An Examination of Stalking Experiences During Military Service Among Female and Male Veterans and Associations With PTSD and Depression

Abstract

Stalking is associated with mental health concerns, although little is known about the influence of stalking and mental health concerns among veterans. This study evaluated stalking experienced during military service in two community-based, nonclinical samples of veterans (N = 1,980). Models explored (a) types of stalking, (b) characteristics of veterans who experienced stalking, and (c) the associations between stalking with posttraumatic stress disorder (PTSD) and depression. Types of stalking varied by sex; female veterans were significantly more likely to experience stalking than male veterans (58.5% vs. 34.6%, p < .001, respectively). Female veterans reported unwanted messages, emails, or phone calls (37.2%), and male veterans experienced someone showing up unannounced or uninvited (23.5%) most frequently. Stalking experiences also differed by age with female and male veterans 18 to 39 years old significantly more likely to have experienced stalking (p < .001 and p < .001, respectively) than veterans over age 40. Associations between prior stalking experiences and mental distress were found for both female and male veterans. Both female and male veterans who experienced stalking were significantly more likely to have probable PTSD (odds ratio [OR] = 1.88, 95% confidence interval [CI] = [1.04, 3.39] and OR = 3.08, 95% CI = [2.27, 4.18], respectively) and depression (OR = 2.54, 95% CI = [1.38, 4.58] and OR = 2.78, 95% CI = [2.05, 3.79], respectively). These findings highlight (a) the rates of stalking experienced during military service, (b) the need for assessment of stalking to inform treatment, and (c) lay the foundation for the Department of Defense (DoD) to further evaluate stalking among military populations.

Keywords

depression PTSD stalking veterans

Veterans experience potentially traumatizing events while serving in the military, including military sexual trauma (Kimerling et al., 2007, 2010; Schuyler et al., 2017). Military sexual trauma is defined by the Department of Defense (DoD) as sexual harassment or sexual assault experienced while serving in the military (Kimerling et al., 2007, 2010). Stalking does not inherently imply a sexual motivation, but it has been recognized as a behavior connected to sexual assault, through its inclusion in military law, that is, the Uniform Code of Military Justice (UCMJ; article 120a; UCMJ, 2006, 2019). Although previously included in the UCMJ, until recently, stalking was not a focus of the DoD. Therefore, stalking experiences have been underevaluated among veterans. Because of this, this research sought to better understand experiences of stalking during military service, and the associations of those experiences on the mental health of veterans.

Defining Stalking

Despite being a part of the literature for more than 20 years (Spitzberg & Cupach, 2003), there is no globally agreed-upon definition of stalking (Mester et al., 2006), with legal definitions varying throughout the United States (Tjaden, 2009). The National Institute of Justice (n.d.) provides the following definition of stalking, “a course of conduct directed at a specific person that involves repeated (two or more occasions) visual or physical proximity, nonconsensual communication, or verbal, written, or implied threats, or a combination thereof, that would cause a reasonable person fear.” In the military, the UCMJ was recently updated to include stalking as a separate article (article 130), separating stalking from rape and carnal knowledge (article 120; UCMJ, 2006, 2019). The current UCMJ defines stalking as involving repeated proximity or verbal or written threats that place an individual in reasonable fear of death or bodily harm (UCMJ, 2019). The UCMJ definition is similar to previously discussed definitions as it includes unwanted and repeated behaviors that cause reasonable fear.

In line with legal definitions of stalking, the presence of experiencing fear is a common inclusion criterion of stalking in the research literature (Purcell et al., 2012). However, some scholars have argued that the presence of stalking should be defined by victims of stalking, and not be solely reliant on the interpretation of the presence of fear by others (Dietz & Martin, 2007; McKeon et al., 2015; Podaná & Imríšková, 2016). Also, as stalking requires repetitive stalking behaviors (Hamid & Maple, 2013; Lyndon et al., 2011; Podaná & Imríšková, 2016; UCMJ, 2006) the acts are more likely to be disruptive and, therefore, have the potential to cause reasonable fear, but may not meet the required threshold for reporting or experiencing fear. When the definition of stalking requires a victim to express that they felt “fearful,” it creates a threshold for the crime that excludes victims that had negative experiences that otherwise meet the criteria of stalking, but did not cause fear (Dietz & Martin, 2007). Therefore, experiences of stalking may go underreported, and barriers to accessing care may increase for victims seeking support.

Rates of Stalking

The current literature highlights stalking among both civilian and military populations. Among females, reported rates of stalking range from 8% to 19% during a lifetime among civilians (Black & Merrick, 2013; Menard & Cox, 2016; Smith et al., 2018), 1% to 11% among active-duty members while serving in the military (Black & Merrick, 2013; Cook et al., 2015), and 35% among veterans during a lifetime (Dardis, Amoroso, & Iverson, 2017). Among males, rates of stalking range from 2% to 6% among civilians during a lifetime, 1% to 2% among active-duty members while serving in the military, and 4% of veterans while serving in the military and 15% during a lifetime, highlighting males are less likely to report stalking than their female counterparts (Clancy et al., 2006; Cook et al., 2015; Smith et al., 2018). There is evidence that the reported rate of stalking during military service among male veterans (Clancy et al., 2006) is double that of male active-duty service members (Cook et al., 2015). These discrepancies may indicate that while active-duty service members experience stalking, it is underreported. Lack of disclosure until that member has separated from the armed services delays instrumental and emotional support that can reduce long-term mental distress associated with stalking experiences.

