Association of sexual revictimization with sexuality and psychological function

Polyvictimization Risk Among North Korean Refugee Women in South Korea

North Korean (NK) refugee women living in South Korea are known to be vulnerable to interpersonal violence, but little is known about the possible link between or co-occurrence of acts of sexual violence (SV) and intimate partner violence (IPV) perpetrated against NK refugee women. This study examined the prevalence of polyvictimization and explored the association between SV in different settings (i.e., North Korea, intermediate countries, and South Korea) and various types of IPV. A convenience sample of 140 adult NK refugee women was analyzed, and logistic regression analyses were conducted to examine the link between SV and polyvictimization in IPV. NK refugee women with a history of SV reported a significantly higher rate of IPV over the previous 12 months (51.2%) compared to those without a history of SV (20.4%). NK refugee women with a history of SV are significantly more likely to become victims of most forms of IPV. SV victimization in intermediate countries significantly increased the odds of being physically victimized by their male partners in South Korea (OR = 3.31, p =.05). An SV victimization history in North Korea (OR = 4.50, p =.04) and SV victimization experienced outside their intimate relationship in South Korea significantly increased the odds of sexual IPV from their current intimate partner (OR = 4.74, p =.03). This study showed that victims of human trafficking and sexual assault during their journey to South Korea were at a greater risk of IPV in South Korea. Male partners of NK refugee women with a history of SV may shame and physically sanction NK refugee women for "breaching honor." Therefore, screening for potential risk of physical and sexual IPV among NK refugee women with a prior exposure to SV is needed to develop programs in safety planning for NK refugee women experiencing SV and IPV.

The Association Between a History of Sexual Violence and Romantic Relationship Functioning: A Systematic Review

The consequences of sexual violence are substantial and include both intra- and interpersonal problems. Notably, sexual violence has been associated with difficulties in interpersonal relationships including intimate relationships. While there have been prior reviews considering various interpersonal and dyadic consequences associated with sexual violence, there has not been a comprehensive review considering the various aspects of adult dyadic functioning including intimacy, relationship conflict, and satisfaction satisfaction among both child and adult victims of sexual violence. The databases PsycINFO and PubMed were searched for terms related to sexual victimization (e.g., sexual assault, sexual victimization, sexual abuse, rape, revictimization), terms related to relationships (e.g., romantic relationship, intimate relationship), and terms related to relationship functioning (e.g., satisfaction, relationship quality, conflict, communication, intimacy, sexual functioning). Eligible studies for this review were required to (1) be an original study, (2) be written in English, (3) identify a sample or subsample consisting of women reporting a history of sexual violence in either childhood or adulthood, and (4) measure at least one of the following relationship areas: intimacy, relationship conflict, or relationship satisfaction in heterosexual adult romantic relationships. A total of 20 articles met inclusion criteria and were included in this review. Results demonstrated mixed findings on the association between sexual violence and relationship functioning, with some studies demonstrating an association between sexual violence and relationship functioning, and others failing to find such associations. These findings are discussed within the context of gaps in the extant literature and future research directions.

A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims

Although rape has been linked to risk for suicidal ideation and attempts, there are scant data on the efficacy of brief interventions to reduce suicidality among recent rape victims. This secondary analysis of a randomized controlled trial investigated whether a video intervention delivered in the emergency department (ED), cortisol measured at the ED, and prior rape history predicted postrape suicidal ideation independently or in combination with the other predictors. Participants were 235 women aged 15-71 years who presented to the ED for a sexual assault medical forensic examination and were randomly assigned to either receive a video intervention that addressed avoidance and promoted healthy coping strategies or standard care prior to the examination. Participants also provided a blood sample for cortisol and completed at least one of three follow-ups at 6 weeks, 3 months, or 6 months postrape. The intervention conferred protection against suicidal ideation among women with elevated cortisol and a prior rape; however, it did not reduce risk for women without a prior rape, particularly those with elevated cortisol. It may be important to consider the influence of prior rape and neuroendocrine reactivity in developing treatments to address suicidal ideation among rape victims. More specifically, there appears to be value in screening victims for prior rape and administering this brief intervention to reduce suicidal ideation; however, other avenues should be explored for victims without a prior rape history. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Repeat attenders are disproportionately vulnerable: An exploration of revictimisation at Saint Mary's Sexual Assault Referral Centre

