Sexual Assault Among Women in College: Immediate and Long-Term Associations With Mental Health, Psychosocial Functioning, and Romantic Relationships

A serial Mediation Model of Depression and Drinking Motives Underlying Problem Drinking Among Hispanic College Women Following Rape

Problem drinking and depression are common following sexual assault. The current study applied a coping motives model of drinking and examined the association between rape experiences and problem drinking serially mediated by depression symptoms and coping-depression drinking motives among Hispanic college women. A total of 330 college women were classified into a single rape experience (SGL) group (n = 44), a multiple rape experiences (MLT) group (n = 70), and a no sexual assault experience group (n = 221). Participants completed self-report measures online. Serial mediation analyses with multi-categorical predictors found that significantly increased alcohol consumptions in rape survivors compared to individuals with no sexual assault experience were largely explained by the serially connected underlying mechanisms of depression symptoms and coping-depression drinking motives. The prevalence rates of rape experiences in this Hispanic female sample are alarming, suggesting Hispanic college women as a particularly vulnerable group for rape. The current results contribute to a greater understanding of the effects of rape experiences on behavioral and emotional outcomes among young Hispanic women who have been underrepresented in sexual victimization research. The findings emphasize the importance of assessing depression symptoms and coping-depression drinking motives in Hispanic rape survivors to reduce risks for hazardous drinking behavior.

General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention

BACKGROUND

Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care.

METHODS

Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05.

RESULTS

Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001).

CONCLUSION

This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

Yes, It's that Common and Yes, It's that Bad: An Estimation of the Prevalence and Psychological Correlates of Rape and Sexual Assault in College Women

Rape myths play a role in rape denialism, in which individuals deny the prevalence and severity of sexual assault. This project aimed to address two common rape myths: that rape is uncommon and its effects are exaggerated. To test these claims, we explored two archival samples consisting of undergraduate women. Study 1, a 5-year chart review of university counseling center intake forms (n = 883), demonstrated that 30.2% of clients had experienced "sexual violence," "sexual contact without consent," or both. Study 2, a re-analysis of an emerging adulthood resilience survey dataset (n = 359), demonstrated that 20.6% of subjects had a history of sexual assault, and that those women reported lower life satisfaction and more severe psychological symptoms than those who did not. These findings are in line with previous literature debunking harmful rape myths that contribute to the perpetuation of rape culture. Our data help validate these rape notions as mythical; rape is indeed common and devastating.

Trauma of the Shared Environment: A Qualitative Analysis of the Experiences of Survivors of College Campus Sexual Assault

Survivors of campus sexual assault are often tasked with healing while sharing an environment with their perpetrators. However, little is known about the effects of a shared environment on survivor well-being. A qualitative thematic analysis design was employed to address this gap. We conducted semi-structured interviews with nine female survivors who identified their perpetrators as fellow students at a large state university in the southeastern U.S. The five themes that emerged are situated within an ecological framework, which is also used to guide our recommendations for supporting survivors' well-being within higher education.

Psychosocial Sequalae of Sexual Assault in a Sample of Partnered Adults Experiencing Alcohol Use Disorder and Intimate Partner Violence

Research has shown that experiencing a sexual assault results in significant and lasting effects in many psychosocial domains. However, most studies on the impact of sexual assault examine university samples or the immediate aftermath of the assault, not taking into account the longer-term complexities and contexts of life for many victims. The current study seeks to evaluate the role of lifetime sexual assault history on several psychosocial outcomes in adults who are in intimate relationships that have included both intimate partner violence (IPV) and alcohol use disorder. The study included 100 adult romantic couples who were part of a larger project addressing violence and alcohol use. A majority of participants were Caucasian (74.3%) and female (53%). Participants reported on lifetime sexual assault history, depression, perceived stress, maladaptive cognitive emotion regulation, and perceived intimate relationship functioning. Multilevel analyses controlled for couple interdependence as well as current levels of alcohol use and IPV. Results indicated that the presence/absence of sexual assault was only related to perceived life stress (p = .016), while the total number of lifetime assault experiences was related to depression symptoms (p < .001), perceived life stress (p = .052), maladaptive cognitive emotion regulation (p = .048), and dyadic adjustment (p = .003). These findings underscore the importance of investigating sexual assault outcomes in complex populations, as well as the need for more thorough and regular assessment of sexual assault history. Focusing on empowerment and recovery for sexual assault victims of any age is an important tool to prevent the detrimental outcomes that particularly accompany multiple victimizations.

