Risk for Mental Disorders Associated With Sexual Assault: A Meta-Analysis

The relationship between childhood trauma, rs1360780 genotypes, FKBP5 intron 7 methylation and posttraumatic stress disorder in women who have experienced rape

Background: Posttraumatic stress disorder (PTSD) is a common sequela of rape. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a core regulator of the stress response, has been implicated in the aetiology and chronicity of PTSD. FK506 binding protein (FKBP5) is a co-chaperone and functional regulator of the glucocorticoid receptor and the HPA-axis.Objective: This study investigated main and interaction effects of childhood trauma and the FKBP5 rs1360780 genotype on longitudinal FKBP5 intron 7 methylation, and whether change in FKBP5 methylation over time was associated with PTSD symptom severity over time.Method: Women who experienced rape (n = 96) were recruited from post-rape care services in KwaZulu Natal, South Africa. Total PTSD symptom scores, derived from the Davidson Trauma Scale, were assessed at baseline, 3-months and 6-months post-rape. Methylation levels at five FKBP5 intron 7 CpG sites were determined using EpiTYPER Sequenom MassArray technology. Genotyping of rs1360980 was completed using the Agena MassArray genotyping system. Mixed linear regression models were used to analyse the data.Results: The interaction between rs1360780 genotype and childhood trauma was a significant predictor of FKBP5 methylation over time. There was a significant positive correlation between childhood trauma and methylation levels in participants with the CT and TT genotypes, while there was a significant negative correlation between childhood trauma and methylation in CC genotype carriers. FKBP5 methylation was not a predictor of PTSD scores over time.Conclusion: This is the first study to investigate longitudinal change in FKBP5 methylation in a demographically homogenous same-trauma sample. The findings implicate childhood trauma and FKBP5 rs1360980 genotype in the trajectory of FKBP5 methylation levels in the aftermath of rape. Further research is needed to investigate the longitudinal role of FKBP5 intron 7 methylation in relation to PTSD symptom trajectories post-rape.

Therapists perspectives on the Early Intervention after Rape study: a qualitative process evaluation of a randomized controlled trial

ABSTRACTBackground: Early interventions using trauma-focused cognitive behavioural therapy have the potential to alleviate post-traumatic stress symptoms in individuals who have experienced recent sexual assault. Specialized Sexual Assault Centers (SACs) in Norway offers psychosocial support, however, this support varies across SACs and its efficacy has not been researched. The Early Intervention after Rape (EIR) study is a multisite randomized controlled trial designed to assess the efficacy and effectiveness of training SAC nurses and social workers to deliver a modified version of prolonged exposure therapy shortly after rape.Objective: This article aims to present a qualitative process evaluation of the implementation of the EIR study across three SACs in Norway, from the perspective of nurses and social workers.Method: We conducted semi-structured interviews with fifteen nurses and social workers, ten of whom received training in prolonged exposure therapy (mPE). We used Thematic Analysis to identify themes and subthemes.Results: Thematic analysis yielded four significant themes for process evaluation: (1) The quality of the new intervention modified prolonged exposure was considered satisfactory through training and supervision and delivered with good adherence to the manual, although some therapists perceived the manual as too rigid; (2) Adoption dynamics within the SACs are complex and include both enthusiasm for clinical research as well as resistance to change; (3) Narrow inclusion criteria and burden with participation for patients may limit reach and representativeness of the RCT; (4) Unintended consequences were identified, such as delayed start, conflicting advices and cross-contamination, underscoring the ongoing necessity for process evaluation alongside RCTs.Conclusion: This qualitative process evaluation offers insight into real-world clinical challenges with implementing a new intervention and conducting a multisite RCT within SACs in Norway. This study may inform opportunities to advance evidence-based practices for rape survivors seeking help.Trial registration: ClinicalTrials.gov identifier: NCT05489133..

She Asked for It? Descriptions of Victims' Behaviors Are Associated With Sentencing in Norwegian Rape Trials

Feminist theorists have long argued that rape myths contribute to normalizing sexual assault, through belittling and denying rape victims' claims. This study examines whether descriptions of victims' behaviors are associated with sentencing in rape trials. A total of 2054 Norwegian court decisions from 2013 to 2023 in judicial records were screened. Fifty-one of these included descriptions of the victims' behavior as operationalized by a subscale of the Illinois Rape Myth Acceptance Scale called "She Asked For It" (IRMAS-SAFI; type of clothing, going to a room alone with a guy at a party, previous sexual behavior, saying no unclearly, and kissing). Matching cases without such descriptions were then selected, resulting in a total sample of 102 court decisions. In addition, a randomly selected comparison group (n = 51) was included for robustness analysis. Results revealed that defendants who had attacked a victim in the IRMAS-SAFI group were sentenced to fewer months in prison (M = 25.3, SD = 20.9) than defendants from the comparison group (M = 41.7, SD = 13.3). This type of description of victims' behavior was significantly associated with shorter prison sentences when controlling for medical evidence, age of the defendant, and use of violence. The results indicate that implementing measures to reduce the influence of rape myths on judges' evaluations in rape trials could lead to fairer court decisions.

What do States Recommend We Teach Adolescents about Sexual Consent? A Content Analysis of K-12 Health Education Standards in the US

Although universities in the US commonly implement sexual consent education programs for students that focus on understanding how to communicate sexual consent, it remains unclear to what extent sexual consent education is taking place in grades K-12. The goal of this study was to assess K-12 health education standards recommendations for sexual consent education. We conducted a content analysis of health education standards from 43 states in the US to evaluate the guidelines provided to health educators across different grade levels. Using inductive and deductive coding, we identified six themes related to sexual consent. These themes were: 1) defining sexual consent, 2) explaining the legal standard of sexual consent, 3) defining personal space, 4) promoting healthy decision-making, 5) emphasizing good communication skills, and 6) defining healthy relationships. Fewer states directly focused on sexual consent education; instead, they provided information that could indirectly relate to consent, such as discussions on relationships and personal space. Across grade levels, topics related to sexual consent became more prevalent as adolescents progressed through school. While many states' health standards do not explicitly discuss sexual consent, they may implicitly address consent through other topics. Educators and policymakers should advocate for more explicit and detailed education on sexual consent in the K-12 school system. This could help increase the number of students educated on sexual consent before entering higher education, potentially reducing rates of sexual violence, and promoting healthier sexual behaviors and attitudes.

How Do College Students Perceive Their Partner Responds to Them When They Refuse Sexual Activity?

Refusal communication is a dyadic process, with one person communicating a refusal and another person responding. To enhance our understanding of this process, we surveyed college students to assess their interpretation of their partners' responses when they declined vaginal-penile sexual activity. In an online survey, participants were prompted to describe their partners' reactions when participants refused their partner's vaginal-penile sex initiation. Through content analysis, three themes were present: (1) partner accepted the refusal, (2) partner experienced negative emotions, (3) partner ignored their refusals. Participants frequently reported their refusals were accepted. Sexual assault prevention initiatives should work to normalize refusal communication.