BACKGROUND

Being a victim of sexual assault is linked to many psychological and physical health problems. Experiencing one episode of assault is a risk factor for revictimisation. Saint Mary's Sexual Assault Referral Centre (SARC) provides aftercare for clients in Greater Manchester and Cheshire who have suffered sexual assault and rape, with physical, psychological and sexual health services.

AIMS

This work's primary aim was to establish the prevalence of re-attendance of adults for a forensic medical examination to Saint Mary's SARC. The secondary aim was to identify the characteristics and vulnerabilities of clients who re-attended Saint Mary's SARC during a twelve-month period.

METHODS

Retrospective analysis of 42 sets of forensic medical notes for repeat attenders in 2017 was performed. A control sample of 42 single attenders from 2017 was randomly selected for comparison.

RESULTS

A total of 740 adult clients attended Saint Mary's for a forensic medical examination in 2017, 5.7% of whom had previously attended. Amongst these clients, significantly higher numbers experienced unemployment (p < 0.001), recent mental health complaints (p < 0.001), previous self-harm (p < 0.001), and previous suicide attempts (p = 0.001). There was a significantly larger number of repeat attenders who scored below the threshold that indicates likelihood of having a learning disability (p = 0.008). All clients who disclosed a history of alcohol abuse were repeat attenders. Repeat attenders were more likely to receive safeguarding than single attenders (p < 0.001).

CONCLUSIONS

Prevalence of repeat attenders at Saint Mary's SARC is lower than reported in many other studies. However consistent with the wider literature, this demographic showed higher level of vulnerability, and higher likelihood of receiving safeguarding. SARC staff and services should be prepared to attend to the additional needs of this group. Powered.

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors

The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.

Trauma and PTSD in the WHO World Mental Health Surveys

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Post-Traumatic Cognition Mediates the Relationship between a History of Sexual Abuse and the Post-Traumatic Stress Symptoms in Sexual Assault Victims

More than half of all sexual assault victims report experiencing sexual victimization more than once. The aim of this paper was to determine the role post-traumatic cognition plays in the relationship between a history of sexual abuse and post-traumatic stress symptoms in sexual assault victims. The relationship between a history of sexual assault and the severity of post-traumatic stress symptoms was investigated retrospectively using data from a sexual assault crisis center in Korea. Data on psychological symptoms were collected in person at the initial assessment and by telephone 1 month later using the Post-traumatic Cognitions Inventory and the Post-traumatic Stress Disorder Symptoms Scale: Self-report Version. Of 105 women included in the analysis, 10 (9.5%) reported prior sexual abuse and were classified as sexually revictimized. Revictimized women had more post-traumatic negative cognition at initial assessment (t = -2.98; P = 0.004) and more post-traumatic symptoms at 1 month follow-up (t = -2.39; P = 0.019) than singly victimized women. At 1 month follow-up, the severity of post-traumatic stress symptoms had increased in revictimized women but had decreased slightly in singly victimized women. Negative post-traumatic cognition fully mediated the association between a history of sexual abuse and the severity of post-traumatic stress symptoms. Early detection of sexually revictimized women and tailored service and treatment intervention is needed to better serve this group of victims. Interventions targeted at preventing revictimization or post crime victimization may also help victims recover from the trauma and prevent future abuse.

Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys

IMPORTANCE

Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions.

OBJECTIVE

To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set.

DESIGN, SETTING, AND PARTICIPANTS

The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016.

