include an overall domain and subdomains of self, world, and self-blame, may be one such mechanism between MSA and PTSD, although this link has not yet been examined in the context of MSA revictimization. Further, literature suggests that men and women may have different risks associated with MSA, PTC, and PTSD, though the evidence is mixed, perhaps due to conflation of trauma types. The current study tested separate models to assess if posttraumatic cognitions explained the association between sexual revictimization and PTSD symptom severity, and if these associations looked different between genders. Revictimization was defined across time periods, including MSA only and premilitary + MSA, and in military rape frequency. Participants were 400 (n = 200 male, 50%) service members and veterans who completed online, anonymous, self-report questionnaires and reported a history of MSA. A significant interaction of gender suggested that women with a revictimization history had a larger increase in PTC overall and about the self compared to men with revictimization history, and men with PTC about self-blame had a larger increase in PTSD symptoms compared to women. There were no unique gender interactions when assessing revictimization by rape frequency, although PTC (overall, subdomains) significantly mediated the association between rape frequency and PTSD symptom severity. PTC may be a beneficial target when treating PTSD in men, and may be especially heightened in women who have experienced revictimization