Women Sexual Assault Survivors Research Articles

“It Literally Makes Me Feel Harder to Kill”: A Qualitative Study of the Perceived Benefits of Recreational Martial Arts Practice Among Women Sexual Assault Survivors

“It Literally Makes Me Feel Harder to Kill”: A Qualitative Study of the Perceived Benefits of Recreational Martial Arts Practice Among Women Sexual Assault Survivors

Experiences of women sexual assault survivors with police in the early aftermath of assault: Results from a large-scale prospective study.

Over 100,000 women present for emergency care after sexual assault (SA) annually in the United States. To our knowledge, no large prospective studies have assessed SA survivor experiences with police. Women SA survivors enrolled at 13 sites (n = 706), and 630 survivors reported on their police interactions. Most women were interested in speaking with police, spoke with police, and reported positive experiences. Latinas and women with lower education and income were less likely to speak with police. Trauma and posttraumatic stress symptoms were associated with more negative experiences. Qualitative comments provide key points for police to consider when speaking with survivors.

Reclaiming Pleasure: Does Satisfying Consensual Sexual Activity Predict Next-Day Positive Affect Among Women with a History of Sexual Assault?

ABSTRACT Substantial research documents the psychosocial benefits of sexual activity, including heightened positive affect and lowered negative affect following sexual encounters. However, it is important to examine whether affective benefits of consensual sexual activity are present among individuals who have also experienced non-consensual sexual activity (i.e. sexual assault), given that sexual assault may have harmful consequences for sexual functioning and pleasure during consensual encounters. This study tested consensual sexual activity and satisfaction as predictors of next-day positive and negative affect among 82 women sexual assault survivors. Participants completed ecological momentary assessment measures for three weeks, including measures of past-day dyadic (i.e. partnered) sexual activity and satisfaction in the morning and current affect in the afternoon. As hypothesized, dyadic sexual activity and greater than usual sexual satisfaction predicted increased next-day positive affect after controlling for past-day positive affect. In contrast, and partially supporting hypotheses, sexual satisfaction, but not activity alone, predicted lowered next-day negative affect after controlling for past-day negative affect. At the between person level, greater sexual satisfaction (but not overall frequency of dyadic sexual activity) was associated with greater positive and lower negative affect on average after controlling for several covariates. Findings indicate that satisfying dyadic sexual encounters lead to relatively long-lasting positive affect changes in women who have experienced sexual assault.

Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.

Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope

BackgroundDepression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope. MethodWomen sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link. ResultsInternalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894). DiscussionWhile findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.

"I still feel so lost": experiences of women receiving SANE care during the year after sexual assault.

ObjectiveEmergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them.MethodsEnglish‐speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi‐site observational study. We qualitatively analyzed responses to the open‐ended question: “What do you think is most important for researchers to understand about your experience since the assault?” asked 1 week, 6 weeks, 6 months, and 1 year after enrollment.ResultsThemes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors’ daily lives.ConclusionsQualitative analyses of open‐ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.

Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain.

Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.

“They Helped Me the Best They Could”: Experiences of Women Sexual Assault Survivors With Police in the Early Aftermath of Assault and Associations With Past Trauma History and Acute Psychological Responses

Approximately 100,000 adult women sexual assault (SA) survivors each year receive emergency care and forensic evidence collection. These women are also contacted/interviewed by police.

Research Among Women Sexual Assault Survivors Presenting for Emergency Care is Justified: Results From a Multi-Site, Prospective Observational Cohort Study

∼100,000 adult women sexual assault (SA) survivors present for emergency care after SA each year. Enduring posttraumatic stress (PTS), depression, and pain in SA survivors are common. Studies to better understand the pathogenesis of these outcomes in SA survivors and develop and test preventive interventions are needed. It is essential that such research be safe for SA survivors; little data regarding safety is available from studies that enrolled survivors in the early aftermath of assault.

Anxiety Sensitivity Prospectively Predicts Increased Acute Posttraumatic Stress and Related Symptoms After Sexual Assault.