MAIN OUTCOMES AND MEASURES

Prevalence of PTSD assessed with the Composite International Diagnostic Interview.

RESULTS

Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0-3.8) and witnessing atrocities (4.2; 95% CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2-1.7), rape (OR, 2.5; 95% CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1-2.3).

CONCLUSION AND RELEVANCE

The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.

Post-traumatic Stress Disorder After Sexual Abuse in Adolescent Girls

The sexual assault of girls and women in this country is estimated at approximately 20%. The development of post-traumatic stress disorder (PTSD) after sexual abuse and assault is one of the potential lingering aftereffects. In this article we describe PTSD after sexual abuse and its effect on presenting complaints, such as sexually transmitted infections, contraception, and chronic pain, for the pediatric and adolescent gynecology (PAG) clinician. Treatment approaches, including the use of antidepressants and anxiolytics, as well as evidenced-based psychotherapies, are highlighted. In addition, this article will assist the PAG clinician in identifying trauma-related concerns during clinic visits and will cover specific screening tools to aid in identification of PTSD. A better understanding of PTSD after sexual abuse will allow PAG providers to deliver better care to their patients.

Nurse-Led Trauma-Informed Correctional Care for Women

PURPOSE

Incarcerated women are a vulnerable and unique population of special concern to nurses as they have high rates of mental illness. In this article, the authors discuss how trauma exposure contributes to mental illness in incarcerated women through abuse, socioeconomic factors, and the prison environment, how this trauma exposure manifests in the inmate survivor, and the related implications for practice.

CONCLUSIONS

A history of trauma and victimization is related to complex mental health issues which affect the majority of justice-involved women. The correctional environment can exacerbate these issues.

PRACTICE IMPLICATIONS

Nursing implications include discussion of the trauma-informed care model. The authors recommend a model of trauma-informed care named "the 4 Es" that can guide nurses in preparing a trauma-informed correctional environment and discuss the importance of nurse-led policy change in finding alternatives to incarceration for women with mental illness.

Attachment style as a mediator between childhood maltreatment and the experience of betrayal trauma as an adult

Previous research has demonstrated a positive association between child maltreatment and adult interpersonal trauma (Arata, 2000; Crawford & Wright, 2007). From a betrayal trauma theory perspective, evidence suggests that the experience of trauma high in betrayal (e.g., child maltreatment by parents or guardians) increases ones risk of betrayal trauma as an adult (Gobin & Freyd, 2009). However, the mechanisms explaining these associations are not well understood; attachment theory could provide further insight. Child maltreatment is associated with insecure attachment (Baer & Martinez, 2006; Muller et al., 2000). Insecure attachment is also associated with deficits in interpersonal functioning and risk for intimate partner violence, suggesting insecure attachment may mediate the relationship between child maltreatment and the experience of betrayal trauma as an adult. The current study tested this hypothesis in a sample of 601 college students. Participants completed online questionnaires including the Child Abuse and Trauma Scale (CATS), the Experiences in Close Relationships - Revised (ECR-R) and the Brief Betrayal Trauma Survey (BBTS). Results indicated that child maltreatment is associated with adult betrayal trauma and anxious attachment partially mediates this relationship.

Sexual revictimization: the impact of attachment anxiety, accumulated trauma, and response to childhood sexual abuse disclosure

It has been proposed that a complexity of personal, interpersonal, and environmental factors is related to sexual revictimization among childhood sexual abuse survivors. In this study, we investigated the relations between attachment dimensions, exposure to accumulated childhood traumas, reaction to childhood sexual abuse disclosure, and adult sexual revictimization. Participants were 60 Israeli women with histories of childhood sexual abuse. Seventy percent of the women reported adult sexual revictimization. Revictimization was related to higher attachment anxiety but not to higher attachment avoidance. Revictimization was also related to emotional and physical child abuse but not to emotional and physical child neglect. Revictimization rates were higher among women who had received negative environmental responses following childhood sexual abuse disclosure than among women who had received supportive reactions and those who had not disclosed childhood sexual abuse at all. Findings were significant even after controlling for severity of childhood sexual abuse. The findings emphasize the role of various contextual-interpersonal factors on revictimization vulnerability among the survivors of childhood sexual abuse.

