|Year : 2018 | Volume
| Issue : 1 | Page : 11-15
Job stress, sexual harassment, self-harm behavior, and suicidal ideation among military personnel in Taiwan
Huei-Ting Jin1, Yi-Ching Lin2, Carol Strong1
1 Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
2 Department of Early Childhood and Family Education, National Taipei University of Education, Taipei, Taiwan
|Date of Web Publication||24-Jul-2018|
Dr. Carol Strong
Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 8F-8068, No. 138, ShengLi Road, North Dist., Tainan City 704
Source of Support: None, Conflict of Interest: None
Introduction: The aim of this study was first to estimate the prevalence of having self-harm behavior and suicidal ideation in a sample of military personnel. Second, we examined whether work stress, sexual harassment experiences, and depression were associated with suicidal ideation and self-harm behavior. Methods: A cross-sectional survey was conducted in Taiwan between January and April 2016. Sample was recruited from large military bases in Taiwan, including army, navy, and air force using convenience sampling. Self-reported data on job stress, sexual harassment experiences, self-harm behavior, and suicidal ideation were collected. Multiple logistic regression was used to determine the risk factors associated with having had self-harm behavior or suicidal ideation. Results: Of 513 individuals surveyed, 4.5% had self-harm behavior in the past 12 months and 9% had considered suicide. The majority of the sample were male (81.9%), between 20 and 29 years old (87.7%), voluntary military service (79.7%), and single or not married (90.8%). A higher level of sexual harassment experiences, higher level of perceived work stress, interpersonal relationship, and a lower level of job satisfaction were associated with self-harm behaviors. In multivariate analysis, gender, education, perceived work stress, sexual harassment, and depression were significantly associated with having had considered suicide in the past 12 months. Discussion: Our study highlighted the importance of acknowledging the vulnerability of the military work environment, including self-harming tendencies and sexual harassment. Education and training to ensure gender equality should be provided through appropriate channels.
Keywords: Job stress, military, self-harm, sexual harassment, suicide
|How to cite this article:|
Jin HT, Lin YC, Strong C. Job stress, sexual harassment, self-harm behavior, and suicidal ideation among military personnel in Taiwan. Soc Health Behav 2018;1:11-5
|How to cite this URL:|
Jin HT, Lin YC, Strong C. Job stress, sexual harassment, self-harm behavior, and suicidal ideation among military personnel in Taiwan. Soc Health Behav [serial online] 2018 [cited 2021 Jan 19];1:11-5. Available from: https://www.shbonweb.com/text.asp?2018/1/1/11/237418
| Introduction|| |
The military is a unique work environment that can be stressful due to the potential for combat, deployment, and difficulty to change jobs. The commitment to the military job, directly involving national security and stability, brings out job-related stress that has been an important research topic in health. Studies found that job satisfaction, levels of organizational commitment, and job embeddedness are associated with voluntary turnover rate in military personnel, showing a need to examine how well-adapted military personnel are in their work environment. Qualitative study also indicated that the hierarchical nature of the military management affects health.
Self-harm and suicidal ideation in the military have been reported in the Western countries,,, and an increasing trend has been reported in the estimated suicide rate in the United States., Job-related problems are alarmingly common for male suicide decedent populations among military personnel; however, data from non-Western countries related to suicide ideation are rather sparse, given the sensitivity of the topic that is likely to be underreported and the lack of surveillance data.
Although they are pressing issues, sexual assault or harassment in the military is often underreported and overlooked. Military sexual trauma in male veteran experiences is associated with mood disorders and more likely to have postdeployment perceived emotional mistreatment, showing a severe impact of sexual trauma on the well-being of military personnel. Although the experiences of sexual harassment and work stress have been reported in military populations, fewer studies have examined their association with self-harm and suicidal ideation. A recent study analyzed a large sample of US soldiers and found that individuals that had been sexually harassed were five times more likely to have a risk of suicide than their counterparts. Even at the unit level, the risk of suicide increased 3-fold in units with higher levels of sexual harassment.
With the increasing attention giving to the prevalence of sexual harassment, more studies devoted to examine stress and sexual harassment in the military related to mental health are needed in various cultural contexts. The aim of this study is first to estimate the prevalence of experiencing self-harm and suicidal ideation in a sample from military bases, and second, we examined whether work stress and sexual harassment were associated with suicidal ideation and self-harm behavior, respectively.
| Methods|| |
Study design and participants
The sample was recruited from large army, navy, and air force military bases in Taiwan through convenience sampling. Data were collected between January and April 2016. Of 700 people we approached for the study, 513 (73.3%) agreed to participate and signed the consent form. Participants were asked to fill out a 20-min anonymous survey including work stress, sexual harassment experiences in the military, depression, and background information. The study was approved by Human Research Ethics Committee at the National Cheng Kung University (REC: 104-042-2).
