Sexual trauma, posttraumatic stress disorder, and health behavior

Sex-specific associations between self-reported physical activity and PTSD among survivors of sexual violence

This study examined sex-specific associations between sexual violence (SV) type and physical activity, and identified associations between PTSD symptoms and physical activity, all among cisgender men and women survivors of SV. Cross-sectional data from men (n = 197) and women (n = 356) survivors of SV were analyzed with stratified (men; women) hierarchical logistic regressions. Additionally, fully adjusted models for the total sample included interaction terms to further assess whether associations between SV type as well as PTSD symptoms (sum, clusters) and physical activity differed significantly by sex. Sexual assault was negatively associated with physical activity in the crude model among women (ORs: 0.58; p < 0.05). Harassment was positively associated with physical activity in the crude and adjusted models (ORs:1.92-2.16; ps<0.05) among women. Among men, there were no significant relationships. Regarding PTSD symptoms among women, crude and adjusted stratified models identified significant positive relationships with intrusion (ORs: 1.18-1.22; ps<0.05). Crude and adjusted models revealed significant positive relationships between avoidance and activity (ORs:1.38-1.41; ps<0.05) among men but not women. The interaction term for this difference in the association between avoidance and physical activity by sex was significant (OR: 0.65; 95%CI: 0.48-0.88; p < 0.01). Overall, findings provide evidence for sex-specific associations between SV and physical activity.

Effects of trauma history on cancer-related screening, diagnosis, and treatment

Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.

Rape Myth Acceptance Buffers the Association Between Sexual Assault and Posttraumatic Stress Disorder Symptoms Among College Students

Rape myths are cultural beliefs that invalidate, blame, and stigmatize rape survivors, thereby perpetuating sexual violence. Few studies have explored associations between rape myth acceptance (RMA) and mental health outcomes, but evidence suggests that RMA can buffer the mental health impact of some forms of sexual assault. The current study examined the buffering effect of RMA on depression and posttraumatic stress disorder (PTSD) symptoms using self-report data from an online survey of 500 female college students. Findings provided support for the buffering effect of RMA on the association between any sexual assault and PTSD symptoms. Experiencing any sexual assault was significantly associated with greater PTSD symptoms among participants with low RMA, whereas this association was only marginally significant among those with high RMA. Findings demonstrate that there are some contexts in which high RMA might lessen the mental health impact of sexual assault. Thus, it is possible that as progress is made to dismantle rape myths in society, mental health symptoms amongst some survivors may exacerbate, thereby increasing the demand for mental health services.

The Relationship Between Sexual Assault History and Cervical Cancer Screening Completion Among Women Veterans in the Veterans Health Administration

Background: Sexual assault affects one in three US women and may have lifelong consequences for women's health, including potential barriers to completing cervical cancer screening and more than twofold higher cervical cancer risk. The objective of this study was to determine whether a history of sexual assault is associated with reduced cervical cancer screening completion among women Veterans. Materials and Methods: We analyzed data from a 2015 survey of women Veterans who use primary care or women's health services at 12 Veterans Health Administration facilities (VA's) in nine states. We linked survey responses with VA electronic health record data and used logistic regression to examine the association of lifetime sexual assault with cervical cancer screening completion within a guideline-concordant interval. Results: The sample included 1049 women, of whom 616 (58.7%) reported lifetime sexual assault. Women with a history of sexual assault were more likely to report a high level of distress related to pelvic examinations, and to report ever delaying a gynecologic examination due to distress. However, in the final adjusted model, lifetime sexual assault was not significantly associated with reduced odds of cervical cancer screening completion (OR 1.35, 95% CI 0.93-1.97). Conclusions: Contrary to our expectations, sexual assault was not significantly associated with gaps in cervical cancer screening completion. Three- to five-year screening intervals may provide sufficient time to complete screening, despite barriers. Trauma-sensitive care practices promoted in the VA may allow women to overcome the distress and discomfort of pelvic examinations to complete needed screening. ClinicalTrials.gov (#NCT02039856).

The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans

The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.

Sexual Harassment, Sexual Assault, and Physical Activity Among U.S. Military Service Members in the Millennium Cohort Study

Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness.

The impact of sexual harassment on obesity in female adolescents: An update and perspective to control

BACKGROUND AND AIMS

Sexual victimization, happened during childhood and beyond, is known to be a substantial contributing factor for obesity development later in life. This work aims to bring about updated information on the relationship between sexual harassment and obesity.