Sexual Violence Among a State Sample of High School Students: The Impact of Gender Identity and Sexual Orientation

Sexual violence is a pervasive public health issue that has a direct and disproportionate impact on U.S. adolescents. Sexual violence victimization (SVV) is strongly associated with adolescent depression, anxiety, post-traumatic stress, and suicidality, and sexual violence perpetration (SVP) with substance abuse and other health risk behaviors. Gender and sexual-orientation-diverse youth may be at greater risk of sexual violence and the associated mental health consequences. We used data from the 2021 Healthy Kids Colorado Survey, a school-based survey administered to a population sample of high school students, to examine the prevalence of SVV and SVP. We examined the prevalence by demographic characteristics and association with mental health outcomes. Among this sample of high school students, 13% reported SVV and 2.6% reported SVP. Prevalence of SVV was significantly higher for cisgender females and transgender students than cisgender males, and higher for lesbian/gay/bisexual youth than heterosexual youth. SVP was significantly lower among cisgender females than males, yet transgender students had significantly higher odds of SVP, as did lesbian/gay/bisexual and asexual/questioning youth, as compared to heterosexual youth. Future research, particularly those with state-representative samples, should ensure careful attention to include questions around sexual violence experiences (both victimization and perpetration), gender/sexual identity, and race/ethnicity, given the magnitude of differences of SVV and SVP among these subgroups of adolescents. Mental health and suicidality are further underscored as key associations with sexual violence experiences, highlighting the importance of additional research and interdisciplinary responses to these critical aspects of public health prevention and care.

Targeting mental health and wellbeing in women who have experienced gender-based violence through moderate-vigorous physical activity: a systematic review

BACKGROUND

Gender-based violence (GBV) is associated with high rates of psychopathology (i.e., depression, anxiety, post-traumatic stress disorder) in victim-survivors. Existing research has demonstrated that physical activity is beneficial for mental health and wellbeing across various populations. However, it is currently unclear whether moderate-vigorous physical activity (MVPA) is efficacious for victim-survivors of GBV. Therefore, this systematic review aims to understand 1) the acceptability and feasibility of leisure-time MVPA interventions for victim-survivors of GBV, 2) the efficacy of leisure-time MVPA interventions for mental health and wellbeing in this cohort, and 3) the implementation strategies used in the development of such interventions.

METHODS

Four databases were searched from inception to January 2024. Leisure-time MVPA intervention studies that reported on at least one measure of mental health or wellbeing for self-identified/biological women who had lived experience of GBV were eligible.

RESULTS

Eleven studies met inclusion criteria, and analysis revealed a range of different types of MVPA (n = 5) and mental health/wellbeing outcomes measured (n = 9). The main findings include: 1) feasibility and acceptability of MVPA for victim-survivors was enhanced where trauma and violence-informed (TVI) practices were used in the development and delivery of interventions. 2) There was a lack of clarity and consistency around TVI practice in physical activity intervention research. 3) Leisure-time MVPA may be positively associated with mental health and wellbeing.

CONCLUSIONS

Limited evidence exists regarding the impact of MVPA on mental health and wellbeing for this important population group. Future studies should embed TVI strategy within the design, delivery, and implementation of interventions.

The cost of being a legal patient: Judicial use of rape defendants' and victims' psychiatric records in South Korea

Mental health evidence in courts can either support or undermine the trustworthiness and accuracy of each party's claims. When defendants and victims of sex crimes against women present their medical evidence, how are their claims impacted differently? This paper examines the court's interpretation of defendants' and victims' psychiatric records in 821 South Korean court cases involving rape (2013-2023). The findings show that a defendant's credibility is discussed as a potential mitigating factor in determining their responsibility and treatability. In contrast, a victim's credibility is debated at the risk of dismissing the entire case, determining the occurrence of the crime and new harm. This structural imbalance is exacerbated when rape trials turn into false accusation trials, in which rape victims must use their psychiatric evidence to invalidate their own rape allegations. The paper highlights the asymmetrical cost of being a patient to speak up in court and discusses the consequences of diagnosis with the term legal patient.

Interaction of sexual violence perpetration and victimization on suicide attempts in Korean adolescents on additive and multiplicative scales: a population-based cross-sectional study

PURPOSE

To evaluate the associations and interaction between sexual violence perpetration and victimization on suicide attempts using a large representative sample of adolescents from South Korea.

METHODS

Based on data from 515,247 adolescents aged 12-18 years from the Korea Youth Risk Behavior Web-Based Survey (2006-2012), a nationally representative repeated cross-sectional survey, we obtained self-reports of suicide attempts over the past year and of lifetime sexual violence perpetration and victimization. Using complex survey weights, weighted logistic regression models were employed to estimate the odds ratios (ORs). The interaction analyses were conducted on both additive and multiplicative scales. All analyses were conducted separately for boys and girls.

RESULTS

Lifetime prevalence of sexual violence perpetration were 1.3% for boys and 0.4% for girls, and about 40% of those perpetrating sexual violence were also victims. After adjusting for several covariates, sexual violence perpetration was independently associated with suicide attempts in boys (ORadjusted for boys 1.80 [95% confidence intervals: 1.53, 2.11]), whereas in girls, the association was only marginally significant (ORadjusted for girls 1.27 [1.00, 1.63]). We found the negative multiplicative and additive interaction between the sexual violence perpetration and victimization on suicide attempts for both boys and girls (the ratio of ORs 0.30 [0.23, 0.39] for boys and 0.20 [0.12, 0.31] for girls; relative excess risk due to interaction - 1.20 [-1.91, - 0.50] for boys and - 2.33 [-3.00, - 1.66] for girls).

CONCLUSION

Sexual violence perpetration and victimization were independently and interactively associated with suicide attempts in adolescents, with a sub-additive interaction found between these two variables. Public mental health services and policies should recognize the importance of actively involving adolescents who had sexually perpetrated others as key intervention targets.

The association between sexual violence and mental disorders among women victim-survivors in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Sexual violence is a serious public health and human rights problem with both short-term and long-term consequences. This review aims to systematically assess the link between sexual violence and poor mental health among sub-Saharan African women.

METHODS

Systematic review and meta-analyses of observational studies were performed. MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane, Global Health and the University of Melbourne library electronic databases were used to find relevant published literature over 12 years from 2012 to 2024 in sub-Saharan Africa with stringent eligibility criteria. Random effects meta-analyses were used to pool estimates of ORs and 95% CIs. The I2 statistic was used to assess heterogeneity.

RESULTS

This systematic review and meta-analysis of 76 observational studies included a total of 80 313 participants and found a consistent small-to-medium association between lifetime sexual violence and experiences of poor mental health. The pooled ORs suggest that women who were exposed to sexual violence were more than twice as likely to experience post-traumatic stress disorder (OR 2.75; 95% CI 1.96 to 3.86; I2=73.4%), depression (OR 2.38; 95% CI 2.04 to 2.77; I2=56.6%), anxiety (OR 2.81; 95% CI 1.67 to 4.72; I2=77.2%), common mental disorders (OR 2.12; 95% CI 1.70 to 2.64; I2=0.0%), suicidal behaviour (OR 2.44; 95% CI 1.92 to 3.10; I2=68.0%) and emotional distress (OR 3.14; 95% CI 1.73 to 5.69; I2=79.6%) compared with women who have not experienced sexual violence.

CONCLUSIONS

Exposure to lifetime sexual violence was consistently associated with small to medium effects on poor mental health among women in sub-Saharan Africa. Thus, policy-makers should develop response strategies as well as mental health screening tools for all violence response service delivery points. In addition, health practitioners must prioritise screening for mental health conditions in patients who present with a history of sexual violence.

Are Rape Myths Inherently Gendered? Examining Assumed Gender Ascribed to Gender-Neutral Versions of the Illinois Rape Myth Acceptance Scale Among College Students

Rape myths are false beliefs about sexual violence that shift blame to the victim rather than the perpetrator. The Illinois Rape Myth Acceptance (IRMA) scale measures these myths, but critiques have led to the creation of gender-neutral versions. This study aimed to investigate how participants perceive gender in these versions. Surveys were given to U.S. college students, with variations in victim and perpetrator gender. Results showed no significant differences in IRMA scores based on gender-neutral versions. However, most participants still associated a female victim and a male perpetrator with sexual assault, indicating the persistent gendered nature of rape myths.