Associations Between Stalking and Mental Health

There is limited research on the stalking experiences of military populations, as stalking is often evaluated as a form of intimate partner violence (IPV) and evaluated in combination with other types of violence, making it difficult to discern the experience of stalking only (Campbell et al., 2003; Dardis, Shipherd, & Iverson, 2017; Sparrow et al., 2017). Thus, little is known about the impact of stalking on mental and physical health. The literature on stalking in military populations has focused on rates of (a) stalking experiences among individuals attending military academies (Cook et al., 2015), (b) intimate partner stalking among female veterans and posttraumatic stress disorder (PTSD; Dardis, Amoroso, & Iverson, 2017; Dardis, Shipherd, & Iverson, 2017), and (c) stalking experiences among male veterans (Clancy et al., 2006). Among active-duty members, 1% to 9% of females and 1% to 2% of males at military academies report having experienced stalking (Cook et al., 2015). In a study of female veterans, the presence of IPV-related stalking was significantly associated with PTSD (Dardis, Amoroso, & Iverson, 2017). Finally, while Clancy and colleagues (2006) report stalking among male veterans, the influence of stalking on mental or physical health has not been evaluated.

Although less is known about military populations, the presence of stalking has been found to negatively affect the mental and physical health of civilian populations. Among female and male civilians, the experience of stalking was significantly associated with anxiety, depression, PTSD, appetite disturbance, and headaches (Kuehner et al., 2012). Similar findings are also supported by studies on female civilians, which found associations between stalking and PTSD, depression, chronic mental illness, and somatization (Basile et al., 2004; Davis et al., 2002). As less is known about military populations’ experiences of stalking while serving in the military, it is important to not only highlight reported rates, but add to the literature and evaluate associations with mental health.

Current Study

This is the first identified study to examine stalking experiences during military service, retrospectively reported by veterans. The retrospective approach allows for the entire career to be included, allowing for all military stalking experiences to be captured. As little is known about stalking experiences during military service, this study will expand the literature by exploring (a) reported types of stalking behaviors and (b) demographic and military-related variables associated with stalking experiences and evaluating (c) associations between stalking experienced while in the military and current mental health among female and male veterans. As the presence of stalking has been found to negatively affect the mental health of civilian populations, it was expected the same would be found among this veteran population. It was also expected that female veterans would experience more stalking experiences than male veterans. Finally, as stalking is a more recent focus of the DoD (UCMJ, 2019), this study will elucidate historical rates and potential negative mental health outcomes among veterans.

Method

Participants and Procedure

Data used for this study were drawn from two community-based, nonclinical studies involving veterans (N = 1,980; Castro & Kintzle, 2017; Kintzle, Rasheed, & Castro, 2016). Both parent studies used convenience sampling strategies to reach out to the veteran populations in Chicago and San Francisco. The primary sampling strategy involved partnering with area agencies serving veterans. Two methods were used to collect agency data: (a) invitations to veterans with a link to take the survey online and (b) on-the-ground data collection events. Other sampling strategies included print advertisements and social media to build a presence in both Chicago and San Francisco (including use of Facebook, Twitter, LinkedIn, and mass emails). Participants were eligible to participate in the survey if they were 18 years or older, had served in the military, were not currently serving in the military, and lived in the greater Chicago or San Francisco area. All participants received a $15 gift card for completing the survey, which took 30 to 90 min. All data collection procedures were approved by the Institutional Review Board at the University of Southern California.

Participants selected for inclusion in this study were individuals who responded to the stalking questions (87.5%; n = 1,733).

Measures

Demographic information and military-related variables

Demographic data collected included age (collected as a continuous, recoded as a categorical, variable: 18–39 years, 40–59 years, or 60+ years), race/ethnicity (non-Hispanic White, Black, or African American, Hispanic, or Latino, and Other), sexual orientation (dichotomized as heterosexual vs. lesbian, gay, or bisexual [LGB]), and level of education (some high school/General Equivalency Diploma [GED]/high school diploma, some college or associate degree, bachelor’s degree, or master’s/doctoral degree). For these analyses, we included one family/partner-level variable, marital status (dichotomized as single, divorced, separated, or widowed vs. married, in a domestic partnership, or in a long-term relationship). We used five variables related to military service: (a) service branch (Air Force, Army, Coast Guard, Marine Corps, or Navy), (b) service era (before vs. after September 11, 2001), (c) rank (coded as E1–E4, E5–E7, E8–E9, or W1–W4, and O1–O10), (d) deployment (ever deployed: yes vs. no), and (e) experienced military sexual assault (yes vs. no). Deployment and military sexual assault were included as control variables as they are known risk factors for PTSD and depression (Hoge et al., 2004; Schuyler et al., 2017).

