Abstract
BackgroundResearch supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women’s well-being. Furthermore, evidence for the impact of the perpetrator’s identity is mixed. There is also little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women’s mental health in the Australian primary care setting.MethodsWe conducted a descriptive, cross-sectional study in general practice clinics. Adult women completed an anonymous survey while waiting for the doctor. Measures included PHQ-9 (depression), GAD-7 (anxiety) and PCL-C (post-traumatic stress disorder). SV was measured using items from the National Intimate Partner and Sexual Violence Survey and categorised into three groups (rape/sexual assault; coercive behaviours and/or reproductive control; and unwanted sexual contact).ResultsWe found significant associations between rape/sexual assault and poor mental health, and between coercion and/or reproductive control and higher PTSD and anxiety scores, compared to women with no SV experiences. SV perpetrated by an intimate partner was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger, and significantly higher depression scores than SV perpetrated by another known person.ConclusionFindings suggest that associations between SV and mental health are mediated by type of SV and perpetrator identity. Health practitioners should enquire about different types of SV beyond stranger rape as a cause of poor mental health, and about perpetrator identity to inform them about the likelihood of ongoing symptoms.
Highlights
Research supports the association between adult sexual violence (SV) and poor mental health
Studies consistently suggest that women are most likely to be sexually assaulted by a known perpetrator in their own home [12], yet community understandings of sexual violence typically focus on stranger rapes in dark alleyways. This is highly problematic, since compared to SV perpetrated by a stranger, SV at the hands of an intimate partner is associated with a higher risk of death or serious injury [13], exposure to multiple and repeated attacks [14], greater risk of sexually transmitted infection [15] and increased feelings of shame [16], all of which are likely to contribute to poor mental health outcomes
Relationship between perpetrator identity and mental health Seventy-eight of the 126 women who had experienced SV responded to the perpetrator identity question. For those who responded to this item, SV perpetrated by an intimate partner was associated with significantly higher mean post-traumatic stress disorder (PTSD) scores than SV perpetrated by a stranger
Summary
Research supports the association between adult sexual violence (SV) and poor mental health. There is little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women’s mental health in the Australian primary care setting. With the exception of a few studies examining the mental health impacts of coercion as an aspect of intimate partner violence [8, 9], and one study from the Cote d’Ivoire on reproductive control [10], little is known about the health effects of these more subtle types of SV, despite their prevalence [11]
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