Sexual assault experience, depression, and heavy substance use among German adults: an exploratory mediation analysis

BACKGROUND

The experience of sexual assault may be associated with numerous adverse outcomes, including depressive disorders and heavy substance use. We aimed to examine the relationship between heavy substance use and depression in victims of sexual assault.

METHODS

We used nationally representative data from the German Health and Sexuality Survey (GeSiD) with N = 4,955 women and men aged 18-75 years. We assessed (i) the potential effect of sexual assault experience on depression mediated through hazardous alcohol, heavy tobacco, and frequent cannabis use and (ii) sexual assault experience on heavy substance use mediated through depression using logistic regression analysis to estimate proportion mediated (PM).

RESULTS

We found some evidence of mediation between sexual assault as a lifetime event and depression by heavy tobacco use (PM = 1.6%) and frequent cannabis use (PM = 14.7%) among women. We also observed mediation by hazardous alcohol use (PM = 35.5%) and heavy tobacco use (PM = 48.6%) among men who experienced childhood sexual assault. Focusing on depression as a potential mediator, we found some evidence of mediation between sexual assault as a lifetime event and heavy tobacco use among women (PM = 17.6%) and men (PM = 13.3%), and between sexual assault as a lifetime event and frequent cannabis use (PM = 26.9%) among women.

CONCLUSIONS

Our findings suggest that public health specialists, clinicians, and therapists should develop early interventions to prevent addiction and the development of depression after experiencing sexual assault.

A latent class analysis of technology-facilitated sexual violence: Associations to other victimizations, psychiatric symptoms, and gender

BACKGROUND

Poly-victimization research has shown the cumulative detrimental effects of violence exposure on mental health. Latent Class Analysis (LCA) of victimization is a growing research field uncovering specific combinations of violence exposures particularly negative to mental health. Despite a growing concern of technology-facilitated violence (TFSV), it is scarcely included in LCA studies.

OBJECTIVES

Investigating victimization typologies that includes technology facilitated sexual violence.

PARTICIPANTS AND SETTING

Cross-sectional survey data from a representative sample of Swedish young people in the age range of 16-23 (N = 3243, mean age = 18.20, SD = 0.61).

METHODS

A Latent Class Analysis was conducted using the package PoLCA in R. A model with three classes was deemed to best fit the data.

RESULTS

Class 1 (sexual polyvictimization, 10.1 %) had high probabilities of all forms of sexual violence including TFSV and the highest proportion of psychiatric diagnosis (45.2 %). This class consisted of mostly girls. Class 2 (child abuse polyvictimization,14.8 %) was characterized by high probabilities of physical and psychological child abuse and had an even gender distribution. 30.6 % of this class endorsed having a psychiatric diagnosis. Class 3 (75.1 %) was a low victimization/normative subgroup with an even gender distribution and a low (12.8 %) frequency of psychiatric diagnosis. Class 1 exhibited the highest levels of psychiatric symptoms.

CONCLUSIONS

Prevention efforts targeted against TFSV should consider the whole web of violence that some young people are situated in. Since TFSV seems to be connected to psychiatric symptoms and diagnosis, Child- and Adolescent Psychiatric services should pay more attention to this type of violence among their young patients.

Considering the Impact of High School Sexual Education on Past Sexual Victimization and Rape Myth Acceptance in a College Sample

Sexual victimization is a serious public health crisis affecting college students, with high rates reported among both women and men. Sexual consent education is crucial as it defines sexual assault and is linked to reduced risk of victimization. Rape myths and stereotyped beliefs shifting blame to survivors are established risk factors for sexual violence. Comprehensive sexual education can mitigate these attitudes, fostering a supportive environment for survivors. However, most high school students in the United States receive abstinence-based or abstinence-plus education, which uses unstandardized protocols and often lacks information about sexual consent. The following study explores the influence of high school sexual education on past sexual victimization and rape myth acceptance in college students. Six hundred sixty-four undergraduate students participated in an online survey through a university participant pool. Results show that those who received comprehensive sexual education were more likely to understand sexual consent and were less likely to endorse past sexual victimization. In contrast, students without comprehensive sexual education reported lower satisfaction with their sexual education and greater acceptance of rape myths. Despite limitations in the study's sample and reliance on self-reporting, this research highlights the importance of implementing comprehensive sexual education, including consent education, in high schools. Policymakers and educators must recognize the influence of comprehensive sexual education in promoting healthy relationships and combating sexual assault. As a significant public health concern, incorporating standardized sexual consent education into high school curricula can equip students with the knowledge and skills to make informed decisions about their sexual health and relationships. Future research should explore diverse populations and the mediating role of related factors that may further influence these relationships. These efforts will contribute to fostering a safer environment within educational institutions and combating sexual assault.

Transgender and Gender-Diverse Minority Stress and Substance Use Frequency and Problems: Systematic Review and Meta-Analysis

The goal of this preregistered study was to systematically review and meta-analyze quantitative research examining relationships between minority stress (distal stress, expectations of gender-based rejection, concealment of gender identity, and internalized transphobia) and substance use (alcohol use frequency and problems, and drug use frequency and problems) in transgender and gender-diverse (TGD) samples. Searches of PsycInfo, MEDLINE, Gender Studies, and LGBTQ+ Source databases were conducted for quantitative articles that included effect sizes for cross-sectional associations between TGD-based minority stress and substance use outcomes. Random-effects meta-analyses were used to compute effect sizes for 16 minority stressor-substance use variable pairs. Moderator analyses were conducted for publication year and proportion of the sample assigned female sex at birth, identified as Black, Indigenous, or people of color (BIPOC), or identified as a sexual minority. Thirty-six studies with 76 effect sizes were included. Significant correlations were observed for relationships between distal stress and alcohol use frequency (r=0.13; 95% confidence interval [CI]=0.06 to 0.20) and problems (r=0.09; 95% CI=0.03 to 0.14), and drug use frequency (r=0.16; 95% CI=0.11 to 0.21) and problems (r=0.14; 95% CI=0.05 to 0.23). No associations for proximal minority stress-substance use variable pairs were significant. Effect sizes for associations between distal stress and alcohol use frequency were higher in samples with more BIPOC participants (z=4.27, p<0.001, R 2=0.740). Findings indicate that distal, but not proximal, minority stress was significantly associated with drug and alcohol use frequency and problems. Theoretical and clinical implications are discussed.

Bisexual minority stress as a risk factor for sexual violence-related posttraumatic stress disorder symptoms among bisexual+ women: A multilevel analysis

Bisexual+ (e.g., bisexual, pansexual, queer) women experience higher rates of sexual violence (SV) and posttraumatic stress disorder (PTSD) than heterosexual and lesbian women, as well as unique identity-related minority stress. We examined between- and within-person associations between bisexual minority stress and PTSD symptoms related to SV in a sample of young bisexual+ women (N = 133) who reported adult SV (Mage = 22.0 years, range: 18-25 years; 85.0% White; 99.3% cisgender). We analyzed data from four waves of data collection (baseline to 3-month follow-up) using multilevel models. Controlling for SV severity, there was a significant within-person effect of antibisexual stigma from lesbian/gay people on PTSD, β = .17, p = .010, suggesting that at waves when women experienced more stigma, they also reported higher PTSD symptom levels. At the between-person level, women who reported higher levels of antibisexual stigma from heterosexual people, β = .26, p = .043, and anticipated binegativity, β = .29, p = .005, on average across study waves also reported higher average levels of PTSD. Additionally, anticipated binegativity explained the association between average antibisexual stigma and PTSD, β = .15, p = .014, 95% CI [0.45, 4.61]. Bisexual minority stress may be associated with higher PTSD symptom severity following SV among young bisexual+ women, and the anticipation of binegativity may be a target mechanism in this association. Study findings highlight the importance of examining the joint contributions of SV and minority stress to identify novel targets for future research and practice to address PTSD symptoms.