METHODS

Based on an intensive scientific literature review in Google Scholar, Pubmed databases, the total of 106 studies (N = 141,199) were assessed including 52 studies on the connection between negative lifetime impacts and obesity, 11 studies on post-traumatic stress disorder (PTSD) symptoms with proposed biological mechanisms related to obesity, 15 studies on the relationship between major depressive disorder (MDD) symptoms and obesity, 11 studies on the body dismorphic disorder (BDD) and 17 studies on the binge eating disorder (BED) were also examined to evaluate the association of obesity and traumatic life experiences.

RESULTS

Although 40-70% of all cases related to obesity have been considered to be hereditary, many experts argue that deviations in the environment contribute to excessive food intake and depressed physical activity in numerous Western countries. Several studies have identified that childhood sexual abuse (CSA) may be nearly as common as obesity. However, just a few researchers have taken notice of the possible connection between these two.

CONCLUSIONS

By mentioning some possible obesity-related psychological disorders in response to CSA, we present updated information on the relationship between sexual harassment and obesity.

Pathways to post-traumatic stress disorder and alcohol dependence: Trauma, executive functioning, and family history of alcoholism in adolescents and young adults

INTRODUCTION

Family history (FH) of alcohol dependence is likely to increase the risk of trauma exposure, post-traumatic stress disorder (PTSD), and alcohol dependence. FH of alcohol dependence and trauma has been separately shown to adversely affect planning/problem-solving aspects of executive function. However, few studies have examined these risk factors in an integrated model.

METHODS

Using data from trauma-exposed individuals from the Collaborative Study on the Genetics of Alcoholism prospective cohort (N = 1,860), comprising offspring from alcohol-dependent high-risk and comparison families (mean age [SE] = 21.9 [4.2]), we investigated associations of trauma (nonsexual assaultive, nonassaultive, sexual assaultive) with DSM-IV PTSD and alcohol dependence symptom counts, and planning/problem-solving abilities assessed using the Tower of London Test (TOLT). Moderating effects of family history density of alcohol use disorder (FHD) on these associations and sex differences were explored.

RESULTS

Family history density was positively associated with PTSD in female participants who endorsed a sexual assaultive trauma. Exposure to nonsexual assaultive trauma was associated with more excess moves made on the TOLT.

CONCLUSION

Findings from this study demonstrate associations with PTSD and alcohol dependence symptom counts, as well as poor problem-solving ability in trauma-exposed individuals from families densely affected with alcohol dependence, depending on trauma type, FHD, and sex. This suggests that having a FH of alcohol dependence and exposure to trauma during adolescence may be associated with more PTSD and alcohol dependence symptoms, and poor problem-solving abilities in adulthood.

A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018

Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.

A multi-method assessment of interoception among sexual trauma survivors

It is well established that many female sexual trauma survivors experience dissociation, particularly disconnection from the body, in the aftermath of sexual trauma. This study aims to address the open question of how sexual trauma is associated with awareness of inner body sensations (i.e., interoception). Given the important role that interoception has in emotion regulation, a process with which survivors often struggle, it is important to understand the associations between interoception and PTSD symptoms among survivors. Through multi-methods, we assessed associations between interoception, dissociation, and PTSD symptoms among 200 female sexual trauma survivors. We assessed two components of interoception: interoceptive accuracy (IAc: accurately perceiving internal body sensations; via heartbeat perception task) and interoceptive sensibility (IS: self-report perception of sensitivity to interoceptive sensations). We hypothesized that IAc and IS would be positively correlated with PTSD, with interactions between IAc/dissociation and IS/dissociation qualifying those main effects, weakening them for survivors with higher dissociation. Results showed an opposite pattern than was predicted: although IAc did explain significant PTSD variance, as IAc increased, PTSD decreased. Although IAc did explain significant variance in PTSD symptoms, interestingly, IS did not. Consistent with extant literature, dissociation predicted significant variance in PTSD. These correlational results suggest that the ability to more accurately perceive inner body sensations is related to lower PTSD symptoms. Findings provide a foundation for future research that can assess if interventions (such as yoga or exercise) that target increasing interoceptive accuracy lead to decreases in PTSD symptoms. We discuss further clinical implications, limitations and future directions.

