Understanding Suicidal Self-Directed Violence Among Men Exposed to Military Sexual Trauma: An Ecological Framework.

Men who experience military sexual trauma (MST) are at increased risk for dying by suicide, yet efforts to explain this have been limited. The present study aimed to describe men's perceptions of the impact of MST on their lives, in relation to their subsequent experiences with suicidal ideation and attempt. Semistructured interviews were conducted with 18 male veterans who experienced MST. Interview transcripts were analyzed through thematic analysis, using an abductive approach that included an ecological framework to organize results. Themes were examined in relation to post-MST suicidal ideation, suicide attempt, or neither, using a modified version of the Self-Injurious Thoughts and Behaviors Interview. Themes were noted at each ecological level. Individual-level themes included emotions (powerlessness and guardedness), coping (isolation, risky behaviors, substance use, and secrecy), and beliefs (masculinity and self-blame). Themes relating to post-MST suicidality at the other levels included actual sexual assault (MST characteristics); negative or supportive reactions from others (microsystem); institutional and cultural influences (meso-/exosystem); perceptions of victim blaming, sexualized environments, and policy (macrosystem); and childhood abuse, combat-related experiences, and homelessness (chronosystem). Our findings suggest a complex, multifaceted etiology of men's suicidal ideation and suicide attempts following MST. Ecological perspectives that consider processes at interpersonal, institutional, and cultural levels may be particularly informative for enhancing suicide prevention efforts for men who have experienced MST.