"Hardly Able to Move, Much Less Open a Book": A Systematic Review of the Impact of Sexual and Gender-Based Violence Victimization on Educational Trajectories

Sexual and gender-based violence (SGBV) is a highly prevalent issue, both in North America and globally, with well-recognized adverse impact on survivors' physical, emotional, and economic well-being. The objective of this systematic review is to collect and synthesize empirical work on the effects of SGBV victimization on educational trajectories, goals, attainment, and outcomes. The review summarizes what is known about factors associated with victimization that affect survivors' educational trajectories and highlights gaps in the literature pertaining to the effects of victimization on education. Five databases were searched for this review: Web of Science, Sociological Abstracts, PubMed, APA PsycInfo, and ERIC. For inclusion, the articles must present research on the academic impact of any form of SGBV experienced in higher education and must have been conducted in the United States or Canada. The 68 studies that met these criteria presented research on six key areas of educational outcomes: impacts on academic performance and motivation; attendance, dropout, and avoidance; changes in major/field of study; academic disengagement; educational attitudes and satisfaction; and academic climate and institutional relationships. Research also revealed factors mediating the relationship between SGBV exposure and educational outcomes such as mental health, physical health, social support, socioeconomic status, and resiliency, which we summarize in a pathway model. The research reviewed had significant limitations, including weak study designs, limited generalizability, and diversity concerns. We offer recommendations for future research on this topic.

Factors Correlated With Sexual Assault Victimization Among College Students in the United States: A Meta-Analysis

Sexual assault (SA) continues to be a serious problem on college campuses in the United States. This meta-analysis sought to identify correlates for SA victimization on college campuses, as well as examine if there were any differences in correlates for men and women. Database searches utilizing Boolean search terms were used to identify studies to be included in the meta-analysis. Studies were included if they provided quantitative data on correlates for SA victimization among college students. A total of 118 studies yielding 405 unique effect sizes were included in this study. The strongest correlates for SA victimization among college students were physical intimate partner violence (IPV) perpetration, physical IPV victimization, emotional IPV victimization, and prior SA victimization. Other significant correlates were related to mental health (e.g., hopelessness, suicidal ideation, trauma symptoms, anxiety symptoms, depressive symptoms), and factors related to a campus party culture (e.g., binge drinking, alcohol use, drug use, Greek membership). We were able to compare seven correlates between men and women. Results of the meta-analysis also highlight the need for future research to examine additional correlates for SA victimization, as well as examine race/ethnicity and gender as separate categories when trying to further understand correlates for SA victimization.

Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies

Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.

Correlates of College Women's Sexual Assault Resistance Self-Efficacy

Studies suggest that actively fighting back against an attacker is effective in decreasing the severity and completion of a sexual assault, yet little is known about the factors that contribute to women's confidence in fighting back. Accordingly, the present study examines correlates of college women's self-efficacy in resisting unwanted sexual advances (N = 650). Results suggest that fewer psychological barriers to resistance, greater sexual communication, increased use of dating self-protective behaviors, and greater sexual assertiveness were associated with increased sexual resistance self-efficacy. Findings underscore the importance of developing sexual assault prevention programs that increase women's confidence in fighting back.

Incidence and risk factors for postpartum mood and anxiety disorders among women veterans

BACKGROUND

Our aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service.

METHODS

A national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20-45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy.

RESULTS

A third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD.

CONCLUSION

Women Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.

Campus interpersonal violence survivor advocacy services

Objective: Although there has been increased attention to campus interpersonal violence, there is limited information on survivor advocacy services. Participants: We recruited participants from 155 U.S. institutions of higher education responsible for advocacy services on their campus. Methods: We used a community participatory action approach in partnership with the Campus Advocacy and Prevention Professionals Association to develop and disseminate a survey regarding campus advocacy services. Results: Participants shared critical insights about (a) advocacy staffing/caseload, (b) program structure, (c) advocacy practices, and (d) connection to services for people who had caused harm. We found that advocacy programs are often providing best practice services for survivors of violence but operating with few staff and unclear privacy protections. Conclusions: This study provided crucial preliminary information about how campuses provide advocacy services, but more researcher-practitioner engagement is needed to build on this study and establish clear practice guidelines.

Comprehensive policies for victims of sexual assault returning to the campus classroom: Lessons from university sports-related concussion policies

ObjectiveThe current paper presents a comparison of university policies and health and academic accommodations offered to undergraduate students following sexual assault (SA) and sports-related concussions (SRC). Procedures and protocols for universities to consider adapting from their SRC policies to their SA policies are detailed.Participants: The SRC and SA policies at the 50 United States public flagship universities were analyzed.Methods: The research team coded for a number of policy details including health referrals, academic and financial accommodations, and requirements for follow-up with university personnel.Results: Compared to SA polices, SRC policies at the public flagship universities offer more comprehensive academic accommodations and physical and mental health resources. Conclusions: Comprehensive policies for student SA survivors, like those available for students who suffer SRCs, would improve student health and academic outcomes and increase SA survivors' likelihood of graduating college, thereby reducing individual and societal human capital loses.