Assessment of stalking during military service

Stalking was assessed with four questions based on a review of the UCMJ (2006) and the Loveisrespect (2013) website due to its focus on ending abuse and use of common, everyday language. Questions were purposely asked directly after sexual harassment and gender discrimination questions, helping to establish them as unwanted behaviors and part of military-related sexual trauma. Questions were behaviorally based; they did not require fear as a requirement of reporting a stalking experience. Survey instructions stated, “The next set of questions asks about experiences of stalking that you encountered during your military service. These behaviors could have occurred on- or off-duty, and on- or off-base. Please indicate how often you experienced stalking during your military service:” (a) “someone showing up at your home or workplace unannounced or uninvited”; (b) “someone following you or waiting for you at places”; (c) “someone sending you unwanted messages, emails, or phone calls”; and (d) “someone using social media to track or follow you” (Loveisrespect, 2013; UCMJ, 2006). Participants were asked how many times each type of stalking occurred, all types of stalking were combined together, and responses were dichotomized: no stalking (0–1 times) and stalking (2 or more times) to represent the repetitiveness component within the definition of stalking (Hamid & Maple, 2013; Podaná & Imríšková, 2016).

Assessment of probable PTSD

Probable PTSD was measured by the 20-item PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V; PCL-5; Blevins et al., 2015). The measure asks participants to rate how much they were affected by exposure to a stressful event (0 = Not at all to 4 = Extremely), using items such as, “In the past month, how much were you bothered by repeated, disturbing, and unwanted memories of the stressful event?” Scores range from 0 to 80, and a clinical cutoff score of 33 was used to indicate probable PTSD (Weathers et al., 2013). As the PCL-5 was utilized without a clinical interview, it is unknown if participants had clinical PTSD; therefore, probable PTSD is used. In this study, Cronbach’s alpha was .97.

Assessment of probable depression

Probable depression was measured using the 9-item Patient Health Questionnaire (PHQ-9; Spitzer et al., 1999). This measure consists of items that assess how often a person has been bothered by depression symptoms (0 = Not at all to 3 = Nearly every day) during the last 2 weeks, such as “feeling down, depressed, or hopeless.” Scores range from 0 to 27, and a clinical cutoff score of 10 was used to indicate probable moderate to severe depression (Kroenke et al., 2001). As the PHQ-9 was utilized without a clinical interview, it is unknown if participants had clinical depression; therefore, probable depression is used. In this study, Cronbach’s alpha was .93.

Data Analysis

Descriptive statistics and logistic regression analyses were carried out in SAS 9.4. First, a correlation matrix was used to examine collinearity (Table 1). Because service era was significantly correlated (greater than .40) with both age and deployment, it was removed from further analysis. All other demographic variables were maintained. Next, we explored associations between demographic characteristics and experiences of stalking among female and male veterans and looked at differences within and between female and male veterans. Statistically significant demographic variables for each sex were included as confounding variables in the logistic regression models. Four logistic regression models were conducted with stalking as the independent variable: (a) female veterans’ experience of stalking and association with PTSD, (b) female veterans’ experience of stalking and association with depression, (c) male veterans’ experience of stalking and association with PTSD, and (d) male veterans’ experience of stalking and association with depression.

Table 1.

Correlations of Variables Among Female and Male Veterans.

Variables	1	2	3	4	5	6	7	8	9	10	11	12	13
1. Age	—	−.05	.11	.12	.04	−.08	–.50	–.29	.25	−.11	−.21	−.06	–.13
2. Race/ethnicity	–.06	—	–.19	.00	.07	.09	.10	.00	.07	.00	.05	.00	.02
3. Sexual orientation	.03	.00	—	.11	–.13	−.07	−.10	–.12	.15	–.17	–.17	–.17	–.18
4. Education	.03	.06	.05	—	−.03	.04	.01	.01	.39	.01	–.13	–.19	–.23
5. Marital	.22	.02	.02	.00	—	−.06	−.04	.00	.03	−.02	.03	.07	.09
6. Branch	−.04	.10	.10	−.06	.00	—	.10	.08	.05	.08	.03	.03	−.07
7. Era	–.73	.05	.05	.00	–.16	.00	—	.43	.15	−.02	−.05	.00	.05
8. Deployment	–.15	.04	.04	.11	−.01	.16	.25	—	.07	.06	.02	.19	.16
9. Rank	.05	.02	.02	.36	.04	–.07	.13	.21	—	−.05	−.04	–.13	–.18
10. Military sexual assault	–.31	−.05	–.10	.04	−.05	–.06	.23	.09	.02	—	.35	.28	.19
11. Stalking	–.28	−.02	−.03	.02	−.01	–.06	.28	.09	.04	.48	—	.26	.27
12. Probable PTSD	–.33	–.06	−.02	–.11	.01	–.06	.26	.12	–.07	.41	.41	—	.61
13. Depression	–.39	–.07	−.02	–.11	.02	–.06	.31	.13	−.05	.43	.42	.67	—

Note. Correlations reported for female veterans in top, right quadrant and male veterans in bottom, left quadrant. Figures in bold are statistically significant at p < .05. PTSD = posttraumatic stress disorder.