Bisexual+ Women and Gender Nonbinary Survivors of Sexual Violence: Comparisons of Substance Use, PTSD Symptoms, and In-Person Social Reactions to Sexual Violence Disclosure

The current study examined whether in-person social reactions to disclosure of sexual violence vary as a function of sexual identity (heterosexual vs. bisexual+ survivors) and gender (women vs. nonbinary survivors). A secondary aim of the current study was to examine whether sexual identity and/or gender moderated the relation between social reactions to disclosure and various negative psychological/behavioral outcomes. (i.e. symptoms of posttraumatic stress disorder (PTSD), heavy episodic drinking, cannabis use). Participants were 472 bisexual+ or heterosexual survivors who identified as women (cisgender and transgender women) or gender nonbinary. Independent sample t-tests and three simple linear regressions were used to examine the study aims. Nonbinary survivors reported higher levels of social reactions that involved turning against the survivor and providing unsupportive acknowledgment of the sexual violence experience, compared to women survivors. Both bisexual+ and nonbinary survivors reported higher levels of PTSD symptoms and greater cannabis use compared to heterosexual and women survivors, respectively. For bisexual+ survivors, reactions that turned against the survivors were associated with lower levels of PTSD symptoms and higher levels of heavy episodic drinking. For bisexual+ survivors, reactions involving unsupportive acknowledgment were associated with higher levels of PTSD symptoms and lower heavy episodic drinking. The current study highlights how identification as bisexual+ or as nonbinary may influence in-person social reactions received upon disclosure of sexual violence as well as psychological outcomes following sexual violence.

Pre-Assault Diagnoses Associated with Post-Assault Emergency Department Visits After Recent Sexual Assault

Characteristics associated with individuals who frequent the emergency department at higher rates have been well established; however, factors associated with greater emergency department visits following a recent sexual assault are largely unknown. The current study evaluated the associations between pre-assault factors such as substance use and physical injuries, assault characteristics such as genital injury, non-genital injury, alcohol or drug use involvement, intimate partner involvement, and emergency department visits one-year after a sexual assault medical forensic exam (SAMFE). The current study included a medical record review of 123 individuals who received a SAMFE at a hospital in the United States. Demographic variables, characteristics of the sexual assault, pre-sexual assault diagnoses, frequency of SAMFEs, and post-SAMFE emergency department visits were examined. A negative binomial regression was used to examine these factors on post-SAMFE emergency department visits. Results indicated that alcohol or drug use during an assault was associated with fewer emergency department visits post-SAMFE. Substance use and physical injury disorders pre-SAMFE were positively associated with post-SAMFE emergency department visits. Findings provide important insight for prevention strategies to potentially increase access to mental and physical health care post-assault to reduce the risk of repeated emergency department visits among recent survivors of sexual assault.

Characterizing Engagement with Web-Based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Traumatic Stress and Substance Misuse After Interpersonal Violence

Screening, brief intervention, and referral to treatment (SBIRT) is a widely used public health approach for delivering early intervention for substance misuse. SBIRT adaptations that incorporate content on interpersonal violence and posttraumatic stress disorder (PTSD) symptoms may be warranted, as experiences of interpersonal violence are prevalent and associated with greater substance misuse; however, more research is needed to refine the delivery of PTSD-substance use content within the SBIRT model. This study examined clinical data collected as part of a web-based SBIRT developed for co-occurring substance misuse and PTSD symptoms after interpersonal violence to characterize the clinical symptoms and responses of adults presenting to agencies serving intimate partner and sexual violence survivors. The respondents (N = 52) completed self-report measures during the SBIRT tool to personalize the recommendations, as well as motivational enhancement exercises. Descriptive statistics were conducted. The results underscored high rates of probable PTSD, substance use, and trauma-related motives for substance use. The respondents were ready to change their substance use on average after receiving personalized feedback. Many expressed values related to trauma recovery and self-empowerment, perceived these values as useful for substance use reduction, and set goals to seek mental health services or reduce their drinking quantity. The findings point to several clinical targets for integrated PTSD-substance misuse interventions for interpersonal violence survivors.

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.

Intimate Partner Sexual Violence: A Phenomenological Interpretative Analysis Among Female Survivors in France

Despite its prevalence, intimate partner sexual violence (IPSV) remains a concealed and poorly understood form of violence against women. Although it is associated with numerous detrimental effects on mental health, very little is known about the subjective meaning of IPSV for survivors. This study addresses this gap by exploring IPSV from the perspective of female survivors within the context of their relationship with a male partner, using interpretative phenomenological analysis. This study seeks to provide a detailed examination of the personal experience of IPSV and to illuminate its meaning from a personal standpoint. We conducted in-depth interviews with seven IPSV survivors who were recruited after filing a complaint for intimate partner violence (IPV) in France. In total, five superordinate themes were identified: (a) "Setting the stage" describes how the complex dynamics preceding IPSV influence self-representation; (b) "Feeling like I'm nothing" describes the emotional experience of IPSV; (c) "Trying to get it, not getting it" describes how IPSV generates intense cognitive load; (d) "Looking back, developing a theory" describes how IPSV is interpreted retrospectively after breaking up with a violent partner; and (e) "Today: living with it" describes how IPSV affects the present. This study highlights how emotional distress and cognitive uncertainty are present on the way to IPSV, through IPSV, and even after filing charges and separating from the violent partner. Additionally, it shows that survivors attribute IPSV to a sense of individual vulnerability related to romantic love, hope, and traumatic childhood history. This study presents unique findings as it is the first one to explore the lived experience of IPSV among a sample of French IPV survivors.

A short screen for lifetime sexual victimization experiences: Expanding research on the Sexual Abuse History Questionnaire (SAHQ) across cultures, genders, and sexual identities

The Sexual Abuse History Questionnaire (SAHQ), a widely used screening tool for childhood sexual abuse (CSA) and adolescent/adult sexual assault (AASA) experiences, has limited examination of its psychometric properties in diverse populations. Our study assessed the SAHQ's psychometric properties (i.e., structural validity and measurement invariance across demographic groups, know-group validity, and internal consistency) and estimated the frequencies of various types of sexual victimization across 42 countries and in diverse gender-, trans-status-, and sexual-identity-based groups that were previously missing from measurement-focused studies. We used a large, non-representative sample (N = 81,465; 57 % women, 3.4 % gender-diverse individuals, Mage =32.34 years, SD=12.48) from the International Sex Survey, a 42-country cross-sectional, multi-language, online survey. The SAHQ demonstrated excellent structural validity in all country-, gender-, sexual-identity-, and trans-status-based groups, as well as acceptable reliability and known-group validity. Occurrence estimates for six CSA and AASA types were reported across sociodemographic groups, corroborating previous evidence that women and gender- and sexual-minority individuals are at greater risk of CSA and AASA. Pansexual and queer individuals emerged as a particularly vulnerable group. Associations between different types of CSA and AASA revealed that participants who experienced any form of CSA were at least twice as likely to experience AASA. The findings have significant implications for policy and interventions, especially for marginalized groups.