A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: The Healing Seasons protocol

Native Americans (NA) experience interrelated risks of trauma exposure, substance use, and HIV risk behaviors that put them at increased risk for HIV infection. Despite these known risk factors, there are very few published randomized trials testing interventions to reduce trauma-related symptoms and substance misuse among NA.

METHODS

The Healing Seasons study is a randomized comparsion trial of two counseling strategies, Narrative Exposure Therapy (NET) addressing PTSD or Motivational interviewing with cognitive behavioral therapy skills training (MIST) addressing substance misuse as a means to prevent HIV among NA. Using a community-based participatory research approach, we adapted both evidence-based interventions to be specific to the risk contexts and realities of NA and to include psychoeducational and skill-building components that include cultural-specific stories, virtues, and traditional treatment strategies. Participants, 16 years and older, were recruited from a Pacific Northwest tribal community, screened over the phone, enrolled in person, and randomized in equal numbers to NET or MIST. We stratified by age (16-29 years and 30 or older) and gender (male or female identified) to ensure balance between treatment arms. The primary outcomes were number of sex partners and frequency of sexual acts (with and without condoms), sex under the influence of substances, frequency of substance use, and PTSD severity.

DISCUSSION

Behavioral interventions for NA are needed to prevent HIV risk behaviors when faced with trauma symptoms and substance misuse. This study will provide evidence to determine feasibility and efficacy of addressing related risk factors as part of counseling-based HIV prevention intervention to reduce sexual risk among this population.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT03112369, registered April 12, 2017.

Caring for Military Veterans in the Community: An Interprofessional Approach

Military veterans are at higher risk for poor health outcomes due to the myriad of physical and mental health problems that may occur during or after deployment to one or more military combat operations. To improve health outcomes for this vulnerable population, it is essential that healthcare providers employ an interprofessional approach when providing care. With increased numbers of veterans receiving healthcare in the civilian sector, community health nurses are in a unique position to implement and manage effective interprofessional collaboration that will ensure the provision of high-quality healthcare.

Person-Centered Care for Patients with Pessaries

Pelvic organ prolapse is a common condition affecting women of any age but more likely to occur in the aging woman. Prolapse has a significant impact on quality of life, sexuality, and body image. Vaginal support pessaries have been used since ancient times and are a safe and effective nonsurgical treatment option. Fitting a pessary results in immediate symptom improvement. A comprehensive evaluation for pessary fitting is time intensive but necessary. Nurse providers perform direct pessary care and have a role in caring for women with prolapse expanding access to care. Caregiver and family involvement is important for pessary care and follow-up.

Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes

INTRODUCTION

The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs.

METHODS

Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome.

RESULTS

Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69-4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged.

CONCLUSIONS

The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.

Predictors of somatic symptom severity: The role of cumulative history of trauma and adversity in a diverse community sample

OBJECTIVE

Somatic symptoms are often reported among victims of trauma, and place a significant burden on primary care health providers. We examined the relationship between lifetime histories of trauma and adversity, including aspects not previously studied (i.e., perceived discrimination), and somatic symptoms, as well as the mediating role of posttraumatic stress symptoms (PTSS) and depressive symptoms.

METHOD

A multiethnic community sample of 500 male and female participants (230 African American and 270 Latino) completed measures of demographic characteristics, the University of California, Los Angeles Lifetime Adversities Screener (LADS), depressive symptoms, PTSS, and somatic symptoms.

RESULTS

An ordinary least-squares regression analysis controlling for age, gender, and race/ethnicity indicated that higher levels of lifetime adversity and trauma were significantly associated with more severe somatic symptoms (b = 6.95, p < .0001). Formal mediation tests indicated that there was a significant indirect effect of LADS on somatic symptoms via PTSS and depressive symptoms, indirect effect = 2.64 (95% confidence interval [CI] [1.2, 4.1]) and 2.19 (95% CI [1.3, 3.3]), respectively. Even after PTSS and depressive symptoms were taken into account, the LADS remained significantly associated with somatic symptoms (b = 2.13, p < .05), suggesting partial mediation.

CONCLUSION

Exposure to traumatic and adverse events (the LADS) was associated with somatic symptom severity. Furthermore, although PTSS and depressive symptoms partially accounted for the association between the LADS and somatic symptoms, the LADS remained significant, suggesting that both exposure to trauma and adversity and the resultant development of PTSS and depressive symptoms influence the development of somatic symptoms. (PsycINFO Database Record

Do trauma type, stressful life events, and social support explain women veterans' high prevalence of PTSD?