Results

Demographic characteristics and trauma experiences of the sample are presented in Table 2. Veterans were more likely to be male (84.1%) and reported primarily having served in the Army (52.8%). Participants were primarily those enlisted in the military at the most junior level (E1–E4) with regard to rank (47.3%). Stalking while in the military was reported by 38.4% of veterans. Reported clinical levels of PTSD were 39.1% and reported clinical levels of depression were 37.9% among veterans.

Table 2.

Sample Characteristics and Trauma Experiences of Female and Male Veterans.

Characteristics	Total	Female Veterans	Male Veterans
	N (%)	n (%)	n (%)
	1,980 (100.0)	315 (15.9)	1,665 (84.1)
Age (n = 1,977)
18–39	718 (36.2)	159 (50.5)	559 (33.6)
40–59	571 (28.9)	128 (40.6)	443 (26.7)
60+	688 (34.8)	28 (8.9)	660 (39.7)
Race/ethnicity (n = 1,976)
Non-Hispanic White	1,233 (62.4)	145 (46.0)	1,088 (65.5)
Black or African American	326 (16.5)	88 (27.9)	238 (14.3)
Latino or Hispanic	232 (11.7)	39 (12.4)	193 (11.6)
Other	185 (9.4)	43 (13.7)	142 (8.6)
Sexual orientation (n = 1,961)
Heterosexual	1,648 (84.0)	262 (83.7)	1,584 (96.1)
Lesbian, gay, or bisexual	313 (16.0)	51 (16.3)	64 (3.9)
Education (n = 1,950)
Some HS, GED, HS diploma	258 (13.2)	27 (8.7)	231 (14.1)
Some college or associate degree	731 (37.5)	136 (43.7)	595 (36.3)
Bachelor’s degree	526 (27.0)	78 (25.1)	448 (27.3)
Master’s or doctoral degree	435 (22.3)	70 (22.5)	365 (22.3)
Marital status (n = 1,980)
Single, divorced, separated, or widowed	806 (40.7)	181 (57.5)	625 (37.5)
Married, domestic partnership, or long-term relationship	1,174 (59.3)	134 (42.5)	1,040 (62.5)
Service branch (n = 1,960)
Air Force	243 (12.4)	52 (16.7)	191 (11.6)
Army	1,034 (52.8)	155 (49.7)	879 (53.3)
Coast Guard	45 (2.3)	14 (4.5)	31 (1.9)
Marine Corps	272 (13.9)	23 (7.4)	249 (15.1)
Navy	366 (18.7)	68 (21.8)	298 (18.1)
Rank (n = 1,912)
E1–E4	905 (47.3)	161 (52.1)	744 (46.4)
E5–E7	589 (30.8)	93 (31.1)	496 (30.9)
E8–E9 or W1–W5	128 (6.7)	16 (5.2)	112 (7.0)
O1–O10	290 (15.2)	39 (12.6)	251 (15.7)
Trauma Experiences
Deployment (n = 1,950)	1,495 (76.7)	214 (68.6)	1,281 (78.2)
Military sexual assault (n = 1,649)	351 (21.3)	120 (44.6)	234 (17.0)
Stalking (n = 1,733)	666 (38.4)	162 (58.5)	504 (34.6)
Mental Health
Probable PTSD (n = 1,738)	679 (39.1)	141 (50.7)	538 (36.9)
Probable depression (n = 1,741)	660 (37.9)	130 (46.8)	530 (36.2)

Note. PTSD measured using the 20-item PTSD Checklist for the DSM-5 with a cutoff of 33 (Weathers et al., 2013). Depression measured using the 9-item Patient Health Questionnaire with a cutoff score of 10 (Kroenke et al., 2001). PTSD = posttraumatic stress disorder; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders (5th ed.); HS = high school; GED = General Equivalency Diploma.

Stalking Experiences Among Female and Male Veterans

Rates of individual stalking experiences were reported by sex (Table 3). The most prevalent type of stalking experienced by female veterans was receiving unwanted messages, emails, or phone calls (37.2%); male veterans most frequently experienced someone showing up unannounced or uninvited (23.5%). Combinations of the four stalking behaviors (i.e., those occurring two or more times) were also evaluated to highlight more than one type of stalking was experienced by female (14.3%–24.1%) and male (9.0%–14.9%) veterans.

Table 3.

Rates of Stalking Experiences and Combinations of Stalking Experiences Among Female and Male Veterans.

Female Veterans and Male Veterans	Unannounced or Uninvited	Following or Waiting	Message, Email, or Phone	Social Media
Female Veterans and Male Veterans	n (%)	n (%)	n (%)	n (%)
Female Veterans (n = 277)
Two or more times (stalking)	79 (23.5)	65 (29.0)	103 (37.2)	63 (24.8)
Combination of stalking experiences
Following or waiting	48 (24.1)
Message, email, or phone	46 (22.2)	47 (22.9)
Social media	36 (16.7)	30 (14.3)	54 (23.5)
Male Veterans (n = 1,460)
Two or more times (stalking)	343 (23.5)	194 (13.3)	261 (17.9)	223 (15.3)
Combination of stalking experiences
Following or waiting	144 (12.2)
Message, email, or phone	181 (14.9)	125 (10.2)
Social media	164 (13.3)	111 (9.0)	154 (12.0)

Stalking experiences of female veterans

Chi-square and Fisher’s exact test analyses were conducted to identify variables significantly associated with stalking among female and male veterans (Table 4). As compared with those who did not experience stalking, female veterans who reported experiencing stalking were younger (18–39 years; 57.4% vs. 34.8%; χ²[2] = 15.41, p < .001), non-Hispanic White (53.1% vs. 39.1%; χ²[3] = 10.81, p < .05), and self-identified as lesbian or bisexual (23.1% vs. 8.7%; χ²[1] = 9.83, p < .01). Those who reported having experienced stalking were significantly more likely to report having experienced military sexual assault (57.0% vs. 24.3%; χ²[1] = 28.31, p < .001).

