“Time does not heal all wounds”: mental health impact of sexual victimisation in old age

Background

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalizing disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to adequately address SV in later life. Studies researching the mental health impact of lifetime SV, i.e. SV that happened during childhood, adulthood and old age, are currently lacking. In this study we research the association between lifetime sexual victimization and adverse mental health outcomes in older adults, and its moderators.

Methods

Between July 2019 and March 2020, 513 older adults living in Belgium participated in a structured face-to-face-interview. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety and post-traumatic stress syndrome (PTSD) were measured using validated scales. Suicide attempts and self-harm were questioned during lifetime and in the past 12-months. SV was measured using behaviorally specific questions based on a broad definition of SV.

Results

Over 44% experienced lifetime SV, 8% in the past 12-months. Rates for depression, anxiety and PTSD were 27%, 26% and 6%. Almost 2% committed suicide, 1% reported self-harm in the past 12-months. Lifetime SV was linked to depression (p =.001), anxiety (p =.001), and PTSD in participants with a chronic illness/disability (p = .002) or no/lower education (p <.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12-months.

Conclusions

Lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are urgently needed.

Key messages

The mental health impact of sexual victimisation continues into old age. Tailored mental health care for older SV victims and capacity building of professionals are of the utmost importance.

Prevalence and nature of sexual violence in a gerontopsychiatric population in flanders

Introduction

Sexual violence (SV) is an important public health concern which may induce important and long lasting mental health problems. However, studies on SV and its mental health impact on older adults and more specifically gerontopsychiatric patients are currently lacking.

Objectives

This study aims to contribute to a better understanding of the prevalence, risk factors and mental health impact of SV in a gerontopsychiatric patient population.

Methods

Between July 2019 and March 2020 100 patients (66%F, 34%M) participated in a face to face interview on health, sexuality and wellbeing during their admission at an old age psychiatry ward in one general hospital and two psychiatric hospitals across Flanders, Belgium. Participation rate was 58%. Interviews were performed by a psychiatric trainee and especially trained master students in medicine.

Results

58% (65%F; 42%M) of the participants were sexually victimised during their life, 45% (51%F, 33%F) experienced hands-off SV, 43% (48%F, 33%M) sexual abuse with physical contact and 16% (6%M, 21%F) was raped. 7% were sexually victimised in the past year. Compared with non-victimized respondents, hands-on SV victims (incl. rape) described more symptoms of depression (p=0.007) and anxiety (p=0.003) and reported lower resilience (p=0.022).

Conclusions

SV appears to be common in the gerontopsychiatric population and is linked to even worse mental health outcomes. These findings confirm the long-lasting mental health impact of SV and highlight the importance of attention to (sexual) trauma in mental health care in old age.

Disclosure

No significant relationships.

Sexual violence in medical students and specialty registrars in Flanders, Belgium: a population survey

BACKGROUND

Sexual violence has globally been recognized as harmful to young people's health. In medical school, which is a highly competitive environment, the risk is supposedly even bigger. In this study we firstly aimed to investigate the magnitude and precipitating factors of sexual violence in medical students and specialty registrars in Flanders, Belgium. Secondly, we wanted to assess the reactive behaviours as well as the knowledge of possible types of bystander reactions as well as potential support resources for victims of sexual violence.

METHODS

This study was initiated and coordinated by the Flemish medical student representation organisation (VGSO). A survey containing demographic and behaviour-specific questions based on the UNMENAMAIS and SAS-V questionnaire was sent to all undergraduate, graduate and postgraduate students of the 5 medical schools in Flanders. Participants were asked to limit their responses to internship-related events. Further questions concerning reactions to sexual violence, assailants, bystander reactions and general knowledge concerning support after sexual violence were asked.

RESULTS

We received 3015 valid responses to our survey, obtaining a response rate of 29% in the potential target population. Within the total study population, 1168 of 3015 participants (38,73%) reported having been victim of at least one type of sexual violence as explored by our survey. This percentage was the highest in GP specialty registrars (53%), followed by specialty registrars (50%) and master students (39%). Assailants of sexual violence varied, most often they were medical staff members, students or patients. In most types of sexual violence, nobody reacted to this behaviour. Women (57.3%) talked about what happened afterwards more often than men (39.7%). When asked about their knowledge of possible bystander reactions and support services for sexual violence, 60% of the respondents did not know about their existence.

CONCLUSIONS

Sexual violence is still a relatively frequent issue in medical students and specialty registrars. Patients form an important part of the assailants. In a third of reported sexual violence cases, nobody reacted. In addition, male victims seem to underreport. There is still much need for sensitisation on support mechanisms and centres for victims and witnesses of sexual violence.