Mood instability and psychosis: analyses of British national survey data

BACKGROUND

We used British national survey data to test specific hypotheses that mood instability (1) is associated with psychosis and individual psychotic phenomena, (2) predicts the later emergence of auditory hallucinations and paranoid ideation, and (3) mediates the link between child sexual abuse and psychosis.

METHODS

We analyzed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N = 8580 and 7403, respectively). The 2000 survey included an 18-month follow-up of a subsample (N = 2406). Mood instability was assessed from the Structured Clinical Interview for DSM-IV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale.

RESULTS

Mood instability was strongly associated in cross-sectional analyses with psychosis (2000: OR: 7.5; 95% CI: I 4.1-13.8; 2007: OR: 21.4; CI: 9.7-41.2), paranoid ideation (2000: OR: 4.7; CI: 4.1-5.4; 2007: OR: 5.7; CI: 4.9-6.7), auditory hallucinations (2000: OR: 3.4; CI: 2.6-4.4; 2007: OR 3.5; CI: 2.7-4.7), and paranoia total score (2000: Coefficient: 3.6; CI: 3.3-3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3; CI: 1.6-3.3) and of auditory hallucinations (OR: 2.6; CI: 1.5-4.4). Finally, it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation and a quarter of that with auditory hallucinations.

CONCLUSIONS

Mood instability is a prominent feature of psychotic experience and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.

A review of the health effects of sexual assault on African American women and adolescents

OBJECTIVE

To review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault.

DATA SOURCES

Searches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape.

STUDY SELECTION

Criteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty-one publications met inclusion criteria.

DATA EXTRACTION

Articles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents.

DATA SYNTHESIS

Sexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes.

CONCLUSION

Sexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents' responses to assault.

History of sexual abuse and development of sexual risk behavior in low-income, urban African American girls seeking mental health treatment

OBJECTIVE

This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment.

METHOD

Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2-T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates.

RESULTS

Sexual abuse was significantly associated with T2 sexual experience, T2-T4 number of partners, T3 inconsistent condom use, and T2-T3 having a risky partner. These relationships decreased when mental health symptoms were controlled.

CONCLUSIONS

This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.

Mediators of the relation between childhood sexual abuse and women's sexual risk behavior: a comparison of two theoretical frameworks

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood, but little research has investigated processes that might mediate this relation. The purpose of this study was to investigate whether constructs suggested by the traumagenic dynamics (TD) model (a theory of the effects of CSA) or constructs suggested by the information-motivation-behavioral skills (IMB) model (a theory of the antecedents of sexual risk behavior) better mediated the relation between CSA and sexual risk behavior in adulthood. Participants were 481 women attending a sexually transmitted infection clinic (66% African American) who completed a computerized survey as well as behavioral simulations assessing condom application and sexual assertiveness skills. Forty-five percent of the sample met criteria for CSA and CSA was associated with sexual risk behavior in adulthood. In multiple mediator models, the TD constructs mediated the relation between CSA and the number of sexual partners whereas the IMB constructs mediated the relation between CSA and unprotected sex. In addition, the TD constructs better mediated the relation between CSA and the number of sexual partners; the TD and IMB constructs did not differ in their ability to mediate the relation between CSA and unprotected sex. Sexual risk reduction interventions for women who were sexually abused should target not only the constructs from health behavior models (e.g., motivation and skills to reduce sexual risk), but also constructs that are specific to sexual abuse (e.g., traumatic sexualization and guilt).