Perceptions of Institutional Response to Sexual Assault Amongst College-Based Victim Advocates

Federal law in the United States mandates that institutions of higher education address sexual assault within their communities. Colleges and universities have increasingly hired full-time professionals to manage response efforts, including campus-based victim advocates. Campus-based advocates provide emotional support, help students access and understand report options, and ensure students receive appropriate accommodations. Very little is known about the experience or perceptions of campus-based victim advocates. In this study, 208 professional campus-based advocates from across the United States completed an anonymous online survey focused on their perceptions of campus response to sexual assault. Multiple regression analysis was applied to investigate how psychosocial factors (burnout, secondary trauma, and compassion satisfaction) and organizational factors (perceptions of leadership, organizational support, and community relational health) were associated with advocate perceptions of institutional response to sexual assault. Findings indicate that while advocates experience burnout and secondary trauma, and have lower than average compassion satisfaction scores, these psychosocial outcomes do not influence their perception of response efforts. However, all the organizational factors significantly contribute to how advocates view response. The more positively advocates viewed leadership, campus support, and relational health, the more positive they viewed the response efforts on campus. In order to improve response efforts, administrators should engage in meaningful training on sexual assault, include campus advocates in high-level discussions of campus sexual assault and ensure appropriate resources are provided to advocacy services.

Image-Based Sexual Abuse Associated Factors: A Systematic Review

Purpose

Image-Based Sexual Abuse (IBSA) is a recently studied form of violence and abuse perpetrated using technology. This systematic review aims to examine and systematize studies exploring factors associated with IBSA (e.g., victimization, perpetration, and propensity to perpetrate).

Method

Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, 17 articles were included.

Results

The results of this study highlighted conceptual and methodological limitations in the literature on IBSA. Aside from these limitations, this systematic review identified factors associated with IBSA, focusing on four macro-areas: victimization, perpetration, propensity to perpetrate IBSA, and IBSA implications. The results demonstrated the role of psychological, relational, and social variables, although the effect sizes observed in the quantitative studies were small or in few cases moderate.

Conclusions

These results suggest further research should be carried out to explore the multidimensionality of IBSA and its associated factors, which may assist in guiding interventions to promote preventive and rehabilitative methods to lower the prevalence of this crime and its consequences.

Fostering college students' responsibility as prosocial bystanders to sexual violence prevention: A meta-analysis of the Bringing in the Bystander program

Objective: To synthesize research examining the effectiveness of the sexual violence bystander program Bringing in the Bystander (BitB). Participants: The analytic sample included 2083 youth in the treatment group and 969 in the comparison group. Method: A search strategy that included a total of 45 search terms was applied to 28 electronic databases. Results: The systematic search yielded a final analytic sample of 14 evaluations, with 38 independent effect sizes calculated across four outcome measures: rape myth attitudes (n = 11), bystander efficacy (n = 11), bystander intentions (n = 11), and bystander behavior (n = 5). The BitB program produced significant, positive pooled effects on measures of rape-supportive attitudes, bystander efficacy, and bystander intentions. Conclusions: The overall results are promising and suggest that the BitB education program may be an effective tool for targeting sexual violence on campuses.

Sexual Assault as a Contributor to Academic Outcomes in University: A Systematic Review

Sexual assault continues to be a prevalent and consequential experience for university students. The aim of this systematic review was to synthesize the literature on the academic consequences of the sexual assault for university students. There is currently no comprehensive review of the literature focusing on the academic consequences for university students who experienced sexual assault. This review was conducted based on searches from five databases including Academic Search Complete, Education Search Complete, Education Resources Information Center (ERIC), PsycINFO, and Google Scholar. We identified 13 articles that examined academic consequences of sexual assault during university. Across all studies, sexual assault was associated with more academic problems including lower grade point average, dropping out of university, and self-regulated learning problems. Although the number of articles is small, the results are consistent. Practically, this means that universities, those providing psychological services, and victims themselves need to understand that the consequences are not just physical and psychological but can also negatively impact academic achievement. Our review also identifies limitations in the literature regarding this topic such as methodological concerns, diversity and inclusion concerns, and the need for future work to investigate mediators of the relationship between sexual assault and academic outcomes. We offer recommendations for future research to combat the concerns identified. Development of interventions to support those who experience sexual assault during university necessitates overcoming the limitations identified.