Associations between defensive victim-blaming responses (DARVO), rape myth acceptance, and sexual harassment

DARVO (Deny, Attack, Reverse Victim and Offender) is a response frequently exhibited by perpetrators of wrongdoing after being confronted or held accountable for their harmful behaviors. Consistent with the original conceptualization of DARVO as a strategy used by sex offenders to deflect blame and responsibility, sexual violence survivors report experiencing DARVO from their perpetrators following an assault. The purpose of the current study was to extend research on the connections between DARVO and sexual violence. We examined whether people who use DARVO as a means of responding to confrontations involving a range of wrongdoings also engage in behaviors and ascribe to beliefs that contribute to sexual violence. A sample of 602 university students was recruited to test hypotheses predicting positive associations between individuals' use of DARVO responses, sexual harassment perpetration, and acceptance of rape myths. Supporting predictions, small but positive correlations emerged between study variables. Data from a second sample of 335 community adults from MTurk were analyzed to replicate findings from the undergraduate sample. Results from the community sample also revealed significant associations between DARVO use, sexual harassment perpetration, and rape myth acceptance. Findings offer further confirmation of a link between DARVO and sexual violence and suggest this defensive response is part of a larger worldview that justifies participation in sexual violence and blames victims.

Impact of neighborhood disadvantage on posttrauma outcomes after sexual assault

In the United States, 8,000,000 people seek emergency care for traumatic injury annually. Motor vehicle collisions (MVCs) and sexual assault are two common sources of trauma, with evidence that reduced neighborhood-level socioeconomic characteristics increase posttraumatic pain and stress after an MVC. We evaluated whether neighborhood disadvantage was also associated with physical and mental posttrauma outcomes after sexual assault in a sample of adult women (N = 656) who presented for emergency care at facilities in the United States following sexual assault and were followed for 1 year. Neighborhood characteristics were assessed via the Area Deprivation Index, and self-reported pain, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms were collected at 6 weeks posttrauma. Adjusted log-binomial regression models examined the association between each clinical outcome and neighborhood disadvantage. Women in more disadvantaged neighborhoods were more likely to be non-White and have lower annual incomes. At 6 weeks posttrauma, the prevalence of clinically significant pain, anxiety, and depressive symptoms more than doubled from baseline (41.7% vs. 18.8%, 62.4% vs. 23.9%, and 55.2% vs. 22.7%, respectively); 40.7% of women also reported PTSD symptoms. Black, Hispanic, and lower-income participants were more likely to report pre- and postassault pain, anxiety, and depression. After adjusting for race, ethnicity, and income, no significant association existed between neighborhood disadvantage and any outcome, ps = .197 - .859. Although neighborhood disadvantage was not associated with posttrauma outcomes, these findings highlight the need for continued research in diverse populations at high risk of adverse physical and mental health symptoms following sexual assault.

Sexual Violence and Hazardous Drinking: Exploring Associations With PTSD Symptoms and Gender Among Adults With Probable PTSD and Hazardous Drinking

ABSTRACT

Sexual violence is associated with posttraumatic stress disorder (PTSD), but relatively less research has explored whether it is associated with hazardous drinking. PTSD symptoms may indirectly influence the association between sexual violence and hazardous alcohol use. This association may be moderated by gender. The aim of the current study was to cross-sectionally test whether sexual violence is indirectly associated with hazardous drinking through PTSD symptoms and explore whether gender moderates this association. Hypotheses were tested among 631 adults ( Mage = 38, 56% men, 78.6% White) with probable PTSD and hazardous drinking who completed online self-report surveys. Results indicated sexual violence, compared with other trauma types, was associated with more severe hazardous drinking. There was a significant indirect effect of PTSD symptoms in this association. There was no evidence of a moderating effect of gender. PTSD symptoms may drive hazardous drinking among sexual violence survivors. Results also underscore associations between sexual violence and alcohol use, regardless of gender. Future work should continue to investigate these associations prospectively.

Adverse Childhood Experiences Are Associated with Mental Health Problems Later in Life: An Umbrella Review of Systematic Review and Meta-Analysis

INTRODUCTION

Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.

METHODS

PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.

CONCLUSION

This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.

Unreal that feels real: artificial intelligence-enhanced augmented reality for treating social and occupational dysfunction in post-traumatic stress disorder and anxiety disorders

Background: Fear- and trauma-related conditions, such as post-traumatic stress disorder (PTSD) and social phobia, often manifest as socially avoidant behaviours, which commonly contribute to social and occupational disability transdiagnostically. While gold-standard treatments (i.e. exposure therapy, psychotropic medications) are effective, they are hindered by high dropout rates and limited impact on real-world functioning. Furthermore, most existing interventions only target symptom reduction, with few addressing avoidance-related deficits in social and occupational functioning.Objectives: This methods paper introduces an innovative augmented reality exposure therapy (ARET) technology designed to address the limitations of traditional interventions for anxiety disorders and PTSD, by directly targeting social and occupational dysfunction through exposure to real-life social contexts.Method: We introduce an ARET system, using artificial intelligence (AI)-driven, augmented reality (AR) technology, that enables exposure to realistic scenarios within the patient's real-world environment, fostering contextual generalization and functional improvement. Featuring holographic three-dimensional humans, precise surface mapping, wireless mobility, and telemedicine capabilities, the software provides customizable exposure scenarios to transform an environment into various spaces (e.g. grocery store, house party) with diverse human characters, as well as flexible AI-driven human interactions tailored to individual needs.Results: We share observations and feedback from the treatment of first responders with PTSD. Patients found the technology easy to use, with immersive realism, active engagement, and strong emotional responses needed for effective exposure therapy. Advances in AI-driven character development and AR hardware accessibility support the wider adoption of ARET by clinicians.Conclusion: By bridging the gap between clinical interventions and real-world functioning, ARET offers a transformative approach to addressing the pervasive impact of psychiatric disorders on social and occupational outcomes.

Predictors of Trauma-Related Self-Blame in Male Survivors of Sexual Violence

Survivors of adult sexual assault and child sexual abuse - together encompassing sexual violence (SV) - experience a number of adverse consequences. High rates of self-blame can lead to increased symptomatology and treatment resistance. There has been a paucity of studies of men who have experienced SV, particularly about self-blame. For this study, 179 cisgender male survivors of SV completed an online survey to explore the relationships among 10 variables, including trauma-related self-blame, rape myth acceptance, tonic immobility, disclosure experiences, sexual arousal, and substance use. Multiple regression analyses and t-tests were used to test the study hypotheses. Results indicate that 93% of the sample reported some level of self-blame. However, only rape myth acceptance was strongly associated with self-blame. Additionally, participants who used substances within 12 hours prior to their SV had higher rates of self-blame, as did participants who had not previously disclosed their abuse. Exploratory analyses also found a significant difference in self-blame between those who experienced SV in childhood and adulthood versus those who only experienced SV in either childhood or adulthood. The findings of this research highlight the high rates of self-blame and how imperative it is to provide psychoeducation about the variables discussed in this study and to normalize these experiences, especially for less well-known phenomena such as physiological sexual arousal and TI.

Perceived Barriers and Benefits of Exercise Among Women Survivors of Sexual Violence by Physical Activity Level and Posttraumatic Stress Disorder Status

An online, cross-sectional survey of women survivors of sexual violence (SV; N = 355) gathered information on perceived barriers and benefits of exercise, along with exercise level and posttraumatic stress disorder (PTSD) symptoms. This study reports exercise perceptions and provides comparisons by exercise level and PTSD status. Differences by exercise level were found in life enhancement, physical performance, psychological outlook, and social interaction (ps < 0.05; rs = -0.04-0.25). Differences were found by PTSD status in physical performance, social interaction, and preventative health and exercise milieu, time expenditure, and family discouragement (ps < 0.05; rs = -0.39-0.21). Findings provide new information relevant for promoting exercise among women survivors of SV.