Sexual victimization among Spanish college women and risk factors for sexual revictimization

Sexual revictimization is frequent among victims of child sexual abuse. Several variables, such as sexual experience, substance abuse, and sexual assertiveness, have been proposed to explain the link between child sexual abuse and adolescent and adult sexual victimization, although they have typically been tested separately. The main objective of this study was to analyze which of these variables better explains the revictimization phenomenon using a multiple mediation analysis. The study also tested the frequency of sexual victimization experiences in a Spanish sample of college women. Four hundred and two women were interviewed. Results showed that 30.4% of them engaged in undesired sexual contact while almost 4% were victims of rape. The most frequent perpetrators were partners or ex-partners, acquaintances, or dating partners, but not strangers. Finally, the relationship between child sexual abuse and adolescent and adult sexual victimization was mediated by number of consensual sexual partners and sexual assertiveness. Results reflect some cultural differences from previous research.

A discussion of HIV/AIDS family interventions: implications for family-focused nursing practice

AIM

This article presents a discussion on the role of family interventions in HIV/AIDS disease prevention and care.

BACKGROUND

Although HIV/AIDS epidemic and its impact on the society traditionally has been measured in terms of individual risk behaviours and individual-level HIV prevention, HIV/AIDS family-focused prevention and management strategies are increasingly becoming a priority. However, little is known as to what constitutes a HIV/AIDS family intervention.

DATA SOURCES

The search was limited to English and published literature starting in the year 1983 to date. CINAHL and PubMed were emphasized using a combination of text words and subject headings. Cochrane Library, PsycInfo, Scopus, and the ISI Web of Science databases were also searched using keywords and in the case of PsycInfo, subject headings were used. The main keywords were 'nurse', or 'nursing', 'HIV/AIDS', 'family interventions', 'family support' and 'family education', and/or 'family subsystems'.

DISCUSSION

The process of theorizing about 'family interventions' and 'HIV/AIDS-family interventions' is critical for putting forth essential components unique for designing culturally specific HIV/AIDS family interventions. In addition, any proposed design of HIV/AIDS family intervention should consider the impact of HIV/AIDS on the family across the family life span, disease trajectory, and from an interdisciplinary perspective.

CONCLUSION

Training needs of family nurses should be met when designing multidisciplinary HIV/AIDS-FIs. Furthermore, nurses should be proactive in advocating for HIV/AIDS family intervention and HIV/AIDS family policies to improve outcomes in family functioning, processes, and relationships. More needs to be done in regard to research on families, family interventions, effectiveness, and cost of family-focused approaches.

The effect of acculturation and immigration on the victimization and psychological distress link in a national sample of Latino women

Distinct bodies of research have examined the link between victimization and psychological distress and cultural variables and psychological health, but little is known about how cultural variables affect psychological distress among Latino victims. Substantial research has concluded that Latino women are more likely than non-Latino women to experience trauma-related symptoms following victimization. In addition, examination of different types of cultural adaptation has found results supporting the idea that maintaining ties with one's culture of origin may be protective against negative mental health outcomes. The present study evaluates the effect of victimization, immigrant status, and both Anglo and Latino orientation on psychological distress in a national sample of Latino women. Results indicate that along with the total count of victimization experiences, Anglo and/or Latino orientation were strong predictors of all forms of psychological distress. Anglo orientation also functioned as a moderator between victimization and psychological distress measures for anger, dissociation, and anxiety. The results suggest a more nuanced and complex interaction between cultural factors, victimization, and psychological distress.

Sexual health in women reporting a history of child sexual abuse

OBJECTIVE

The present study examined the association between child sexual abuse (CSA) and sexual health outcomes in young adult women. Maladaptive coping strategies and optimism were investigated as possible mediators and moderators of this relationship.

METHOD

Data regarding sexual abuse, coping, optimism and various sexual health outcomes were collected using self-report and computerized questionnaires with a sample of 889 young adult women from the province of Quebec aged 20-23 years old.