Table 4.

Characteristics of Female and Male Veterans With and Without Stalking.

Characteristics	Stalking		No Stalking		Female Veterans (Stalking vs. No)	Male Veterans (Stalking vs. No)	Female vs. Male (Stalking)
	Female Veterans	Male Veterans	Female Veterans	Male Veterans	Female Veterans (Stalking vs. No)	Male Veterans (Stalking vs. No)	Female vs. Male (Stalking)
	n (%)162 (58.5)	n (%)504 (34.6)	n (%)115 (41.5)	n (%)952 (65.4)	χ² (df) or Fisher’s exact	χ² (df)	χ² (df)
Experienced stalking							57.61 (1)***
Age					15.41 (2)***	240.52 (2)***	12.12 (2)**
18–39	93 (57.4)	292 (57.9)	40 (34.8)	205 (21.5)
40–59	59 (36.4)	134 (26.6)	58 (50.4)	250 (26.3)
60+	10 (6.2)	78 (15.5)	17 (14.8)	497 (52.2)
Race/ethnicity					10.81 (3)*	24.23 (3)***	4.87 (3)
Non-Hispanic White	86 (53.1)	288 (57.3)	45 (39.1)	660 (69.4)
Black or African American	31 (19.1)	86 (17.1)	42 (36.5)	128 (13.5)
Latino or Hispanic	20 (12.4)	79 (15.7)	13 (11.3)	87 (9.2)
Other	25 (15.4)	50 (9.9)	15 (13.0)	76 (8.0)
Sexual orientation					9.83 (1)**	1.20 (1)	45.37 (1)***
Heterosexual	123 (76.9)	476 (94.8)	105 (91.3)	902 (96.1)
Lesbian, gay, or bisexual	37 (23.1)	26 (5.2)	10 (8.7)	37 (3.9)
Education					4.27 (3)	2.23 (3)	7.85 (3)*
Some HS, GED, HS	17 (10.6)	60 (12.0)	7 (6.2)	134 (14.3)
Some college or AA	76 (47.2)	180 (36.1)	45 (39.8)	338 (36.2)
Bachelor’s	33 (20.5)	148 (30.0)	31 (27.4)	251 (26.8)
Master’s or doctoral	35 (21.7)	111 (22.2)	30 (26.6)	212 (22.7)
Marital status					1.06 (1)	0.82 (1)	28.51 (1)***
Single	96 (59.3)	179 (35.5)	61 (53.0)	361 (37.9)
Married	66 (40.7)	325 (64.5)	54 (47.0)	591 (62.1)
Service branch					^a	30.54 (4)***	12.38 (4)*
Air Force	24 (14.8)	57 (11.3)	22 (19.1)	116 (12.2)
Army	80 (49.4)	283 (56.2)	58 (50.4)	496 (52.1)
Coast Guard	11 (6.8)	22 (4.4)	3 (2.6)	8 (0.8)
Marine Corps	13 (8.0)	74 (14.7)	5 (4.4)	135 (14.2)
Navy	34 (21.0)	68 (13.5)	27 (23.5)	197 (20.7)
Rank					^a **	64.85 (3)***	7.86 (3)*
E1–E4	86 (53.1)	212 (42.4)	59 (51.3)	455 (48.2)
E5–E7	45 (27.8)	142 (28.4)	35 (30.4)	292 (30.9)
E8–E9 or W1–W5	15 (9.3)	76 (15.2)	1 (0.9)	33 (3.5)
O1–O10	16 (9.9)	70 (14.0)	20 (17.4)	165 (17.5)
Trauma Experiences
Deployment (Yes)	111 (68.5)	421 (83.7)	76 (66.1)	719 (75.8)	0.18 (1)	12.04 (1)***	17.65 (1)***
MSA (Yes)	90 (57.0)	203 (41.8)	27 (24.3)	31 (3.5)	28.31 (1)***	326.48 (1)***	11.10 (1)***
Probable PTSD (Yes)	100 (62.1)	317 (64.7)	40 (35.1)	209 (22.5)	19.50 (1)***	245.30 (1)***	0.35 (1)
Probable depression (Yes)	94 (58.4)	324 (65.5)	34 (29.8)	198 (21.4)	21.88 (1)***	270.06 (1)***	2.63 (1)

Note. PTSD measured using the PCL-5 with a clinical cutoff of 33 (Weathers et al., 2013). Depression measured using the PHQ-9 with a clinical cutoff of 10 (Kroenke et al., 2001). PTSD = posttraumatic stress disorder; PCL-5 = PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.); PHQ-9 = 9-item Patient Health Questionnaire; HS = high school; GED = General Equivalency Diploma; AA = Associate; Single = single, divorced, separated, or widowed; Married = married, domestic partnership, or long-term; MSA = military sexual assault.

