Women Survivors Of Sexual Violence Research Articles

An epigenome-wide study of a needs-based family intervention for offspring of trauma-exposed mothers in Kosovo.

Maternal stress and trauma during pregnancy have been shown to influence cortisol levels and epigenetic patterns, including DNA methylation, in the offspring. This study aimed to determine whether a tailor-made family intervention could help reduce cortisol levels in children born to traumatized mothers, and to determine whether it effected offspring DNA methylation. The secondary aim was to determine whether the family intervention influenced DNA methylation aging, a marker of biological aging. A needs-based family intervention was designed to help address relational difficulties and family functioning, and included a focus on family strengths and problem-solving patterns. Women survivors of sexual violence during the Kosovar war in 1998-1999, and their families (children with or without partners) were randomly assigned to 10 sessions of a family therapy over a 3-5-month period, or to a waitlist control group. Both mothers and children completed assessments prior to and after the intervention phase. Children's blood samples collected at these two time points were used to measure cortisol and epigenome-wide DNA methylation patterns (Illumina EPIC array). Cortisol levels, and genome-wide DNA methylation changes pre-/postintervention were compared between children in the intervention and the waitlist groups. DNA methylation age and accelerated biological aging were calculated. Sixty-two women-child dyads completed the study, 30 were assigned first to the intervention group, and 32 to the waitlist control group. In adjusted linear regression, the family intervention was associated with a significant decline in cortisol levels compared to the waitlist control (β=-124.72, 95% confidence interval [CI]: -197.4 to -52.1, p=.001). Children in the intervention group, compared to the waitlist control group, showed >1% differential methylation degree at 5819 CpG (5'-C-phosphate-G-3') sites across the genome (p<.01), with the largest methylation difference being 21%. However, none of these differences reached genome-wide significant levels. There was no significant difference in DNA methylation aging between the two groups. We find evidence that a tailored family-based intervention reduced stress levels in the children (based on cortisol levels), and modified DNA methylation levels at a number of sites across the genome. This study provides some preliminary evidence to suggest the potential for tailored interventions to help break the intergenerational transmission of trauma, however, large studies powered to detect associations at genome-wide significant levels are needed.

“They raped me and killed my husband”: Women survivors of sexual violence’s experience in South and North Kivu, Democratic Republic of Congo.

“They raped me and killed my husband”: Women survivors of sexual violence’s experience in South and North Kivu, Democratic Republic of Congo.

An agricultural field, a dangerous place for women: survivors of sexual violence’s experience ineastern democratic republic of Congo

ABSTRACT This study investigates Congolese girls’ and women’s experience in the eastern Democratic Republic of Congo concerning the rape they face during field activities. A qualitative approach was employed to collect data from 40 single young women and married women aged 18–45 years old. Four focus group discussions and 28 individual interviews were conducted among women survivors of sexual violence from the South and North Kivu provinces. Findings indicate that the agricultural fields in remote areas represent a sexually hostile work environment where militias or attackers gang-rape women and girls. According to the participants, they occasionally avoid going to the fields due to pain, fear, and illness resulting from rape. It is believed that the enemy is using such brutal rape as a tactic to instil fear in the community and families in order to force them to starve. Greater efforts are needed from the government to ensure the protection of traumatized population, girls and women living in rural areas.

Living in the Aftermath: Spiritual Struggles of Hong Kong Christian Women Survivors of Sexual Violence