RESULTS

A total of 31% of adult women reported a history of CSA. Women reporting a severe CSA were more likely to report more adverse sexual health outcomes including suffering from sexual problems and engaging in more high-risk sexual behaviors. CSA survivors involving touching only were at greater risk of reporting more negative sexual self-concept such as experiencing negative feelings during sex than were non-abused participants. Results indicated that emotion-oriented coping mediated outcomes related to negative sexual self-concept while optimism mediated outcomes related to both, negative sexual self-concept and high-risk sexual behaviors. No support was found for any of the proposed moderation models.

CONCLUSIONS

Survivors of more severe CSA are more likely to engage in high-risk sexual behaviors that are potentially harmful to their health as well as to experience more sexual problems than women without a history of sexual victimization. Personal factors, namely emotion-oriented coping and optimism, mediated some sexual health outcomes in sexually abused women. The results suggest that maladaptive coping strategies and optimism regarding the future may be important targets for interventions optimizing sexual health and sexual well-being in CSA survivors.

At risk: the relationship between experiences of child sexual abuse and women's HIV status in Papua New Guinea

Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample of 415 women across four provinces of Papua New Guinea: National Capital District, Western Highlands, Western, and Morobe. Participants were asked about violence they had experienced as children and in their adult relationships and the impact of the violence. The quantitative data was analyzed using SPSS, and qualitative data was coded using a thematic approach. Child sexual abuse was reported by 27.5% of the sample (n = 114). Women reporting child sexual abuse were more likely to live in violent relationships, be HIV positive, and have a higher number of sexual partners.

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.

Childhood sexual abuse associated with dating partner violence and suicidal ideation in a representative household sample in Hong Kong

This study investigated the prevalence and impact of childhood sexual abuse (CSA) on future intimate partner violence (IPV) in dating relationship in Hong Kong, China. A total of 1,154 Chinese adult respondents engaged in dating relationships were interviewed face-to-face about their CSA histories, childhood witnessing of parental violence, adult sexual victimization (ASV) by others and IPV victimization with their current dating partner. Self-reports also measured levels of suicidal ideation, self-esteem, and demographic details. Overall, 1.7% reported some form of CSA with a higher percentage being women. No gender differences were found in the prevalence of either ASV or IPV. Results showed that CSA had an independent effect on physical IPV and suicidal ideation. The odds of IPV were increased by behavioral and psychological factors of victims such as alcohol and drug abuse, sex with partner, and low self-esteem. The odds of suicidal ideation were also increased by drug abuse, childhood witnessing of parental psychological aggression, and low self-esteem. Clinical implications of results included screening for CSA victims and suicidal victims when treating IPV patients, tailoring treatment according to individual IPV victim's problems, correcting behaviors that are associated with risks of IPV, such as engagement in casual sex and substance abuse, and focusing not only on tangible services but also on the social and psychological aspects that are placing the victims at risk for IPV.

Child sexual abuse reported by an English national sample: characteristics and demography

AIM

The 2007 adult psychiatric morbidity survey in England provides detailed information of high quality about sexual abuse. Given the major psychiatric implications of child sexual abuse (CSA), we aimed to establish its sociodemographic distribution in the general population.

METHOD

The experience of sexual abuse was elicited in a random sample of the English household population (N = 7,353), using computer assisted self-completion interviewing. Respondents were handed a laptop, and entered their responses to detailed questions. The interviewer was blind to their responses. CSA was defined as occurring before the age of 16.

RESULTS

2.9% of women and 0.8% of men reported CSA involving non-consensual intercourse, figures that rose to 11.1 and 5.3% if experiences involving sexual touching were included. CSA was common before puberty, but peaked in adolescence. CSA greatly increased the chance in adulthood both of further sexual abuse (OR 10.6; CI 8.9-12.6), and of prostitution (OR 3.3; CI 1.9-5.5). There was no association with ethnicity or social class, but people over 65 were less likely to report CSA. The odds of CSA were doubled in those not brought up with both biological parents until the age of 16.