OBJECTIVES

To examine factors that account for women veterans' higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.

METHODS

Cross-sectional analyses of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.

RESULTS

Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans' and civilians' prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.

CONCLUSIONS

Number of trauma types, type of trauma, and social factors may together help explain women veterans' higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

Risk and protective factors of posttraumatic stress disorder among African American women living with HIV

We sought to examine risk and protective factors for Posttraumatic Stress Disorder (PTSD) among African American women living with HIV. This is a cross-sectional analysis of baseline data from a randomized trial of an HIV stigma reduction intervention. We examined data from two-hundred and thirty-nine African American women living with HIV. We examined whether age, marital status, level of education, internalized HIV-related stigma, and social support as potential protective and risk factors for PTSD symptoms using logistic regression. We analyzed bi-variate associations between each variable and PTSD symptoms, and constructed a multivariate logistic regression model adjusting for all variables. We found 67% reported clinically significant PTSD symptoms at baseline. Our results suggest that age, education, and internalized stigma were found to be associated with PTSD symptoms (p < 0.001), with older age and more education as protective factors and stigma as a risk factor for PTSD. Therefore, understanding this relationship may help improve assessment and treatment through evidence- based and trauma-informed strategies.

Intimate violence as it relates to risky sexual behavior among at-risk females

OBJECTIVE

Rates of sexually transmitted infections (STIs) among adolescents are on the rise. The majority of adolescents who contract STIs do so through risky sexual behavior. Previous literature has identified multiple correlates of risky sexual behaviors among adolescents, including physical and sexual victimization, mental health concerns, and substance use. Few studies, however, have examined these relationships together in a comprehensive model. The primary purpose of this study was to examine whether relationship violence was related to risky sexual behavior, and whether mental health symptoms and substance use mediated this relationship.

METHOD

A cross-sectional design was used, and adolescent females (N = 179), recruited from social service agencies, were 18.9 years old on average and were 37.2% White, 19.3% Black, 37.9% multiracial, and 5.6% other.

RESULTS

Regression results revealed that females who were physically assaulted and sexually victimized by their intimate partners did engage in more sex without condoms. Mediational analyses indicated that PTSD symptoms significantly influenced the relationship between (1) physical assault and risky sexual behavior and (2) sexual victimization and risky sexual behavior.

CONCLUSION

Contrary to expectations, PTSD may act to reduce risk perhaps by reducing interest in sex. It is important to address victimization, PTSD, and sexual risk in young women. More work is needed to understand these complex relationships using longitudinal designs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trauma exposure, posttraumatic stress, and preventive health behaviours: a systematic review

Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

From Sexual Assault to Sexual Risk: A Relational Pathway?

Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ²(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.

Sexual Coercion, Trauma, and Sex Work in Justice-Involved Women with Substance Use Disorders

Sexual victimization is strongly associated with mental health problems, traumatic responses, earlier onset of substance use and criminal justice involvement. It is well known that multiple forms of sexual victimization and aggression have been experienced by most incarcerated women. Two hundred women with a substance use disorder and involvement with the criminal justice system within the previous two years (parole, probation, arrest, or incarceration) were recruited from multiple sites in metropolitan Chicago. We examined whether empowerment moderates the relationship between trauma symptoms, trading sex and the experience of being forced or coerced to have sex. There was a significant three-way interaction between sexual coercion, trading, and empowerment scores on trauma symptoms. For individuals who have not traded sex, lower levels of empowerment were associated with a larger difference in trauma symptomatology between individuals who have been coerced and those who have not been coerced. For individuals who had been coerced to engage in sexual activity, lower levels of empowerment were associated with a larger difference in trauma symptomatology between those who have traded and those who have not traded. The promotion of empowerment beliefs and attitudes in women disproportionately impacted by violence and sexual trauma may reduce the harm that results from being victimized. Furthermore, providing specific interventions that educate women regarding gender roles and cultural values may help women avoid situations that result in exploitation and coercion.