Spiritual trauma is one of the common outcomes for Christian women trauma survivors together with other psychological challenges (McNulty & Wardle in Child Abuse & Neglect, 18, 549–555, 1994; Rudolfsson & Tidefors in Pastoral Psychology, 64, 453–467, 2015; Yih in "Business as usual": Are Hong Kong faith communities supportive to Christian women with sexual harassment trauma? under review). Victims frequently experience much disappointment with the pastoral or congregational support they receive in the aftermath of their disclosure, which critically exacerbates their primary traumatic overwhelm and causes various faith-related challenges collectively known as spiritual struggle (Doyle in Sexual abuse in the Catholic clergy: A decade of crisis, 2002–2012 (pp. 171–182). Praegar, 2011). In this paper, I critically examine the spiritual aspect within the complex processes of Hong Kong Christian women survivors of sexual violence trauma recovering from the impacts caused by the responses of the victims’ faith communities using the qualitative research methodology of interpretative phenomenological analysis (IPA). The paper contributes to the growing efforts to develop an integrated and holistic provision of theologically robust and trauma-informed pastoral care for those struggling on the complex and challenging journey in the aftermath of trauma caused by sexual violence.

High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo.

Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population. A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status. For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL). This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.

Peer Support Groups Integrated with Trauma-Sensitive Yoga for Women Survivors of Sexual Violence: A Feasibility Study and Qualitative Examination.

Trauma Center Trauma-Sensitive Yoga (TCTSY) is an evidence-based yoga protocol and approach used for somatic trauma care. Seven women participated in a 12-week TCTSY-integrated peer support group for sexual violence survivors at a community rape crisis center. Three semi-structured interviews were conducted: interview 1 at 1-2 months post-group, interview 2 at 8-9 months post-group, and interview 3 at 24-33 months post-group. Thematic analysis was conducted following Clandinin and Connelly's three-dimensional space approach. Participants described themes related to improvements in trauma symptoms, mind-body connection, present-centered awareness, self-regulation, and relationships with self and others. Changes were sustained at the final interview. TCTSY-integrated peer support groups appeared feasible and acceptable to women victim-survivors of sexual violence.

Framed as (Un)Victims of Sexual Violence: An Intersectional Model

This study presents an intersectional analysis of beliefs about and experiences of Black women regarding sexual violence, using focus group and survey methods with BIPOC college students ( N = 37). Based on the analysis, we propose a theoretical model of “(un)victimization” that integrates two inequality frames – misogynoir and legal cynicism – applied to sexual assault. Specifically, this model explains the experiences of Black women survivors of sexual violence who simultaneously experience sexual victimization, are denied legitimate victim status, and have reason to distrust legal forms of justice. We theorize the process of (un)victimization enables future sexual assault of Black women.

Screening and risk factors for cervical cancer among survivors of sexual violence in conflict settings, in Eastern Democratic Republic of Congo.

This study assesses the risk that rape survivors have of developing cervical cancer in the context of conflict. A cross-sectional and descriptive study conducted in Bunyakiri and Kavumu, a conflict region in the east of the Democratic Republic of the Congo during the period from September 1 to 10, 2022, including 47 women survivors of sexual violence, 41 of whom were selected on the basis of certain criteria with age ranging from 18 to 50 years. Speculum examination was performed with visual inspection with acetic acid (VIA). After collecting data, the latter were encoded in the Excel file and grouped in the form of tables then analyzed after calculating the percentage. Ages of 21-30 years was the most represented, i.e., 56%. Among them, 34.1% were married and 31.7% were abandoned. Majority was in secondary school (46.3%) and illiterates (34.1%). 36.5% complained of pelvic pain and 36.5% reported first sexual intercourse at the age range of 13-15 years, of which 25 cases, i.e., 61% were sexually active. 39% reported having had 3 sexual partners in their life. VIA was negative in 97.5% of cases. It should be mentioned in this study that the environment of conflict zone, the circumstances of rape and the risky sexual behavior of survivors are an ecosystem that predisposes them to cervical cancer.

Sex-specific associations between self-reported physical activity and PTSD among survivors of sexual violence.