Fisher’s exact test.

p < .05. **p < .01. ***p < .001.

Stalking experiences of male veterans

Younger male veterans were also more likely to have experienced stalking (57.9% vs. 26.6% and 15.5%; χ²[2] = 240.52, p < .001). Male veterans who ended their careers at the most senior levels (E8–E9 or W1–W5) were also significantly more likely to have experienced stalking (E8–E9 or W1–W5; 15.2% vs. 3.5%; χ²[3] = 64.85, p < .001; Table 4). Those who experienced stalking were also significantly more likely to have experienced military sexual assault (41.8% vs. 3.5%; χ²[1] = 326.48, p < .001).

Stalking experiences: Comparing female and male veterans

Among veterans who experienced stalking, we explored differences in characteristics by sex. Female veterans were significantly more likely to report stalking experiences than male veterans (58.5% vs. 34.6%; χ²[2] = 57.61, p < .001; Table 4). Having experienced both stalking and military sexual assault was significantly more likely among female, as compared with male veterans (57.0% vs. 41.8%; χ²[1] = 11.10, p < .001).

Stalking Experiences and Associations With PTSD and Depression

Stalking experiences were significantly associated with both probable PTSD and depression among female veterans (Table 5). After adjusting for statistically significant confounding variables (age, race/ethnicity, sexual orientation, rank, and experience of military sexual assault), female veterans who experienced stalking were significantly more likely to have probable PTSD (odds ratio [OR] = 1.88; 95% confidence interval [CI] = [1.04, 3.39]; R² = .225) and probable depression (OR = 2.54; 95% CI = [1.38, 4.58]; R² = .222) than those who did not. In regard to confounding variables (separate from stalking experiences), among female veterans, Black or African American participants were significantly less likely to have probable PTSD (OR = 0.49; 95% CI = [0.25, 0.97]) and probable depression (OR = 0.49; 95% CI = [0.25, 0.98]). Also, officers in all ranks (O1–O10) were significantly less likely to have probable PTSD (OR = 0.35; 95% CI = [0.14, 0.89]) and probable depression (OR = 0.19; 95% CI = [0.07, 0.53]) when compared with enlisted female veterans who ended their military careers at the most junior levels, E1–E4. In regard to confounding variables (separate from stalking experiences), female veterans who experienced military sexual assault were significantly more likely to have probable PTSD (OR = 2.20; 95% CI = [1.25, 3.89]) compared with those who did not.

Table 5.

Stalking, Probable PTSD, and Probable Depression Among Female and Male Veterans.

	Probable PTSD		Probable Depression
	OR	95% CI	OR	95% CI
Female Veterans
Stalking (Ref, No stalking)	1.88*	[1.04, 3.39]	2.51**	[1.38, 4.58]
Age (Ref, 18–39)
40–59	1.64	[0.90. 2.98]	1.29	[0.70, 2.35]
60+	1.00	[0.34. 3.00]	1.63	[0.54, 4.92]
Race/ethnicity (Ref, Non-Hispanic White)
Black or African American	0.49*	[0.25, 0.97]	0.49*	[0.25, 0.98]
Latino or Hispanic	0.82	[0.34, 1.98]	1.07	[0.44, 2.59]
Other	1.11	[0.50, 2.50]	1.12	[0.50, 2.50]
Rank (Ref, E1–E4)
E5–E7	0.71	[0.39, 1.29]	0.58	[0.32, 1.08]
E8–E9 or W1–W5	2.89	[0.71, 11.80]	1.00	[0.31, 3.23]
O1–O10	0.35*	[0.14, 0.89]	0.19**	[0.07, 0.53]
Sexual orientation (Ref, LGB)
Heterosexual	0.52	[0.25, 1.12]	0.58	[0.27, 0.23]
MSA (Ref, No MSA)	2.20**	[1.25, 3.89]	1.59	[0.90, 2.82]
Adjusted R²	.225		.222
Male Veterans
Stalking (Ref, No stalking)	3.08***	[2.27, 4.18]	2.78***	[2.05, 3.79]
Age (Ref, 18–39)
40–59	1.10	[0.74, 1.54]	0.73	[0.52, 1.02]
60+	0.33***	[0.23, 0.47]	0.18***	[0.12, 0.26]
Race/ethnicity (Ref, Non-Hispanic White)
Black or African American	1.20	[0.93, 2.04]	1.23	[0.83, 1.84]
Latino or Hispanic	0.76	[0.49, 1.17]	0.88	[0.57, 1.36]
Other	1.20	[0.75, 1.91]	1.01	[0.63, 1.62]
Branch (Ref, Air Force)
Army	1.48	[0.94, 2.33]	1.49	[0.92, 2.41]
Coast Guard	2.85	[0.85, 9.53]	2.71	[0.81, 9.07]
Marine Corps	1.20	[0.70, 2.08]	1.04	[0.58, 1.84]
Navy	0.70	[0.41, 1.20]	1.01	[0.58, 1.75]
Rank (Ref, E1–E4)
E5–E7	0.94	[0.69, 1.30]	0.93	[0.67, 1.28]
E8–E9 or W1–W5	0.51*	[0.30, 0.88]	2.12***	[1.21, 3.71]
O1–O10	0.49*	[0.32, 0.75]	0.43***	[0.28, 0.68]
Deployed (Ref, Not deployed)	2.07***	[1.42, 3.02]	1.82**	[1.25. 2.67]
MSA (Ref, No MSA)	5.01***	[3.31, 7.60]	3.87***	[2.55, 5.86]
Adjusted R²	.380		.425