Correlates of Risky Heterosexual Behaviors Among Women Who Use Methamphetamine

Women who use methamphetamine are at heightened risk of engaging in sexual behaviors that increase their odds of contracting HIV or sexually transmitted infections (STIs). However, little is known regarding correlates of such behaviors within this population. In a community-based sample of women who use methamphetamine ( N = 322), we examined participant characteristics (i.e., demographics, drug- and sex-related behaviors, and mental health characteristics) associated with three operationalizations of risky heterosexual behaviors in the past 6 months (i.e., number of male partners, condomless sex with male partners, and both multiple male partners and condomless sex). Analyses revealed important distinctions in the correlates of risky heterosexual behaviors as a function of outcome. Results suggest that HIV and STI prevention strategies should consider characteristics associated with differing risky heterosexual behaviors. In addition, differences in correlates of these behaviors suggest a need for standardization in measurement and evaluation of sexual risk in research and practice with women who use methamphetamine.

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. Inperson interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.

Barriers and Facilitators of Mental Health Treatment-Seeking in U.S. Active Duty Soldiers With Sexual Assault Histories

Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others.

Sexual assault in the military

Military sexual assault is a pervasive problem throughout the military services, despite numerous initiatives to end it. No doubt the military's lack of progress stems from the complexity of sexual assaults, yet in order to develop effective strategies and programs to end sexual assault, deep understanding and appreciation of these complexities are needed. In this paper, we describe the root causes and numerous myths surrounding sexual assault, the military cultural factors that may unintentionally contribute to sexual assault, and the uncomfortable issues surrounding sexual assault that are often ignored (such as the prevalence of male sexual assault within the military). We conclude by offering a broad, yet comprehensive set of recommendations that considers all of these factors for developing effective strategies and programs for ending sexual assault within in the military.

Silenced suffering: the need for a better understanding of partner sexual violence

This article has two overall goals. First, to examine the current state of sexual violence research to highlight several shortcomings in the knowledge on partner sexual violence. Second, to describe several factors to consider in future research to facilitate a more in-depth understanding of partner sexual violence. Shortcomings of the research on partner sexual violence include (1) overreliance on dichotomous yes/no representations of sexual violence experiences; (2) lack of, or inadequate documentation of the scope and nature of partner sexual violence; (3) inadequate ways to account for impairment of consent under different circumstances; (4) difficulties in discriminating unwanted from nonconsensual sexual activities; and (5) limited information about the role sexual violence plays in the larger context of coercive control. In order to facilitate a more in-depth understanding of partner sexual assault, there is a need (1) to better understand the scope and nature of partner sexual assault and (2) to better understand the role partner sexual violence plays in coercive control. By improving the measurement of this phenomenon, victims, researchers, practitioners, and those involved in the justice system might be better equipped to respond to sexual violence among intimate partners.

Sexual victimization history, depression, and task physiology as predictors of sexual revictimization: results from a 6-month prospective pilot study

The current study examined depression and physiological reactivity to a sexual threat task as longitudinal predictors of sexual revictimization in women with sexual victimization histories. The sample included 14 young adult women (M(age) = 19.15) who reported child sexual abuse. Heart rate and root mean square of the successive differences were measured at baseline and during the presentation of sexual victimization-related words during an Emotional Stroop task. Results indicated that women who reported a greater history of childhood sexual abuse and adult sexual victimization were at increased risk for sexual revictimization 6 months after initial data collection. Furthermore, even after accounting for their childhood and adult sexual victimization histories and depression symptoms, women who exhibited reduced, or blunted, physiological activity during the sexual victimization stimuli of the Stroop task were more likely to report sexual revictimization during the 6-month follow-up. The findings suggest that sexual victimization survivors may benefit from interventions that address physiological blunting and the recognition of sexual threat cues in their environment.

Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska Native women

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.

Relationships between sexual violence and chronic disease: a cross-sectional study

BACKGROUND

Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and mental health. Research has demonstrated that individuals who experience sexual assault during childhood are more likely to engage in risky behaviors later in life, such as smoking, alcohol and drug use, and disordered eating habits, which may increase the risk of developing a chronic disease. Despite the high prevalence and economic burden of sexual assault, few studies have investigated the associations between sexual violence and chronic health conditions in the US. The purpose of this study is to identify associations between sexual violence and health risk behaviors, chronic health conditions and mental health conditions utilizing population based data in Kansas.