From sleep to sip? Examining a daily model of sleep and trauma-related drinking among sexual violence survivors

OBJECTIVE

Alcohol misuse is common among women who have experienced sexual violence and is often attributed to the self-medication model of alcohol use to alleviate posttraumatic stress disorder (PTSD) symptoms. Despite the proximal theorized role of PTSD symptoms, less attention has been given to daily associations between PTSD symptoms, trauma-related drinking to cope (TRD) motives, and ensuing alcohol use by survivors. Moreover, despite indications that poor sleep impacts affective functioning and may exacerbate daily PTSD symptoms, the role of sleep duration and quality in drinking to cope with PTSD symptoms is not well understood. This study examined an integrated model testing whether shorter sleep duration and poorer sleep quality predict greater daily PTSD symptoms and, in turn, greater alcohol use later that day through TRD motives.

METHOD

Participants were 82 cisgender women (Mage = 22.8, 73.2% White, 13.4% Hispanic/Latina, 56.1% heterosexual, 30.5% bisexual) who had experienced sexual violence. Participants completed ecological momentary assessment measures and wore actigraphs for 3 weeks.

RESULTS

Contrary to hypotheses, shorter-than-usual sleep duration did not predict greater alcohol use quantity via daily PTSD symptoms and TRD motives. However, poorer-than-usual sleep quality predicted greater PTSD symptoms that day, which in turn predicted greater same-day TRD motives.

CONCLUSIONS

Findings underscore the importance of sleep quality in heightened PTSD symptoms but suggest survivors did not drink more to alleviate trauma-related distress. Future research should examine other drinking motives among survivors to inform proximal interventions to prevent alcohol misuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Shame in Associations with PTSD and Depression Symptoms and Hazardous Drinking Among Bisexual Women Who Experienced Sexual Violence

Bisexual (i.e. those with attraction to multiple genders) women experience disparities in sexual violence and mental health outcomes, including PTSD, depression, and hazardous drinking, compared to lesbian and heterosexual women. Unique stigma due to bisexual identity (antibisexual stigma), negative reactions to sexual violence (SV) disclosure (e.g. victim blaming), and prior child sexual abuse (CSA) may all contribute to shame. We tested whether shame explained the associations of antibisexual stigma, negative reactions to SV disclosure, and CSA severity with PTSD symptoms, depression, and hazardous drinking among young bisexual women. Participants who self-identified as bisexual women, between the ages of 18-35, residing in the US were recruited via Amazon's Mechanical Turk (MTurk) and completed online questionnaires. Women who reported SV since age 18 that they disclosed to someone were included in the current study, yielding a sample of 156 bisexual women (Mage = 25.7; 98.1% cisgender, 86.5% White). Path analysis with bias-corrected bootstrapping was conducted. There were significant direct effects of negative reactions on hazardous drinking and CSA on PTSD, and direct effects of shame on PTSD and depression symptoms. Shame explained the associations of antibisexual stigma, negative reactions, and CSA with PTSD symptoms, depression symptoms, and hazardous drinking. Shame may explain why stigmatizing experiences related to bisexual identity, sexual violence, and CSA history relate to distress among bisexual women. Shame is an important treatment target among bisexual survivors of SV.

Understanding the Perspectives and Experiences of Male Perpetrators of Sexual Violence Against Women: A Scoping Review and Thematic Synthesis

Worldwide, sexual violence is a significant public health issue. Although any person can be victimized, the vast majority of sexual violence is perpetrated by men against women. Research has increasingly explored the experiences of victims, however, the perspectives of male perpetrators of sexual violence have largely been sidelined. This limits the ability to design effective public health and policy responses to sexual violence. Our aim was to synthesize the available peer-reviewed qualitative research exploring the perspectives of adult male perpetrators of sexual violence against women. Five databases were searched: MEDLINE, EMBASE, PsychINFO, CINAHL and SocINDEX. We included qualitative, peer-reviewed English-language studies published in the past 40 years, focused on the perceptions and experiences of male perpetrators of sexual violence. Fourteen articles (describing 12 studies) were identified. Most (10) of the articles examined the perspectives of convicted male sex offenders serving a custodial sentence. Of the remaining four articles, two focused on anonymous users of the online forum, Reddit.com, and the remaining two focused on students on university campuses. These four articles were the most recent. We developed four major themes from our thematic analysis of the study findings that represent the experiences and perceptions of male perpetrators of sexual violence. These themes describe deflecting blame onto the victim, external circumstances as mitigating factors, or the perpetrator's uncontrollable biological urges. One theme involved some expression of remorse or acceptance of responsibility. Although our findings may have implications for prevention and rehabilitation programs, further research is urgently needed in this area.

Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood

In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.

Research with women sexual assault survivors presenting for emergency care is safe: Results from a multi-site, prospective observational cohort study

A barrier to research with sexual assault survivors is the concern that research participation might be a negative experience for participants. We report the experiences with research of adult women sexual assault survivors participating in a large-scale, multi-site, prospective observational study that enrolled participants at the time of presentation for emergency care. Participants (n = 706, M = 28 years of age; 57% white, 15% Black) self-reported their experience with research 1 week, 6 weeks, 6 months, and 1 year post-assault. The vast majority rated the research experience as positive (95-97%), reported no drawbacks (84-89%), and felt that participating was worth it (93-95%). Positive experiences with research remained stable across the year, were generally consistent across demographic and clinical groups, and were reflected in qualitative comments. Given the tremendous morbidity experienced by sexual assault survivors and lack of progress in developing improved treatments for this population, ethically-conducted research with sexual assault survivors receiving emergency care should be encouraged.

"I Want to Be Heard": Rape Victims' Encounters With Swedish Police

Interactions with police are vitally important to victims' ability to process their trauma. This study focused on the experiences of victims who reported a rape to police in Sweden. Thirteen women participated in interviews; the material was analyzed using inductive thematic analysis. Findings include lack of information and the role of luck in finding an understanding officer; some found comfort, and some felt violated once again. Long processing times bound participants to their trauma. Findings highlight the need for improved knowledge of trauma among police, victims' needs for information and rights to support, and structural barriers that need to be addressed.

A Comparative Study of the Help-Seeking Behavior of Victims of Contact Sexual Violence and Image-Based Sexual Harassment and Abuse

Sexual victimization may have serious consequences for victims' well-being. Thus, seeking support is encouraged and associated with positive outcomes. However, no research has compared the help-seeking behavior of victims of contact and image-based (i.e., noncontact) sexual violence. This study explores the differences in help-seeking behavior, and barriers to help-seeking, by comparing datasets from two online survey studies. The findings highlight that victims of contact sexual violence appear more likely to seek help, but also experience the barriers to help-seeking as greater. An exception is the minimization of the incident, which is experienced similarly by both. Future longitudinal research is recommended.