Note. PTSD measured using the PCL-5 with a clinical cutoff of 33 (Weathers et al., 2013). Depression measured using the PHQ-9 with a clinical cutoff of 10 (Kroenke et al., 2001). PTSD = posttraumatic stress disorder; PCL-5 = PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.); PHQ-9 = 9-item Patient Health Questionnaire; LGB = lesbian, gay, bisexual; OR = odds ratio; CI = confidence interval; Ref = Reference; MSA = military sexual assault.

p < .05. **p < .01. ***p < .001.

Stalking experiences were also significantly associated with both probable PTSD and depression among male veterans. After adjusting for statistically significant confounding variables (age, race/ethnicity, branch, rank, deployment, and military sexual assault), male veterans who experienced stalking were significantly more likely to have probable PTSD (OR = 3.08; 95% CI = [2.27, 4.18]; R² = .380) and probable depression (OR = 2.78; 95% CI = [2.05, 3.79]; R² = .425) than those with no reported stalking experiences. In regard to confounding variables (separate from stalking experiences), male veterans who experienced deployment were significantly more likely to experience probable PTSD (OR = 2.07; 95% CI = [1.42, 3.02]) and probable depression (OR = 1.82; 95% CI = [1.25, 2.67]). Furthermore, male veterans who experienced military sexual assault were more likely to have probable PTSD (OR = 5.01; 95% CI = [3.31, 7.60]) and probable depression (OR = 3.87; 95% CI = [2.55, 5.86]).

Discussion

Our findings expand upon what is known about the experiences of stalking during military service, furthering the literature base by including types of stalking by sex, characteristics within and between sexes, and the associations of stalking and mental health. Similar to previous findings among civilian populations (Black et al., 2011; Menard & Cox, 2016), female veterans were significantly more likely to experience stalking than their male counterparts. The overall percentage of female veterans who experienced stalking during military service (57%) was well above those in a previous study on active-duty females’ experiences of stalking perpetrated by both intimate and non-intimate partners (11%; Black & Merrick, 2013). The percentage of male veterans who experienced stalking while in the military was exceptionally higher (35%) than in a previous study of pre-9/11 male veterans (4%; Clancy et al., 2006). The higher rate among male veterans may be due to our sample also including post-9/11 male veterans, as some types of stalking experiences included those that are more likely to be reported among post-9/11 female and male veterans due to advancements in technology (e.g., receiving unwanted messages or emails and someone using social media to track you).

Types of Stalking Experiences

The current study adds to the literature by highlighting types of stalking experiences. Among female veterans, 36% are likely to have experienced unwanted messages, emails, or phone calls, which is less than the primary types of stalking experienced by female civilians (e.g., unwanted phone calls [79%] and unwanted phone messages [58%]; Black et al., 2011). In the literature on military populations, female veterans primarily reported being followed, watched, or spied on (66%) and experiencing unwanted phone calls (65%; Dardis, Amoroso, & Iverson, 2017). The current finding among female veterans (36% experienced unwanted messages, emails, or phone calls, and 29% experienced being followed or someone waiting for them) are similar to previous findings on female veterans, expanding that work with the addition of measured experiences while in the military (vs. lifetime experience and/or experience related to IPV; Dardis, Amoroso, & Iverson, 2017; Dardis, Shipherd, & Iverson, 2017). Among male veterans, the primary type of stalking experienced is someone showing up unannounced or uninvited (29%), whereas male civilians most often experienced unwanted phone messages (76%) and then having someone show up uninvited or unannounced (58%; Black et al., 2011). As previous studies have not evaluated types of stalking during military service among male veterans, this study provides new information to inform future research and provides specific types of stalking to inform clinical evaluation.

Characteristics of Veterans Who Experienced Stalking

Female veterans who experienced stalking were more likely to be sexual minorities (Dardis, Shipherd, & Iverson, 2017). Our study expands the literature by highlighting stalking experienced during military service and stalking separate from IPV among bisexual and lesbian women. Our findings also showed that female and male veterans who served in higher ranks (i.e., E8–E9 or W1–W5) reported more stalking while in the military. This may be due to (a) achieving these ranks requires more years of service and allows for more time for the stalking to occur and/or (b) being in the military during a specific time period (e.g., violence prevention was less of a focus in the past compared with current initiatives). However, future research should seek to expand our understanding of stalking experiences during military service among current active-duty beyond female active-duty members (Black & Merrick, 2013) to include male active-duty members, female and male guard and reserve personnel, and female and male veterans.