Given the sensitive topic, the survey was completely anonymous. We used several approaches to ensure confidentiality and to encourage an honest report. Participants were fully informed that the data would only be used for academic purposes and that no consequence or follow-ups would occur to any individual. After they filled out the anonymous survey, they put it in an envelope and returned it to a large box to ensure their responses were not revealed. Other than the researcher and the assistants, no one could access the envelope at the site.
Self-harm behaviors and suicidal ideation
Participants were asked whether they had ever hurt themselves on purpose in any way, such as taking an overdose of pills or cutting themselves, and if so, how many times in the past 12 months they had done so. Participants were considered as having self-harm behaviors if they had hurt themselves at least once in the past 12 months. For suicidal ideation, we asked whether they had seriously considered suicide in the past 12 months (yes or no).
We used the simple job stress scale developed and widely assessed by the Institute of Labor, Occupational Safety and Health, and Ministry of Labor in Taiwan. Job stress was measured by five subscales: perceived work stress, job control, job demand, interpersonal relationship, and job satisfaction; 24 questions were answered on a scale of 1 (strongly disagree) to 4 (strongly agree). A sum score was calculated by each subscale with a Cronbach's in our study sample.
Sexual harassment experiences
We used the Sexual Experiences Questionnaire developed by Fitzgerald et al. that has been utilized in several populations, such as in the military. We used 19 items from three subscales: gender harassment, unwanted sexual attention, and sexual coercion; for example, participants were asked during their military service whether they had ever been in a situation where people made crude sexual remarks, on a scale from 0 (never) to 4 (always), with α = 0.93 in our sample. A total score was calculated by each subscale and for the whole scale.
Depression was measured using the Center for Epidemiologic Studies Depression Scale using 20 items on a scale of 0 (rarely or none of the time) to 3 (most or all of the time), with α = 0.87 in our sample. A sum score was calculated by adding up the score of each item. A person with a sum score equal to or more than 16 was considered depressed.
Background information was also asked: of age, gender, military ranking, and highest educational attainment.
T-test, Chi-square tests, and Fisher's exact tests were applied to conduct univariate analysis to identify sociodemographic, job stress, sexual harassment experiences, and depression in association with the outcome variables. Multiple logistic regression was used to determine risk factors associated with experienced self-harm behaviors and suicidal ideation.
| Results|| |
Of 513 individuals surveyed, 4.5% had self-harm behavior in the past 12 months, and 9% had considered suicide [Table 1]. The majority of the sample were male (81.9%), between 20 and 29 years of age (87.7%), and voluntary military service (79.7%). About half of the participants had a college degree or above (58.1%). Less than half had depression (40.9%). In bivariate analysis, having had self-harm behaviors and suicidal ideation were both associated with gender, perceived work stress, job demand, job satisfaction, sexual harassment, and depression.
|Table 1: Characteristics of military personnel who had self-harm behavior or had considered suicide in the past year (n=513)|
Click here to view
In [Table 2], multivariate analysis indicates that having had self-harm behaviors was significantly associated with being female (odds ratio [OR] = 3.35, 95% confidence interval [CI] = 1.12–9.99), being younger (age 30–50 vs. age 20–29, OR = 0.09, 95% CI = 0.01–0.91), and having lower educational attainment (high school or below vs. university or above, OR = 0.26, 95% CI = 0.08–0.81). More intense sexual harassment experiences, a higher level of perceived work stress, poor interpersonal relationship, and a lower level of job satisfaction were associated with self-harm behaviors. In multivariate analysis, gender, education, perceived work stress, sexual harassment, and depression were significantly associated with having suicidal ideation in the past 12 months.
|Table 2: Multivariable analysis of factors associated with having self-harm behavior or considered suicide in the past year (n=513)|
Click here to view
| Discussion|| |
Compared to a study that involved a community sample in Taiwan and reported that 4.9% of the participants exhibited suicidal ideations over the past week, our data – that showed that 9% of the participants exhibited suicidal ideations over the past 12 months – may not exceed the general population. Although the prevalence of self-harm behaviors and having suicidal thoughts affects only 4.5% of the community and 9% in our study sample, military personnel – given their easier access to firearms – makes it more concerning than for the general population. Our study also shows that sexual harassment and job strain in the military were risk factors for self-harm behaviors and suicidal ideations.
Socioeconomic status, including income and employment, was found to be associated with suicide death in Taiwan. Our study provided a potential explanation for the association between occupation and suicide death. It is likely that job-related stress is one of the mechanisms that lead to suicidal ideations. We also showed that for military personnel, perceived work stress may be more important than job control or job demand to be associated with self-harm behavior or suicidal ideations. Two other aspects of job strain, interpersonal relationship and job satisfaction, also appear to be related to self-harm behavior. Understanding the nature of the job in the military and implementing early intervention to reduce perceived stress is necessary for improving the well-being of military personnel.