CONCLUSION

CSA is common, particularly in women, and is not the preserve of any particular social group. Its frequency and its association with psychiatric consequences render it a major public health issue.

Association between childhood sexual abuse and adult sexual victimization in a representative sample in Hong Kong Chinese

OBJECTIVE

The current study investigated the prevalence and impact of childhood sexual abuse (CSA) on adult sexual victimization (ASV) in Hong Kong, China. This study also examines correlates of demographic characteristics, depression, suicidal ideation, and self-esteem with ASV.

METHODS

A total of 5,049 Chinese adult respondents were interviewed face-to-face about their experiences of CSA, childhood witness of parental violence, ASV (by non-partner), and intimate partner violence (IPV). Self-reports also measured depression, suicidal ideation, self-esteem, and demographic details.

RESULTS

Of all respondents, 0.9% reported some form of CSA, with a higher percentage being women. CSA was found to pose a significant risk for preceding year IPV (sexual) after controlling for demographic factors. Gender, age, indebtedness, alcohol and drug abuse, depression, and low self-esteem significantly increased the odds of IPV (sexual), whereas suicidal ideation and being newly arrived from China increased the risk of ASV (by non-partner). Childhood witness of parental psychological aggression and physical violence were also associated with a higher risk of IPV (sexual).

CONCLUSIONS

Childhood sexual abuse may have an independent association with future sexual victimization in adulthood, but many covariates can also affect the impact of CSA and increase the risk of revictimization.

PRACTICAL IMPLICATIONS

Intervention with ASV should include an assessment of CSA history and thus a screening for multiple victimization from IPV among victims. Prevention of revictimization for IPV victims with CSA histories may focus on making social and individual changes.

Sexual revictimization in a clinical sample of women reporting childhood sexual abuse

BACKGROUND

Child and adolescent sexual abuse (CSA) increases the risk for adult sexual assault (ASA), and psychological vulnerability as well as aspects of CSA and upbringing might influence the risk.

AIMS

The aims of this study were to investigate whether women who reported both CSA and ASA: 1) have been exposed to more severe CSA and 2) have greater psychological distress and vulnerability than women who were not revictimized.

METHODS

The study was a cross-sectional study of 161 adult women with a reported history of intrafamilial CSA. Thirty-six per cent of the women stated they had been exposed to ASA. The severity of CSA, psychological distress (Symptoms Checklist-90-R) and Cognitive Distortion were assessed. Five factors of Cognitive Distortion (fearful, scared, shy, mistrust and vulnerable) were identified by factor analysis of Symptoms Checklist-90-R sub-scale.

RESULTS

The CSA was significantly more severe (penetration: 77%/60%; multiple offenders: 67%/25%) in women exposed to ASA compared with their counterparts, as was the rate of suicide attempts (47%/30%). Also, the psychological distress and the factors: fearful, scared, shy and mistrust were significant higher.

CONCLUSION

The results showed an increased psychological vulnerability among women with ASA, but whether the results are cause or effect of sexual revictimization or can be generalized to other clinical samples are not clear. Interventions targeting the increased risk of ASA should be developed, implemented and tested in prevention as well treatment programmes.

From the margins to the center: ethnic minority women and the mental health effects of sexual assault

The trauma of sexual assault is heightened for many women by the interlocking experience of societal traumas such as racism, sexism, and poverty. The mental health effects of sexual assault are mediated by race and ethnicity. The investigators explore the experiences of African American, Asian American, Latina, and Native American female survivors of sexual assault. The sociohistorical context of intergenerational trauma in the lives of ethnic minorities is a part of the context for the contemporary experience of sexualized violence. Racial and ethnic dynamics related to sexual assault prevalence, mental health effects, and disclosure are examined. Literature related to cultural beliefs, community attitudes, and perceived social support in relation to sexualized violence are also reviewed. Finally, practice, research, and policy implications are discussed.