Posttraumatic stress disorder (PTSD) prevalence: an umbrella review

Posttraumatic stress disorder (PTSD) is one of the most serious and incapacitating mental diseases that can result from trauma exposure. The exact prevalence of this disorder is not known as the literature provides very different results, ranging from 2.5% to 74%. The aim of this umbrella review is to provide an estimation of PTSD prevalence and to clarify whether the prevalence depends on the assessment methods applied (structured interview v. self-report questionnaire) and on the nature of the traumatic event (interpersonal v. not-interpersonal). A systematic search of major databases and additional sources (Google Scholar, EBSCO, Web of Science, PubMed, Galileo Discovery) was conducted. Fifty-nine reviews met the criteria of this umbrella review. Overall PTSD prevalence was 23.95% (95% confidence interval 95% CI 20.74-27.15), with no publication bias or significant small-study effects, but a high level of heterogeneity between meta-analyses. Sensitivities analyses revealed that these results do not change after removing meta-analysis also including data from underage participants (23.03%, 95% CI 18.58-27.48), nor after excluding meta-analysis of low quality (24.26%, 95% CI 20.46-28.06). Regarding the impact of diagnostic instruments on PTSD prevalence, the results revealed a lack of significant differences in PTSD prevalence when structured v. self-report instruments were applied (p = 0.0835). Finally, PTSD prevalence did not differ following event of intentional (25.42%, 95% CI 19.76-31.09) or not intentional (22.48%, 95% CI 17.22-27.73) nature (p = 0.4598). The present umbrella review establishes a robust foundation for future research and provides valuable insights on PTSD prevalence.

Early Intervention after Rape to prevent post-traumatic stress symptoms (the EIR-study): an internal pilot study of a randomized controlled trial

BACKGROUND

Rape is one of the trauma incidents with the highest risk of subsequent post-traumatic stress disorder. Early interventions, such as prolonged exposure therapy (PE), have shown promise in preventing PTSD following a sexual assault. The primary objective of this internal pilot trial was to examine the feasibility of the EIR study protocol, which used modified prolonged exposure therapy (mPE) as a preventive intervention after rape.

METHODS

This parallel two-arm clinical pilot study involved three sexual assault centers (SACs) in Trondheim, Oslo, and Vestfold, with data collected between June 2022 and March 2023. Women seeking assistance at one of these three SACs within 72 h after rape or attempted rape received acute medical treatment and forensic examinations. Women who wanted further psychosocial treatment were, if eligible and consenting, recruited to complete baseline assessments and a clinical interview before being randomized to one of two study arms. The intervention group prescribed up to five sessions of modified PE (mPE) in addition to treatment as usual (TAU), starting within the first 14 days after the rape incident, followed by weekly sessions. The other group received TAU. The present pilot evaluation is based on 22 participants, i.e., nine mPE + TAU and 13 TAU alone. Primary outcomes were predefined progression criteria regarding recruitment, retention, intervention implementation, a harm reporting system, and applying biological measurements and actigraphy.

RESULTS

During the 6-month recruitment period, 235 women visited the three SACs. After eligibility screening and consent, 22 (9.4%) women were randomized. Three months later, 14 (63.6%) participants completed the final assessments. Intervention implementation was successful using trained SAC personnel to deliver mPE. The harm reporting system was used according to the study's plan, and adverse and serious adverse events were detected during the trial. The biological measurements and actigraphy had substantial missing data but were still considered usable for statistical analyses.

CONCLUSION

It may be feasible to conduct a full-scale RCT of early intervention after rape by comparing mPE + TAU to TAU alone. Minor design refinements were made to the protocol to enhance the main study outcome.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05489133. Registered on 15 July 2022, retrospectively.

Exploring the roles of compassion and post-traumatic stress disorder on global distress after sexual trauma

OBJECTIVES

Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables.

METHODS

155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms.

RESULTS

An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution.

CONCLUSIONS

That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.

Readiness for HIV Postexposure Prophylaxis (PEP) Decision Making Following Sexual Violence

HIV post-exposure prophylaxis (PEP) can reduce the risk of acquiring HIV infection following sexual assault. However, only about half of people offered HIV PEP will initiate the medication. Factors associated with patient readiness for HIV PEP following sexual assault have been attributed to structural and clinical barriers. This study utilized the Theory of Reasoned Action and Planned Behavior to better understand how personal factors, cognitive factors, mental health, barriers and facilitators that could influence a patient's decision to start HIV PEP post sexual assault. A web-based cross sectional survey was conducted from October 2017 to January 2020 and a total of 228 responses were included from participants that had experienced sexual assault in the previous 3 months. Using linear regression modeling fear of HIV, post-traumatic stress symptoms, validating social responses to disclosure, and having someone else pay for HIV PEP were all associated with feeling better prepared for HIV PEP decision making. Results indicate that structural, social, and individual factors impact patient decision making. These findings highlight opportunities for health systems and providers to improve HIV education and the importance of initiating HIV PEP following sexual assault.

A Within-Person Examination of Alcohol-Involved and Non-Alcohol-Involved Internal and External Sexual Consent Communication

OBJECTIVE

External consent communication and internal consent feelings may be influenced by alcohol consumption. However, whether the way someone communicates sexual consent differs when alcohol is or is not involved is not well understood. The goal of this study was to assess the within- and between-person effects of alcohol use, gender, and sexual identity on internal and external consent.

METHOD

Young adults (n = 375) completed a 10-minute web-administered survey about their internal and external consent in a recent alcohol- and non-alcohol-involved sexual encounter. External consent included five different behaviors to communicate consent. We conducted a repeated-measures analysis of variance to assess the within- and between-person effects of alcohol use, gender, and sexual identity on internal and external consent.

RESULTS

Internal consent did not differ across sexual experiences or identities. In alcohol-involved encounters, there was a decreased use of implicit communication. Heterosexual women used more verbal communication during alcohol encounters than during sober encounters. Compared with men, women used more nonverbal and implicit communication across encounters.

CONCLUSIONS

Alcohol use did not influence internal consent and was associated with a reduced use of implicit communication. The disinhibiting effects of alcohol may lead people to feel more confident and open about expressing their sexual desires. Affirmative consent initiatives can use findings to encourage more clear communication and continue to educate on gender differences in sexual consent.

Preliminary Evaluation of the SafeBAE Youth-Developed Sexual Violence Prevention Summit

The current study evaluates a single-day youth-designed sexual assault prevention summit for adolescents. Attendees (N = 284) completed pre-and post-summit surveys addressing 1) confidence in consent knowledge; 2) perceived capability to respond to someone who was assaulted or harassed; 3) awareness of Title IX rights; 4) perceived capacity to get help for a survivor; 5) perceived acceptability of sexual coercion; 6) endorsement of belief that it is wrong to stop sexual activity once it starts; 7) perceived seriousness of sharing nude photos without permission; and, 8) perceived prevalence of false accusations of sexual violence. At post-summit, participants reported increased perceived confidence in consent knowledge, increased perceived capacity to respond to a survivor, increased awareness of Title IX rights, and increased perceived capacity to get help for a survivor. Both perceived acceptability of sexual coercion and endorsement of the belief that someone should not stop sexual activity decreased at post-summit. Findings provide preliminary support for a youth-developed sexual assault prevention summit.

A month in review: longitudinal dynamics between daily PTSD symptom networks, affect, and drinking behaviors in female college students

Introduction

Sexual victimization (SV) is common among college women, with approximately half of those who have experienced SV meeting criteria for posttraumatic stress disorder (PTSD) within a year. Both SV and PTSD are associated with alcohol misuse among college women, often explained by the self-medication hypothesis. Existing literature focuses on overall PTSD severity rather than potential day-to-day fluctuations in specific symptoms, which might play a crucial role in understanding alcohol misuse risk. Studies also examine only same-day or next-day associations between PTSD and drinking, neglecting the potential for longer-term changes.