Improving medical students' communication competencies to deal with intimate partner violence using clinical simulations in Mozambique

BACKGROUND

During their medical training, medical students aim to master communication skills and professionalism competencies to foster the best possible patient-physician relationship. This is especially evident when dealing with sensitive topics. This study describes and analyses the outcomes of a simulation-based training module on clinical communication competency through interacting with simulated intimate partner violence (IPV) survivors. The training was set up as part of a broader IPV module within a Gynaecology and Obstetrics Bachelor of Medicine and Bachelor of Surgery of Medicine (MBBS).

METHODS

In total, 34 (59%) of all fourth-year medical students from one medical school in Mozambique were involved. A mixed-method approach was adopted. First, a quasi-experimental pre-test/post-test design was adopted to study the impact of the intervention to tackle critical IPV knowledge, skills, and attitudes, underlying a patient communication script. Second, a qualitative analysis of student perceptions was carried out.

RESULTS

The results of the paired sample t-tests point at a significant and positive change in post-test values when looking at the general IPV self-efficacy (IPV SE) score and the subscales mainly in attitudes. Participants expressed a desire for additional IPV communication competency and suggested enhancements to the module.

CONCLUSION

We conclude that due to IPV being a sensitive issue, simulation activities are a good method to be used in a safe environment to develop clinical skills. The results of this study are a good complement of the analysis of the competencies learned by the medical students in Mozambique with the current curriculum.

Applying Community Based Participatory Research on sexual health & sexual violence with refugees, asylum seekers and undocumented migrants in Europe and the European Neighbourhood

Background

Refugees, asylum seekers and undocumented migrants are at risk of sexual violence (SV). SV can induce ill-health in the victims, their offspring and community. However, prevention and response actions are leaping behind and rarely tap on the agency of the migrants themselves. Community Based Participatory Research (CBPR) is a collaborative research approach in public health that focuses on inequalities and aims to improve the health and well-being of community members by integrating knowledge in action, including personal, social and policy change.

Methods

Building on the concept of Desirable Prevention from a human-rights and gender-sensitive perspective, in three consecutive projects we applied CBPR to study SV and sexual health (SH) and collegiately developed SV prevention and response tools for personal, social and policy change.

Results

Each of the three CBPR projects was steered by local Community Advisory Boards composing of key stakeholders. With 1001 Community Researchers being refugees, asylum seekers, undocumented migrants and asylum reception professionals themselves we collegiately conducted the mixed-method research and co-created the tools that were validated at largely attended public seminars and implemented widely. While the projects clearly resulted in social and policy change, several professional researchers personally struggled with the principle of co-learning and co-creation while migrants struggled with the regained respect and identity that fell away beyond project scopes and in between project resulting in poor mental health in some.

Conclusions

Applying CBPR with refugees, asylum seekers and undocumented migrants on sensitive topics as SV and SH is a valuable research approach. Yet, the CBPR principles of cyclical participatory processes and the commitment to sustainability might clash with the current funding and timing of EU research projects challenging participants’ mental health and researchers’ ethics.

Piloting Sexual Assault Care Centers in Belgium: Who do they reach and what care is offered?

Background

Care for victims of sexual violence is fragmented in Belgium. Therefore, sexual assault care centers (SACCs) were piloted in three cities from November 2017 onwards. The SACCs offer forensic, medical and acute psychological care through a forensic nurse, while vice inspectors perform an interrogation at the SACC for those wishing to report. The nurse coordinates the follow-up care and a psychologist provides mental health support. A quantitative prospective study was carried out assessing the characteristics of SACC patients, the sexual violence they experienced and the care received, in order to inform the national scale-up of the model.

Methods

Data on SACC patients was routinely collected in the electronic patient files by the SACC personnel between November 1st 2017 and October 31th 2018. Data was analyzed in SPSS.

Results

Within the first year SACCs were attended by 930 victims. Mean age was 24,5 years (SD = 12.8), and one third were minors. Eighty-eight percent of victims was female and 67% presented for rape. Fifty-seven percent of the assailants were known to the victim. Thirty-five percent of the victims self-referred to SACC, 41% were referred by the police, and 66% of victims attended services within 72 hours. Respectively 75%, 61%, 47% and 68% of victims received medical care, a forensic examination, psychological care and reported to the police.

Conclusions

Without big publicity the SACCs received a higher than expected number of victims. Expansion of the collaboration with police and targeted communication strategies should further increase the number of victims receiving appropriate care. Qualitative research assessing the acceptability of the SACC model will further inform the scale-up of the model.

Key messages

The quantitative study led to a better understanding of the population using the SACCs. The study allowed to improve the training of the staff members, adapt the SACC procedures before scale-up and define targeted service-promotion strategies.