Stalking and Military Sexual Assault

Similar to the literature on civilian populations (Basile et al., 2004; Kuehner et al., 2012), the current study found both female and male veterans who experienced stalking were also more likely to have experienced military sexual assault. These findings highlight the high correlation between multiple types of military-related sexual trauma. Future research should further evaluate stalking experienced while in the military by including it as a variable of interest when evaluating military sexual assault and/or military sexual harassment.

Stalking Associations With PTSD and Depression

Veterans who experienced stalking while in the military were more likely to report current probable PTSD and depression. These findings are in line with the literature on civilian (Basile et al., 2004; Kuehner et al., 2012) and military populations, where PTSD and depression are found to be strongly associated with having been stalked (Dardis, Amoroso, & Iverson, 2017; Kuehner et al., 2012). However, the current study demonstrates stalking experiences during military service were significantly associated with female and male veterans’ current clinical levels of PTSD and depression, years after military service. These findings lay the foundation for inclusion of stalking assessment in treatment evaluation and intervention among veterans, but also provide evidence to assess for stalking experiences during military service to provide treatment and intervention during military service rather than after. Finally, the rates of stalking experiences during military service combined with probable PTSD and depression later in life provide evidence for the DoD to further assess stalking experiences in combination with other military-related traumas, such as combat.

Limitations and Future Directions

Despite the importance of the current findings that highlight the presence of stalking in the military, characteristics of stalked veterans, and links with current mental health, the present study had limitations. Participants self-selected into the study, making selection bias possible, and, thus, findings cannot be generalized to all veterans. The retrospective nature of the assessment could lead to recall biases.

The current study did not enquire about the perpetrator of the stalking behaviors. Thus, it is unknown if repetitive stalking behaviors were committed by one or more persons. In addition, future research should determine if the perpetrator was an intimate or non-intimate partner or if the perpetrator was an active-duty member or a civilian. The current study also included a short measure of behaviors to determine if stalking occurred; future research should include a broader set of potential stalking behaviors. Finally, the current study did not capture when during military service the stalking occurred. Future research should expand on these findings by assessing when stalking occurs to effectively target the most appropriate points of intervention.

Conclusion

Currently, the Veterans Health Administration evaluates all veterans for experiences of military sexual harassment and military sexual assault (Kimerling et al., 2007), but does not assess for the experience of stalking. These findings highlight the importance of fully evaluating military sexual assault experiences among female and male veterans, including stalking, when they seek health and mental health services. Current practices should include assessing for the experience of stalking while in the military as it adds another potential trauma that is significant among veterans who have experienced military sexual assault. Individuals who experience cumulative traumas are known to have increased risk for mental health concerns (Turner & Lloyd, 1995), and traumas must be shared with providers to appropriately inform treatment. Furthermore, future research should include many forms of military-related sexual trauma (i.e., sexual harassment, gender discrimination, stalking, and sexual assault) to evaluate cumulative trauma and mental health among military populations (i.e., active-duty, guard, reserve, and veterans).

As the stalking in this study occurred during military service, it is highly recommended to evaluate current rates of stalking among active-duty, guard, and reserve personnel to provide real-time information to support a potential need for prevention, reporting avenues, and tools for command response. Also, it is possible the negative mental health implications among veterans may be present among service personnel and may hinder mission readiness. Finally, to prevent or minimize potential negative mental health associations with stalking, service personnel need to not only be aware of prevention and intervention services, such as Family Advocacy for concerns with current or previous intimate partners and Sexual Assault Prevention and Response when sexual assault has also occurred, but actively engage in support services as soon as concerns are present.

Footnotes

Acknowledgements

The lead author would like to thank Dr. Richard John for his guidance in preparation of this article. The views expressed in this article are those of the authors and do not reflect the official policy and position of the U.S. Government, the Department of Defense, or the Department of the Air Force.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Robert R. McCormick Foundation, Wells Fargo, Deloitte, and Prudential.

ORCID iDs

Carrie L. Lucas

Sara Kintzle

Author Biographies

Carrie L. Lucas, PhD, MSW, MPA, MMOAS, is Family Medicine Faculty and Chief of Behavioral Medicine at Travis Air Force Base, California. Her research focuses on military-related sexual trauma and highlights mental and physical health disparities among service members and veterans. She is interested in using research to enhance treatment interventions for victims and provide support for policy change within the military.

Julie A. Cederbaum, PhD, MSW, MPH, is an Associate Professor at the Suzanne Dworak-Peck School of Social Work at the University of Southern California (USC). Her expertise lies in the design and utilization of mixed methods. She uses both social work and public health perspectives in investigating primary and secondary prevention methods to reduce adverse outcomes in individuals who have experienced trauma.

Sara Kintzle, PhD, MSW, is Deputy Director of the Military and Veterans Programs and an Associate Research Professor in the USC Suzanne Dworak-Peck School of Social Work. She has focused on building expertise in the experiences of individuals who have served in the military with particular emphasis on transition from active duty to civilian life.

Carl Andrew Castro, PhD, is the Director of the Military and Veteran Programs and an Associate Professor at the Suzanne Dworak-Peck School of Social Work at USC. A retired Army Colonel, he served as Director of the U.S. Army Military Operational Medicine Research Program. He has authored more than 150 scientific articles and chairs a NATO research group.

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