Age at Sexual Assault and Posttraumatic Stress Disorder in Females Residents of Virginia

Abstract

Background Post Traumatic Stress Disorder (PTSD) is a psychiatric debilitating condition that can occur in individuals who experience extremely stressful or traumatic life events. Sexual assault is considered as one of the most traumatic stressor in life. Although few studies investigated the association between history of sexual assault and PTSD, no studies have examined the impact of age at sexual assault on PTSD. Method A cross-sectional telephone survey was conducted among adult female residents of Virginia from November 2002 to February 2003. A total of 1,769 women aged and older were interviewed using a random digit dialing method. Detailed screening questionnaire was utilized to ascertain the occurrence of sexual assault, age at sexual assault and PTSD. The DSM-IV diagnostic criteria were used to define PTSD. Result The prevalence of PTSD among women with no history of sexual assault, those victimized before the age of and and above was 8.1%, 35.3%, and 30.2% respectively. Multivariate logistic regression model showed an increase risk of PTSD among women assaulted at a younger age. Compared to women with no history of sexual assault, women who were victimized before their 18 birthday were 2.8 times more likely to suffer from PTSD [OR=2.78 (95% C1=1.874.23)]. The risk of PTSD among women victimized as adults was 2.6 times higher compared to women with no history of sexual assault [OR=2.59 (95%CI =1.43-4.70)]. Conclusion This study provided important information on the association between PTSD and age at sexual assault. The risk of PTSD is relatively higher among those assaulted before the age of 18. The adverse effect of sexual assault as a risk for PTSD in addition to other negative health problems is a major public health concern. Primary prevention strategies should be in place to detect sexual assault victims and prevent the occurrence of PTSD. Introduction Sexual assault is a serious public health problem. In the United States 20 to 30 women are sexually assaulted every one hour.13233 Approximately 30% of women experiences some form of sexual assaults in their lifetime and, approximately 24 percent of children will be sexually assaulted before their 18th birthday; about 74 percent will be According to the Children Bureau of the US Department of health and human services (DHHS), approximately 903,000 cases of child maltreatment were substantiated in the United States in 2002.)~~ Sexual assault affects all sectors of society and has many psychiatric implications. In study of sexually and physically abuse boys and girls age 7-13, Post Traumatic Stress Disorder (PTSD) was only the fourth most common diagnosis, following separation anxiety, oppositional defiant, and conduct disorder.) PTSD is a psychiatric debilitating condition that can occur in individuals who experience extremely stressful or traumatic life events. It is characterized by upsetting memories or thoughts of ordeal, blunting of emotions, increased arousal, and sometimes severe personality changes. It can affect people of all ages. As the individual struggles to cope with life after the event, ordinary situations reminiscent of the trauma often trigger frightening and vivid memories. Among the most troubling symptoms of PTSD are flashbacks, which can be triggered by sounds, smells, feelings, or images. During the flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again. To diagnose PTSD, DSM-IV (American Psychiatric Association) focuses on both the objective characteristics of the event (i.e. a traumatic event is defined as involving actual or threatened death or serious injury, or threat to the physical integrity of self or others) and the subjective response of the person exposed to the trauma (fear, helplessness, or horror). A number of studies have investigated PTSD in individuals exposed to rape seem to have a strong relation to the subsequent development of PTSD' 2. Hezler et al, and Davidson et al, both using DSM-III criteria and the Diagnostic interview schedule (DIS) to assess PTSD, reported life time prevalence rates of 1.0 and 1.3 percent respectively. According to the National Survey Psychiatric Epidemiology study on the prevalence of violent events and PTSD in the Mexican population .2.3 percent of women and 0.49 percent of men present PTSD. Rape, harassment, kidnapping, and sexual abuse were the events most associated with PTSD~. The European Study of the Epidemiology of Mental Disorders (ESEMD) project recently reported considerably lower life time PTSD prevalence rate (0.9 percent for men and 2.9 percent for women, over all 1.9 percent). German study found life time PTSD prevalence rate of 1 percent for men and 2.2 for women in 14-24 years old4. Studies in the general population with randomly selected subjects are relatively scarce, with only half dozen published, the majority reporting prevalence rates in the United States, and none has studied PTSD as one of the commonest mental health outcome in relation to age at sexual assault. This study was designed to assess the mental health outcome of sexual assaults, focusing in PTSD, with comparison between underage and adult women victims. Methods A cross-sectional survey was conducted using a random digit dialing (RDD) sample selection method from November 2002 through February 2003. A total of 1,769 female adult years and older residents of Virginia were surveyed. The instrument for this study was adopted from a survey completed in Washington state and two national studies; National Women's Study (NWS) and the National Violence against Women Survey (NVAWS). The questionnaire was programmed in Computer Assisted Study Exec~~tion System (CASES) using the Computer Assisted Telephone Interviewing (CATI) system. Survey respondents were asked about their history of sexual assault, the type of assault, consequences of the assault and perception of community responses to sexual assault. Sexual assault was defined as (yes response to any of the following questions): forced to have vaginal sex, oral sex, and anal sex, forced sex with objects, attempted rape and sex when the victim was unable to give consent due to heavy alcohol consumption or being under the influence of illicit drugs. Child rape or molestation (less than years old). All survey respondents were interviewed about moods, emotions and overall behavioral well-being. A questionnaire was used in diagnosing PTSD that has been validated against the DSM-IV scale (American Psychiatric Association). The questionnaire also contains socio-demographic variables: race and ethnicity, age, marital status, educational level, spiritual and religious belief and income. Victims of sexual assault were asked about: Health seeking practices after being victimized, weapon used, weather the victim talked to a close one, counselor, therapist or other professional to get help and support. Victims also were asked about the consequences of sexual assault such as sexually transmitted disease or pregnancy. PTSD was defined using the following criteria: Criteria (A): The person has been exposed to a traumatic event in which both of the following