Methods

This study explores the short-term longitudinal stability and time-lagged predictive dynamics of PTSD symptoms, affect, and drinking behavior among 174 female college heavy episodic drinkers over four weeks. Participants were categorized into three groups: those with a history of SV and PTSD (n = 77), women with SV but without PTSD (n = 59), and women without prior trauma history (n = 38) to be able to examine differences by trauma exposure, and PTSD. We compared the longitudinal stability of PTSD symptom networks, affect (arousal, positive affect, and negative affect), and drinking behavior across groups. Support vector regression determined which PTSD symptom networks and affect best predict drinking behavior at specific time lags within a 0-7 day range.

Results

The PTSD group showed higher longitudinal stability for PTSD symptom networks (adjusted ps <.049) and arousal (adjusted ps <.048), but lower stability for negative affect (adjusted p =.013) and drinking behavior, including alcohol cravings (adjusted p =.019) and consumption (adjusted ps =.012), compared to the comparison groups. This suggests individuals with PTSD have more stable symptoms and arousal levels but greater fluctuations in negative affect and alcohol-related behaviors. Secondary analysis revealed PTSD symptom networks optimally predicted alcohol cravings with a three-day time lag (r=.88, p <.001) and consumption with a four-day time lag (r=.82, p <.001).

Discussion

These findings challenge assumptions regarding immediate effects of PTSD and affect on drinking behavior and underscore the need for therapeutic approaches that consider longer-range effects. Future research should expand on these findings by incorporating longer-range assessments and exploring a broader range of symptom interactions.

An Increased Need to Identify Protective Factors for Sexual Assault

The Article Abstract is not available.    

Do Concerns About Police Reporting Vary by Assault Characteristics? Understanding the Nonreporting Decisions of Sexual Assault Victims Who Utilize Alternative Reporting Options

INTRODUCTION

Forensic nurses routinely provide services to sexual assault victims who are uncertain about reporting their assault to police. The purpose of this study was to determine whether assault characteristics are related to the concerns about police reporting expressed by sexual assault victims who have forensic evidence collected but do not report their assault to police at that time.

METHODS

We analyzed medical records of patients who received services at a hospital-based forensic nursing program between 2010 and 2021. Records were included if a sexual assault evidence kit was collected, the patient declined to report the assault to police, and the patient completed a nonreport sexual assault evidence kit supplement form that included a question asking why they chose not to report the assault ( N = 296). We qualitatively analyzed patients' reasons for not reporting the assault and then used two-variable case-ordered matrices and chi-square analyses to explore relationships between reasons for not reporting and assault characteristics.

RESULTS

Identified reasons for not reporting included lacking information about the assault, fear of harm/retaliation, and self-blame/minimization. Physical force, drug/alcohol consumption, and victim-offender relationship were related to patients referencing lacking information and fearing harm/retaliation as reasons for not reporting, but not related to the frequency of patients referencing self-blame/minimization.

IMPLICATIONS

Results indicate that assault characteristics are related to reasons for not reporting at the time of the medical forensic examination. Being aware of these relationships may help forensic nurses provide patient-centered services and anticipatory guidance.

Intimate Partner Sexual Violence: An Exploratory Study on Sexual Victimization Profiles Among Survivors of Intimate Partner Violence in France

Intimate partner sexual violence (IPSV) is a common form of intimate partner violence (IPV). This study aimed to (a) identify a typology of intimate partner sexual victimization among French women victims of IPV on the basis of the frequency of various forms of sexual violence and (b) evaluate whether these profiles differ in several clinical characteristics. A total of 93 women consulting a specialized hospital service were recruited. Cluster analyses suggested four profiles: highly frequent rapes (5.4%), predominant sexual coercion (20.4%), medium frequency of all forms (20.4%), and low frequency of all forms (19.4%). Further person-centered research focusing on IPSV is warranted.

Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender?

Introduction

While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes.

Methods

N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving).

Results

Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men.

Discussion

Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women.

Child sexual abuse, adolescent/adult sexual violence, and sexual functioning among college women: a systematic review

BACKGROUND

Sexual violence, including childhood sexual abuse and adolescent/adult sexual assault, is a major public health concern, especially for college women. Sexual violence is associated with numerous negative consequences, including difficulties relating to sexual functioning. The current systematic review aimed to synthesize the existing research literature examining the association between sexual violence on sexual functioning among college women.

METHODS

Only peer-reviewed articles reporting original data and written in English, which assessed for sexual functioning and sexual violence among a sample of college women, were included in the review. Articles were included if the research study assessed sexual violence occurring in childhood, adolescence, or adulthood.

RESULTS

A total of 21 articles met these inclusion criteria and were included in the synthesis of the literature. In studies of college women, sexual violence occurring in adulthood was associated with worse sexual functioning outcomes among college women in 7 of the 21 studies. Findings were mixed regarding the association between childhood sexual abuse and sexual functioning among college women. Further, in three studies, psychological symptoms (e.g., depression, anxiety) mediated the association between sexual violence in adulthood and worse sexual functioning among college women. Studies varied in what domains of sexual functioning were assessed, and as a result, a limited number of studies included assessments of the same domain of sexual functioning. Further, some studies did not assess sexual violence at multiple points in development (i.e., childhood, adolescence, adulthood).

CONCLUSIONS

Future studies with longitudinal designs and a wider range of sexual functioning outcomes are needed, including studies focused on women attending 2-year and technical colleges.

Alcohol's Effects on the Bystander Decision-Making Model: A Systematic Literature Review

To decrease rates of sexual assault victimization, young people are encouraged to become involved when they see questionable sexual situations (i.e., be a prosocial bystander). Several factors can facilitate or inhibit intervention, including alcohol use. To inform bystander prevention programs that aim to address alcohol's impact on bystanders, the current study reviewed research focused on alcohol use and bystander decision making. In December 2022, the authors searched published studies from six major electronic databases. Empirical articles were deemed eligible if they examined alcohol and the bystander decision-making model within the context of sexual assault, were based in the United States or Canada, and not an intervention study; 32 studies were included in the final review. Across 32 studies published between 2015-2022, 12 assessed the proximal effects of alcohol on bystander constructs and the additional studies examined the distal effects of alcohol on bystander constructs. Alcohol use appeared to impede earlier steps of the bystander decision-making model; however, alcohol use was associated with impeding and facilitating bystander decision making at the latter half of the model. Overall, alcohol use appears to be negatively rather than positively associated with bystander constructs. Bystander intervention programs may want to move beyond the narrative of alcohol as a risk factor for sexual assault and discuss how alcohol impairs a bystanders' ability to recognize risk. More work is needed to ensure researchers assess alcohol consistently and with similar methods (number of drinks, subjective intoxication) to increase generalizability of findings to prevention programs.

Longitudinal patterns of posttraumatic stress disorder symptoms among sexual assault survivors: A latent transition analysis

OBJECTIVE

The aim of this study was to identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a community sample of sexual assault survivors whose assaults occurred varying lengths of time in the past and to explore patterns of transition between those latent classes over time.

METHOD

Latent class analysis was used to identify naturally occurring subgroups of PTSD symptoms in a sample of sexual assault survivors who completed two mailed surveys 1 year apart (N = 1,271). Latent transition analysis was then used to examine individuals' probabilities of transitioning into each latent class at Time 2 based on their latent class membership at Time 1.

RESULTS

A four-class model emerged as the best fitting model at both Time 1 and Time 2. Classes demonstrated overall severity and symptom cluster severity differences. Transition into a lower severity class was more common than transition into a higher severity class, though escalation was demonstrated by 6-20% of participants in each latent class.

CONCLUSIONS

The substantial heterogeneity in sexual assault survivors' PTSD symptoms highlights the variety of ways that posttraumatic stress may be experienced years after a sexual assault. Future research should explore factors that affect long-term symptoms, including cumulative lifetime trauma and social support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).