Campus Climate and the Sexual Assault Victimization of LGBQ College Students

Sexual minority college students are disproportionately impacted by sexual assault in college, however, there is a paucity of research exploring the role of the college environment in victimization. This study explores the relationship of campus climate with sexual assault victimization for these students. This sample included 1,110 current college students in the United States who identified as a sexual minority. Logistic regression results indicated that the more observations of harassment and discrimination of sexual minority students by participants, the more likely they were to experience sexual assault victimization in college. Also, the more out a participant was on campus, and the stronger sense of belonging they had to their college, the less likely they were to experience sexual assault victimization. Sexual assault prevention efforts on college campuses would benefit from programming and policies that support belonging and address discrimination and harassment.

The impact of sexual violence in mid-adolescence on mental health: a UK population-based longitudinal study

BACKGROUND

A large gender gap appears in internalising mental health conditions during adolescence, with higher rates in girls than boys. There is little high-quality longitudinal population-based research investigating the role of sexual violence experiences, which are disproportionately experienced by girls. We aimed to estimate the effects of sexual violence experienced in mid-adolescence on mental health outcomes.

METHODS

In this study, we used data from the longitudinal UK Millennium Cohort Study, a large nationally representative cohort of children born in the UK in 2000-02, for participants with information available at age 17 years on sexual violence in the past year (eg, sexual assault or unwelcome sexual approach), mental health outcomes (eg, completion of the Kessler Psychological Distress K6 scale in the past 30 days, self-harm in the past year, and lifetime attempted suicide). Multivariable confounder adjusted regressions and propensity matching approaches were used, and population attributable fractions (PAFs) were calculated.

FINDINGS

We included 5119 girls and 4852 boys (8063 [80·8%] of whom were White) in the full analysis sample. In the fully adjusted model, compared with no sexual violence, sexual violence was associated with greater mean psychological distress in girls (mean difference 2·09 [95% CI 1·51-2·68]) and boys (2·56 [1·59-3·53]), higher risk of high psychological distress in girls (risk ratio [RR] 1·65 [95% CI 1·37-2·00]) and boys (1·55 [1·00-2·40]), higher risk of self-harm in girls (RR 1·79 [1·52-2·10]) and boys (RR 2·16 [1·63-2·84]), and higher risk of attempted suicide in girls (RR 1·75 [1·26-2·41]) and boys (RR 2·73 [1·59-4·67]). PAF estimates suggest that, in a hypothetical scenario with no sexual violence, the prevalence of adverse mental health outcomes at age 17 years would be 3·7-10·5% lower in boys and 14·0-18·7% lower in girls than the prevalence in this cohort.

INTERPRETATION

Reductions in sexual violence via policy and societal changes would benefit the mental health of adolescents and might contribute to narrowing the gender gap in internalising mental ill health. Clinicians and others working to support adolescents should be aware that sexual violence has a widespread, gendered nature and an impact on mental health.

FUNDING

UK Medical Research Council.

Implementation of empowerment self-defense programming in a university counseling center: An effective sexual violence prevention delivery model

Objective: Empowerment Self-Defense (ESD) is a sexual violence prevention approach backed by rigorous empirical research, yet its availability on college campuses is limited. This manuscript evaluates the feasibility and efficacy of an ESD program embedded within a university counseling center. Methods: Participants completed an 8-session ESD intervention and group counseling program. Results: Feasibility and acceptability of this program were demonstrated by excellent participant retention and supported by institutional buy-in and counselor involvement. Pre-post assessments demonstrated that participants reported significant reductions in posttraumatic stress symptoms, F (1, 56) = 22.46, p < .001 and improvements in both interpersonal self-efficacy, F (1, 56) = 88.81, p < .001, and self-defense self-efficacy, F (1, 56) = 100.20, p < .001. Conclusion: The findings support the use of ESD programming as part of college campus sexual violence efforts and provide a blueprint for administrators and college mental-health centers who wish to offer this effective program to the college students they serve.

An exploratory analysis of factors related to reporting sexual assault to college officials by LGBTQ student survivors

Sexual assault is a persistent problem on college campuses that disproportionately impacts sexual and gender minority identified students. Objective: This study explores how circumstances of the crime, disclosure to informal sources, training and campus climate are associated with reporting sexual assault to college officials by these students. Participants: A total of 409 lesbian, gay, bisexual, transgender and queer/questioning college students who experienced sexual assault while attending their current four-year college. Results: Chi-square and t-test analysis found that reporting to college officials was significantly associated with the type of assault experienced, disclosure to a campus advocates, disclosure to a parent/guardian, and the campus climate for LGBTQ students. Conclusion: These findings suggest that practitioners and college officials may support reporting behavior amongst sexual and gender minority identified students through enhanced campus support systems and strategic educational efforts.