METHODS

Secondary analysis was done using data from the 2011 Kansas Behavioral Risk Factor Surveillance System sexual violence module (N = 4,886). Crude and adjusted prevalence rate ratios were computed to examine associations between sexual assault and health risk behaviors, chronic health conditions and mental health conditions, overall and after adjusting for social demographic characteristics. Additional logistic regression models were implemented to examine the association between sexual assault and health risk behaviors with further adjustment for history of anxiety or depression.

RESULTS

There was a significantly higher prevalence of health risk behaviors (heavy drinking, binge drinking and current smoking), chronic health conditions (disability, and current asthma) and mental health conditions (depression, anxiety, and suicidal ideation) among women who ever experienced sexual assault compared to women who did not, even after adjustment for potential confounders.

CONCLUSIONS

Study findings highlight the need for chronic disease prevention services for victims of sexual violence. There are important implications for policies and practices related to primary, secondary, and tertiary prevention, as well as collaborations between sexual violence, chronic disease, and health risk behavior programs.

Poly-Victimization Risk in Prison: The Influence of Individual and Institutional Factors

Victimization research suggests that individuals who either witness or are direct victims of violence are substantially more likely to experience long-term negative outcomes. Although recent studies identifying factors associated with prison victimization are emerging, the risk factors predicting inmate's experience of multiple types of victimization, called poly-victimization, remain unknown. Utilizing a lifestyles model that incorporates the importation/deprivation framework, the current study examines whether certain features of the prison environment or individual characteristics predict who is most likely to experience victimization. Data from more than 1,600 recently released inmates confirm that the environmental and individual-level factors are related to poly-victimization in prison. The findings from the study have implications for policy and practice.

The driving behavior survey as a measure of behavioral stress responses to MVA-related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.

The Driving Behavior Survey as a measure of behavioral stress responses to MVA-related PTSD

Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n=40) were racially diverse adults (M age=40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r=.41-.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.

Exposure to Verbal Parental Aggression and Sexual Activity among Low Income African American Youth

The study examined whether witnessing verbal parental aggression (VPA) was related to sexual activity among African American youth who were mostly low income, and whether psychological symptoms mediated this relationship. Five hundred and sixty-three African American high school adolescents (ages 13 to 19) completed self-administered questionnaires, which assessed demographics, psychological problems (e.g., depression, anxiety, aggression and posttraumatic stress disorder symptoms), witnessing VPA, and sexual activity. Participants who witnessed high versus no VPA were 2 times more likely to report sexual activity. This relationship was mediated by aggression for males and females, and posttraumatic stress disorder symptoms for females only. Youth service providers should be trained to understand the prevalence of co-occurring problems such as exposure to VPA, aggression, PTSD symptoms, and sexual activity, with the goal of more effectively supporting the healthy development of African American youth.

The effects of stress on physical activity and exercise

BACKGROUND

Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress.

OBJECTIVE

The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise.

METHODS

A systematic search of Web of Science, PubMed, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included "stress", "exercise", and "physical activity". A rating scale (0-9) modified for this study was utilized to assess the quality of all studies with multiple time points.

RESULTS

The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work-family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥ 7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced.

CONCLUSIONS

Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors.

Sexual Function, Sexual Activity and Quality of Life in Women with Ovarian and Endometrial Cancer

Background: Gynecological cancer (GC) is assumed to have an impact on sexual function and activity, but pertinent evidence is currently limited. Patients and Methods: Sexual function and activity were investigated in patients with gynecological cancer (GC) and in a control group (C), using the "Sexual Activity Questionnaire" (SAQ), the "Female Sexual Function Index" (FSFI), and parts of the EORTC QLQ-C30. Results: 727 women (335 GC and 392 C) were given a questionnaire and 22.8 % of them responded. Response rates were equivalent for both groups (23.6 % [GC] and 22.2 % [C]). 51.5 % (C) and 59.5 % (GC) were not sexually active, mainly owing to lack of a partner (37 %) or lack of interest (21 %) (C group), and lack of interest (40 %, p < 0.05), physical problems (31.9 %, p < 0.05), and physical problems suffered by their partner (21 %, p < 0.05) (GC group). There were significant differences between both groups in the SAQ discomfort score (p < 0.05), but no significant differences in quality of life or other scores for sexuality. Conclusion: The quality of sexuality tends to be impaired in GC patients, but this does not appear to influence quality of life. A shift in priorities caused by the considerable anxiety about surviving the cancer might explain our findings.