Anxiety sensitivity is a potential risk factor for posttraumatic stress symptoms (PTSS) and has been hypothesized to contribute to PTSS development. However, few prospective studies have evaluated whether anxiety sensitivity predicts PTSS. In a subsample of 48 women sexual assault survivors enrolled as part of a larger prospective observational study, elevated anxiety sensitivity measured via a brief assessment 1 week after experiencing a sexual assault was concurrently associated with PTSS at 1 week and prospectively predicted PTSS 6 weeks after the event, with small-to-medium effect sizes, η2 p = .10, even after covarying for trauma history. Heightened anxiety sensitivity at 1-week postevent also interacted with time to predict anxiety and depression both before and after sexual assault, with medium-to-large effect sizes, ηp 2 = .21- .24. This is consistent with research linking anxiety sensitivity to PTSS, but this was the first prospective study of which we are aware to demonstrate that anxiety sensitivity in the acute posttrauma period predicts PTSS among women who have recently experienced sexual assault. Future research should use the full Anxiety Sensitivity Index to replicate findings in a larger sample and explore whether targeting anxiety sensitivity could mitigate the development of PTSS in this vulnerable population.

Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study.

Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault. Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey. Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged. Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.

Psychological and Physical Morbidity of Sexual Assault Among Adult Women Students

The high risk of sexual assault (SA) faced by female college students is the subject of increasing national attention, but few prospective studies have enrolled college women sexual assault survivors in the immediate aftermath of SA and assessed adverse mental and physical health outcomes over time.

Sexual Assault Survivors' Post-Traumatic Growth: Individual and Community-Level Differences.

Past research has focused on individual differences in post-traumatic growth (PTG) among survivors, but no studies to date have examined differences at the neighborhood level. This exploratory study uses data from a 3-year longitudinal study of women sexual assault survivors (N = 1,863) living in a segregated city. We tested random intercept models of individuals nested within neighborhoods. Disrupted core beliefs, greater perceived control over recovery, less post-traumatic stress disorder (PTSD), religious coping, and positive social coping predicted more PTG. White survivors had lower PTG scores than the women of color in this study. Neighborhood-level differences in PTG scores persisted even though violent crime rate and neighborhood poverty did not emerge as significant in our model.

(188) Clinically Significant New or Worsening Pain is Common Six Weeks after Sexual Assault: Results of a Large-Scale Cohort Study

Many adult women sexual assault (SA) survivors report persistent pain triggered by the assault, yet to date no large-scale longitudinal studies of adult women SA survivors have been performed. In this analysis, we evaluated the severity and distribution pain symptoms during the first six weeks after SA among women participating in an ongoing, large-scale, multisite study that enrolls women SA survivors in the immediate aftermath of assault and evaluates health outcomes over time. Women ≥ 18 years of age (n= 549) who presented to one of 14 sexual assault treatment centers in the immediate aftermath of assault were enrolled. In the immediate aftermath of assault, moderate or severe pain (severity score ≥ 4 on a 0-10 NRS) was reported by 394/549 (72%) of women. Clinically significant new or worsening pain (pain increase of ≥ 2 on a 0-10 NRS in comparison to reported pain during month prior to assault (assessed at one-week follow-up) was present in 76% of women SA survivors one week after the assault and 54% of women SA survivors six weeks after the assault. Most women SA survivors reported pain in many body regions, with a mean of 8 (SD = 6) body regions with pain at the time of initial exam, 8 (SD = 7) body regions with pain at one-week follow-up, and 5 (SD = 6) at 6 week follow-up. The most common body regions affected by persistent pain were the back (49%), neck (43%), and head (41%). These data indicate that clinically significant new or worsening pain, with pain in a number of body regions, is present in most women sexual assault survivors in the weeks after assault. Research is needed to determine the mechanisms responsible for this pain, and to identify preventive/treatment interventions.

F276. Use of HIV Post-Exposure Prophylaxis Among Women Sexual Assault Survivors is Not Associated With Increased Posttraumatic Stress Symptoms

To reduce HIV risk, post-exposure prophylaxis (PEP) is prescribed to some women sexual assault (SA) survivors who present for emergency care after SA. However, the use of HIV PEP, and/or accompanying medication side effects, may serve as reminders of the SA, augmenting posttraumatic stress symptoms (PTSS).

PTSD and Problem Drinking in Relation to Seeking Mental Health and Substance Use Treatment Among Sexual Assault Survivors.

This study seeks to understand the effects of the co-occurrence of PTSD and problem drinking on formal help-seeking among sexual assault survivors over time. Data comes from a diverse sample of 1,863 women in a large Midwestern city who participated in a three-year study on women's experiences with sexual assault. Generalized Estimating Equations (GEE) were used to estimate the parameters of generalized linear models to assess the effects of PTSD and problem drinking on survivor mental health help-seeking and substance use treatment-seeking over time. In our models, having more PTSD, more education, and receiving a reaction of tangible support increased the odds of survivors seeking mental health treatment, which replicates past findings. This is the first study of women sexual assault survivors to find a unique effect of both PTSD and problem drinking on substance use treatment- seeking. The findings suggest survivors with co-occurring PTSD and problem drinking are less likely to seek substance use treatment over time. Future directions are discussed for research on survivors with co-occurring symptoms.