An ecological model of the impact of sexual assault on women's mental health

This review examines the psychological impact of adult sexual assault through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology contribute to post-assault sequelae. Using Bronfenbrenner's (1979, 1986, 1995) ecological theory of human development, we examine how individual-level factors (e.g., sociodemographics, biological/genetic factors), assault characteristics (e.g., victim-offender relationship, injury, alcohol use), microsystem factors (e.g., informal support from family and friends), meso/ exosystem factors (e.g., contact with the legal, medical, and mental health systems, and rape crisis centers), macrosystem factors (e.g., societal rape myth acceptance), and chronosystem factors (e.g., sexual revictimization and history of other victimizations) affect adult sexual assault survivors' mental health outcomes (e.g., post-traumatic stress disorder, depression, suicidality, and substance use). Self-blame is conceptualized as meta-construct that stems from all levels of this ecological model. Implications for curbing and/or preventing the negative mental health effects of sexual assault are discussed.

Forcible, drug-facilitated, and incapacitated rape in relation to substance use problems: results from a national sample of college women

This is the first study to examine the relation between rape and substance use problems in college women as a function of three legally recognized forms of rape: forcible, incapacitated, and substance-facilitated rape. Data were collected via structured telephone interview with a large national sample of college women aged 18-34 years (n=1980). Lifetime prevalence of any type of rape was 11.3% in the sample. Prevalence estimates for binge drinking and substance abuse were 15.8% and 19.8%, respectively. Lifetime experience of incapacitated rape and drug-alcohol facilitated rape, but not forcible rape, were associated with increased odds of past-year binge drinking and substance abuse. Findings have implications for secondary prevention and call for continued differentiation in assessment of rape type.

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.

Epidemiology and consequences of women's revictimization

This study uses Kraemer's approach for nonrandom comorbidity to identify the parameters of revictimization among women, using a diverse, population-based sample. Participants (n = 11,056) are from the California Women's Health Survey. Women were asked about childhood and adult violence and current symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. Logistic regressions adjusted for age, ethnicity, education, and poverty indicate that women who experienced childhood physical or sexual abuse were 5.8 (95% confidence interval, 5.2-6.4) times more likely to experience adult physical or sexual victimization. Revictimization affected 12% of women, and these women were substantially more likely to report current symptoms of anxiety, depression, and PTSD than women exposed to violence only in childhood or only as an adult. Revictimization is a methodologically distinct concept and is a potent risk factor for adult mental health problems. Prevention should target women exposed to both physical and sexual assault.

Obesity, body image, and unsafe sex in men who have sex with men

Little is known about the relationship among body weight, body image, and HIV/AIDS sexual risk behaviors. We examined this issue in a midwestern U.S. metropolitan area community sample of 316 men who have sex with men, a group at relatively high risk for HIV/AIDS. All data were self-reported by questionnaire using standard items to assess current body image, height and weight, and HIV/AIDS sexual risk behaviors. Logistic regression models were used to estimate cross-sectional associations. Forty-nine (15%) of the 316 men were classified as obese, and 56 (18%) had unsafe sex in the past three months. Normal weight or overweight men were 3.6 times more likely than obese men to have had unsafe sex, after adjusting for differences in body image and age. Men with better body image were 1.4 times more likely than men with lower body image to have had anal sex, after adjusting for differences in body weight and age. Non-obese men were no more or less likely than were obese men to have engaged in anal sex or in any sex in the past three months. This is the first study showing a positive relationship between below-obese body weight and unsafe sex and between better body image and anal sex in men who have sex with men. Future research should investigate these novel findings, perhaps using other study designs and data collection tools with less measurement error. Advances in knowledge about HIV/AIDS risk factors, including body weight and body image, could potentially contribute to more effective approaches to reducing this risk.