Associations between women's experiences of sexual violence and forgiveness

The purpose of this study was to examine forgiveness and sexual violence among college women. Undergraduate women (N = 503) completed an online survey assessing experiences of sexual violence and forgiveness. Simultaneous multivariate regressions revealed that experiencing more sexual violence was associated with more revenge and avoidance, and less benevolence. Furthermore, findings indicated that more experiences of sexual violence were negatively associated with forgiveness of self, forgiveness of others, and forgiveness of uncontrollable situations. This work begins to fill critical gaps in the extant literature because it is the only study to date that examines sexual violence and the positive psychological construct of forgiveness. Implications and directions for future research are discussed.

Mistreatment and self-reported emotional symptoms: results from the National Elder Mistreatment Study

Many community-residing older adults in the United States report past year mistreatment; however, little is known about mental health correlates of abuse. This study investigated whether a recent history of emotional, physical, or sexual abuse is associated with self-reported emotional symptoms (e.g., anxiety, depression) among a representative sample of older adults. Results demonstrated that each abuse type increased likelihood of reporting emotional symptoms; when other known correlates were controlled, only emotional abuse remained a significant predictor. Additional study of mistreatment-related correlates of depression and anxiety is needed, with a focus on the often overlooked category of emotional mistreatment.

Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon

OBJECTIVE

To determine the prevalence and predictors of psychiatric disorders in a general population from South Lebanon, an area that was under military occupation for more than 20 years.

METHOD

This study assessed post-traumatic stress disorder (PTSD) and depression thresholds along with general health (GHQ) among 625 citizens in six villages in South Lebanon using a cross-sectional design through random sampling.

RESULTS

The prevalence ranged from 17.6 to 33.3% for PTSD and from 9.2 to 19.7% for depression. GHQ total score was found to be 6.7 significantly greater than the internationally established mean score of 5.0. Social support, financial resources, gender, and war exposure were significantly related to PTSD and depression thresholds.

CONCLUSION

The results strongly suggest that the general population in South Lebanon suffer from mental health disorders calling for appropriate psychiatric interventions and development planning.

The Impact of PTSD Symptoms on Women's Safer-Sex Negotiation: Influence of Ethnicity

PTSD has been shown to predict later self reported sexual risk behavior, yet behavioral research is lacking in this area. The present study investigated the impact of PTSD severity on negotiation and interpersonal skills effectiveness in simulated high-risk sexual situations among 368 inner-city women. Participants engaged in role-play scenarios involving 1) refusing sex without a condom, 2) abstaining from drinking prior to sex, and 3) refusing sex until both partners were tested for HIV. Interviews were audio taped and rated along dimensions of negotiation effectiveness by blind raters. Hierarchical linear regression analyses were conducted to investigate the impact of PTSD and ethnicity on 4 theoretically derived skill sets 1) assertiveness, 2) using health and preparedness skills 3) social joining skills and 4) higher order negotiation skills. Generally, results indicated that PTSD severity predicted poorer rated negotiation effectiveness among European Americans, but not African Americans. African Americans' expectations that may prepare them for facing more hardship may help explain ethnic differences.

Cancer screening and history of sexual violence victimization among U.S. adults

BACKGROUND

Little is known about the effect a history of sexual violence (SV) victimization has on the likelihood of reporting screening tests for cancer. This study investigates the association between SV victimization and cancer screening behaviors.

METHODS

We analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) from 11 states and 1 territory (U.S. Virgin Islands) that administered the SV module to describe demographic characteristics, quality of life, health status, cancer screening behaviors, healthcare coverage, and use of healthcare services for 58,665 women and men who reported SV victimization compared to women and men who did not. The SV victimization measure includes unwanted touching, exposure to sexual material, or ever experiencing completed or attempted unwanted sex. Statistical significance was determined using chi-square tests and multivariate logistic regression models.

RESULTS

Multivariate logistic regression results presented as adjusted proportions showed SV victimization was significantly associated with mammography screening for women (74.0 % victims vs. 77.1% nonvictims, p=0.02). SV victimization was not associated with cancer screening among men. Fewer women reporting SV victimization had healthcare insurance, a personal doctor or healthcare provider, and received regular checkups within the past 1-12 months. Fewer men reporting SV victimization had healthcare coverage.

CONCLUSIONS

These data suggest that SV victimization may have a negative association on overall healthcare use, including breast cancer screening for women. Healthcare providers should consider SV victimization as a potential barrier for women who report not being up-to-date with mammography.