Asian American Women Sexual Assault Survivors’ Choice of Coping Strategies: The Role of Post-Assault Cognitive Responses

ABSTRACTEven though approximately one in three Asian American (AA) and Pacific Islander women experience sexual assault victimization, there is a dearth of literature examining how AA women sexual assault survivors cope with this traumatic experience. This study examined AA female sexual assault survivors’ choice of coping strategies post-assault and how their cognitive responses toward sexual assault victimization (e.g., attributions of self-blame, perceived control over the recovery process) relate to their use of coping strategies. Using the AA subsets of two large community studies, a total of 64 AA women ages 18 to 58 with unwanted sexual experiences after the age of 14 years were included in the analyses. Results indicated that AA survivors used Acceptance and Self-Distraction the most to cope with sexual assault. In addition, those who perceived they had less control over their recovery process tended to use more maladaptive coping strategies, such as substance abuse and behavioral disengagement (e.g., giving up). The discussion includes clinical implications and recommendations for using language, modalities, and foci of interventions that are consistent with clients’ and their families’ worldviews (e.g., indirect inquiries, solution-focused).

Improving Formal Support After Sexual Assault: Recommendations From Survivors Living in Poverty in Canada.

Despite the extensive and often long-lasting sequelae of sexual assault, a significant majority of survivors do not seek assistance from formal support sources, such as police, medical or mental health professionals, and community-based agencies. While growing attention has been directed toward understanding the help-seeking barriers faced by sexual assault survivors, few studies have explored the experiences of survivors living in poverty and how help-seeking can be improved for this marginalized population. The present study sought to understand these issues from perspectives of survivors themselves. Women sexual assault survivors who self-identified as living in poverty (n = 15) were recruited from community-based agencies in the Greater Toronto Area, and participated in semistructured interviews focused on their personal decisions around help-seeking and broader views on access to and quality of formal assistance. Two research questions were of interest. First, what can be done to encourage service use among survivors living in poverty? Second, what is needed to improve the quality of assistance they receive? Thematic analysis revealed three key themes around which participants' recommendations centered: (a) increased accessibility of information, (b) improved training for formal support providers, and (c) greater opportunities for empowerment. Practical implications of these findings improving the service utilization rates and experiences of formal help-seeking among marginalized women survivors of sexual assault are discussed.

Predicting the Effects of Sexual Assault Research Participation: Reactions, Perceived Insight, and Help-Seeking.

This study examined effects of participating in survey research for women sexual assault survivors with other trauma histories to understand the role of study participation on perceived insight and long-term help-seeking behaviors. A diverse sample of 1,863 women from a large Midwestern city participated in a 3-year study on women's experiences with sexual assault. Regression analyses were conducted to (a) examine predictors of immediate positive and negative reactions to survey participation and (b) assess the impact of the survey on perceived insight and women's long-term help-seeking behavior. Overall, most women in the study had a higher positive than negative reaction to the survey (92%), with a significant proportion indicating they sought additional services as a result of participation (55%). Women with child sexual abuse (CSA), more emotion dysregulation, and more characterological self-blame had more negative reactions to the survey, whereas those with more education and individual adaptive coping had more positive reactions. Women who said they gained insight from answering survey questions were most likely to seek additional help. This study extends the literature by examining cumulative trauma and postassault symptoms in relation to the effects of survey participation. This is also the first study of women sexual assault survivors to find a relationship between gaining perceived insight from research and subsequent help-seeking. Participating in sexual assault research may help survivors gain greater insight into their recovery, which can lead them to seek out more resources for their ongoing trauma-related problems.

Predicting Sexual Assault Revictimization in a Longitudinal Sample of Women Survivors: Variation by Type of Assault

This study used a large community sample of women sexual assault survivors to prospectively assess 17 theorized predictors across four types of sexual assault revictimization: unwanted contact, coercion, substance-involved assault (SIA), and force. Results indicated that predictors varied across types of revictimization: Unwanted contact and coercion appeared more common in social contexts more hostile toward survivors, whereas forcible assaults and SIAs occurred in circumstances where survivors were vulnerable to being targeted by perpetrators. Overall, the strongest predictors were social environments hostile to survivors, race, childhood sexual abuse, decreased refusal assertiveness, and having more sexual partners. We discuss implications for intervention and research.