Our study showed that sexual harassment experiences were independently associated with self-harm behavior and suicidal ideations in the military. An estimate in the US military shows that 1.5% of the active-component military personnel experienced at least one sexual assault in the past year and that women were disproportionately affected: about 1 in 20 women but <1 in 100 men. Although using a different scale and not being able to provide estimates of the prevalence, our data also indicated that sexual harassment exists in the military. Our study contributes to raising the awareness and stepping toward zero tolerance for sexual harassment in military settings. In Western countries, there is a long history of military training that emphasizes hypermasculinity. It is likely that it holds true in some non-Western cultures, such as Taiwan. A work environment with heightened emphasis on masculinity may result in gender role stress for both men and women and diminish gender equality. Addressing masculinity ideology and stereotypical gender roles in the military is an imperative to ensure respect and create a gender-safe environment.
Limitations of this study were also considered while interpreting our findings. First, although measures were taken to ensure anonymity, it may be inevitable that all measures were underreported given such a sensitive issue in the military culture. The scope of the prevalence of self-harm behaviors, suicidal ideation, and sexual harassment might be larger than reported. Second, causal inference cannot be made based on the cross-sectional data. It is not known whether the occurrence of any sexual harassment events was before having suicidal ideations or self-harm behavior. Third, our study results had limited generalizability and were currently specific to the military work environment in Taiwan.
| Conclusion|| |
Our study highlighted the importance of acknowledging the vulnerability in the military work environment, including the incidence of self-harming and sexual harassment. Proper perspectives of gender equality and training programs should be provided through appropriate channels. Individuals would be benefitted from the content, and hopefully, the traditional gender role stereotypes in the military can be well balanced.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Elovainio M, Heponiemi T, Jokela M, Hakulinen C, Presseau J, Aalto AM, et al.
Stressful work environment and wellbeing: What comes first? J Occup Health Psychol 2015;20:289-300.
Holtom BC, Smith DR, Lindsay DR, Burton JP. The relative strength of job attitudes and job embeddedness in predicting turnover in a US military academy. Mil Psychol 2014;26:397-408.
Bahadori M, Sanaeinasab H, Ghanei M, Mehrabi Tavana A, Ravangard R, Karamali M, et al.
The social determinants of health in military forces of Iran: A qualitative study. J Environ Public Health 2015;2015:524341.
Bauldoff GS, Ryan-Wenger NA, Diaz PT. Wrist actigraphy validation of exercise movement in COPD. West J Nurs Res 2007;29:789-802.
Kuehn BM. Soldier suicide rates continue to rise: Military, scientists work to stem the tide. JAMA 2009;301:1111, 1113.
Logan J, Skopp NA, Karch D, Reger MA, Gahm GA. Characteristics of suicides among US army active duty personnel in 17 US states from 2005 to 2007. Am J Public Health 2012;102 Suppl 1:S40-4.
Rough JA, Armor DJ. Sexual assault in the U.S. military: Trends and responses. World Med Health Policy2017;9:206-24.
Mondragon SA, Wang D, Pritchett L, Graham DP, Plasencia ML, Teng EJ, et al.
The influence of military sexual trauma on returning OEF/OIF male veterans. Psychol Serv 2015;12:402-11.
Griffith J. The sexual harassment-suicide connection in the U.S. military: Contextual effects of hostile work environment and trusted unit leaders. Suicide Life Threat Behav 2017. doi:10.1111/sltb.12401.
Kidger J, Heron J, Lewis G, Evans J, Gunnell D. Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: A self-report survey in England. BMC Psychiatry 2012;12:69.
Institute of Labor, Occupational Safety and Health. Psychometric Tests Platform: Institute of Labor, Occupational Safety and Health, Ministry of Labor in Taiwan; 2013. Available from: https://www.meeting.ilosh.gov.tw/overwork/index.aspx
. [Last accessed on 2018 Jun 01].
Fitzgerald LF, Gelfand MJ, Drasgow F. Measuring sexual harassment: Theoretical and psychometric advances. Basic Appl Soc Psychol 1995;17:425-45.
Fitzgerald LF, Magley VJ, Drasgow F, Waldo CR. Measuring sexual harassment in the military: The sexual experiences questionnaire (SEQ—DoD). Mil Psychol 1999;11:243-63.
Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401.
Lung FW, Lee MB. The five-item brief-symptom rating scale as a suicide ideation screening instrument for psychiatric inpatients and community residents. BMC Psychiatry 2008;8:53.
Mahon MJ, Tobin JP, Cusack DA, Kelleher C, Malone KM. Suicide among regular-duty military personnel: A retrospective case-control study of occupation-specific risk factors for workplace suicide. Am J Psychiatry 2005;162:1688-96.
Tsai JF. Socioeconomic factors outweigh climate in the regional difference of suicide death rate in Taiwan. Psychiatry Res 2010;179:212-6.
Morral AR, Gore KL, Schell TL. Sexual Assault and Sexual Harassment in the U.S. Military. Estimates for Department of Defense Service Members from the 2014 RAND Military Workplace Study. Vol. 2. Santa Monica Ca: RAND National Defense Research Institute; 2015.
Shields DM, Kuhl D, Westwood MJ. Abject masculinity and the military: Articulating a fulcrum of struggle and change. Psychol Men Masculinity 2017;18:215-25.
[Table 1], [Table 2]