Chronic disease and health behaviours linked to experiences of non-consensual sex among women and men

OBJECTIVES

Few studies have examined the association between non-consensual sex and health indicators for both women and men. The current study examined this relationship as part of a large public health survey that collected information on a range of health behaviours and health risks.

METHODS

The Behavioural Risk Factor Surveillance System (BRFSS) is an annual random-digit-dialled telephone survey providing surveillance of health behaviours and health risks among US adults. In 2005, an optional module on sexual violence was available for use at the discretion of each US state/territory. Over 115,000 respondents in 25 states/territories were administered the sexual violence module within the BRFSS. Logistic regression analyses were conducted from January to December 2008.

RESULTS

Among both women and men, previous non-consensual sex was associated with health conditions such as high cholesterol, stroke and heart disease, and risk behaviours such as human immunodeficiency virus risk factors, smoking and excessive drinking. Sexually victimized women were more likely to report having had a heart attack or heart disease than non-victims.

CONCLUSIONS

The experience of non-consensual sex is associated with a number of chronic disease outcomes and risk factors. The development and implementation of effective sexual violence prevention strategies may reduce the risk of chronic conditions among persons who have experienced sexual victimisation.

Posttraumatic stress disorder, poor physical health and substance use behaviors in a national trauma-exposed sample

Both experiencing a traumatic event and PTSD are related to physical health problems (e.g., Schnurr and Jankowski, 1999) and health-risk behavior (e.g., Stewart, 1996). Using structural equation modeling analyses, we examined the interrelationships among number of distinct traumatic event exposures, PTSD diagnosis, physical health, and substance use behavior using epidemiological data from the National Comorbidity Survey Replication (NCS-R; Kessler et al., 2004). Results provide some evidence that PTSD mediates the relationship between: (a) number of distinct traumatic event exposures and poor physical health defined by clusters of difficulties with gastrointestinal, musculoskeletal, and/or cardiovascular health, and (b) number of distinct traumatic event exposures and substance use behaviors. However, substance use behaviors did not significantly mediate the relationship between PTSD and poor physical health.

Sexual violence, posttraumatic stress disorder, and the pelvic examination: how do beliefs about the safety, necessity, and utility of the examination influence patient experiences?

BACKGROUND

Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.

AIMS

This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions.

MATERIALS AND METHODS

A total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.

RESULTS

Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.

CONCLUSION

Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.

The mediating effect of depressive symptoms on the relationship between traumatic childhood experiences and drug use initiation

Stressful experiences such as childhood trauma and depressive symptoms have both been implicated in the initiation of drug use; however, longitudinal designs have not yet been used to elucidate their respective roles to better understand the causal sequence. In the present study, a sensitivity analysis was conducted using two mediation strategies to examine how this sequence may differ by various levels of statistical control, including (1) the standard mediational model in which the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) is mediated by levels of depressive symptoms (Year 2); and (2) a stronger test of causality such that the effect of lifetime traumatic stressors (Year 1) on the onset of drug use (Years 3 and 4) was mediated by changes in depressive symptoms (Year 1 to 2), measured by a residualized change score that controlled for levels in Year 1. Two types of trauma were studied in a community-based study of 489 Hispanic preadolescents (aged 10-12): (a) the number of lifetime traumatic stressors and (b) seven specific lifetime stressors. We also controlled for new onset traumatic stressors occurring between Years 1 and 2. Primary findings indicate that drug use initiation during early adolescence (e.g., ages 14-16) may not be tied to immediate proximal perturbations in risk factors, such as traumatic experiences and depressive symptoms. Rather, the effects of trauma on depression in this sample appear to be established earlier in childhood (ages 10-14 or younger) and persist in a relatively stable manner into middle adolescence when the risk for drug use may be heightened.

Military sexual trauma among U.S. female veterans

Sexual abuse among female veterans reportedly occurs in significant numbers in the U.S. military and has been recognized to cause posttraumatic stress disorder (PTSD). PTSD, which stems from sexual abuse, has been called military sexual trauma (MST), which has only recently been recognized by the Department of Defense. Consequently, there has been scant research on the prevalence, impact, and treatment of MST. This article explores the phenomenon of sexual aggression against female veterans in the U.S. military, risk factors for MST, PTSD as a result of MST, a conceptual framework for treating PTSD stress, and treatment strategies for PTSD.