This study examined sex-specific associations between sexual violence (SV) type and physical activity, and identified associations between PTSD symptoms and physical activity, all among cisgender men and women survivors of SV. Cross-sectional data from men (n = 197) and women (n = 356) survivors of SV were analyzed with stratified (men; women) hierarchical logistic regressions. Additionally, fully adjusted models for the total sample included interaction terms to further assess whether associations between SV type as well as PTSD symptoms (sum, clusters) and physical activity differed significantly by sex. Sexual assault was negatively associated with physical activity in the crude model among women (ORs: 0.58; p < 0.05). Harassment was positively associated with physical activity in the crude and adjusted models (ORs:1.92-2.16; ps<0.05) among women. Among men, there were no significant relationships. Regarding PTSD symptoms among women, crude and adjusted stratified models identified significant positive relationships with intrusion (ORs: 1.18-1.22; ps<0.05). Crude and adjusted models revealed significant positive relationships between avoidance and activity (ORs:1.38-1.41; ps<0.05) among men but not women. The interaction term for this difference in the association between avoidance and physical activity by sex was significant (OR: 0.65; 95%CI: 0.48-0.88; p < 0.01). Overall, findings provide evidence for sex-specific associations between SV and physical activity.

Justice-Involved, Sexually Victimized Women's Perspectives on the Acceptability of Receiving Trauma-Focused Therapy in Prison.

Incarcerated women report high rates of sexual victimization. Interviews with 63 previously incarcerated women survivors of sexual violence explored perceptions toward receiving trauma-focused therapy while incarcerated and postrelease trauma-focused therapy utilization. Nearly all participants (97%) recommended that trauma-focused therapy be available to incarcerated women. Most believed that prisons are acceptable places to receive trauma-focused therapy, without qualification (65%); some reported mixed feelings or indicated acceptability but identified factors that would increase acceptability (33%). Notably, most were currently experiencing trauma-related symptoms, but few had attended trauma-focused therapy following release. Findings indicate that access to prison-based trauma-focused therapy is necessary and acceptable.

A phenomenological inquiry into support-seeking experiences for women survivors of sexual violence in the South Asian diaspora.

A phenomenological inquiry into support-seeking experiences for women survivors of sexual violence in the South Asian diaspora.

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.

Impact of Military Affiliation on Exercise Perceptions Among Survivors of Sexual Violence.

Military service members disproportionately experience sexual violence (SV) and its related health concerns. Although recent work has shown physical activity to be an effective strategy for improving physical and mental health among trauma-exposed military populations, little of this work has focused specifically on military service members with a history of SV. To address these gaps in knowledge and practice, this study identified the most salient perceived benefits/barriers of exercise among men and women survivors of SV with military affiliations. Additionally, these analyses explore willingness to engage in exercise programs, and preferences for the structure/content of these programs, among men and women survivors of SV with military affiliations. An online, cross-sectional survey of women (n = 355) and men (n = 198) survivors of SV was completed using Amazon Mechanical Turk. Inclusion criteria were men and women, age between 18 and 65 years, self-reported history of SV, and located in the United States. Information on sociodemographics and post-traumatic stress disorder symptoms was collected alongside perceived barriers and benefits to exercise, willingness to engage in exercise programs, and preferences for the structure/content of these programs. Analyses were stratified by sex. Comparisons by history of military involvement (active duty military or veteran; no military involvement/civilian) were reported. Both military-involved men (n = 68) and women (n = 139) were more likely to prefer at-home and online exercise options when compared to civilians (Ps < .05; Cramer's Vs 0.19-0.36). Additionally, both men and women with military involvement reported strongly favoring exercising with an instructor over no instructor and preferred that this instructor identifies with their same gender (Ps < .01; Cramer's Vs 0.28-0.36). Women with military involvement also preferred shorter program durations and exercising alone or in a group online or in person, whereas men with military involvement were open to longer program durations, when compared to their civilian counterparts (Ps < .05; Cramer's Vs 0.19-0.37). Women and men with military involvement were more likely than their civilian counterparts to perceive that exercise benefits their psychological outlook and social interactions. They were also more likely than civilians to indicate poor exercise environment, high time expenditure, and family discouragement as perceived barriers to exercise (Ps < .05; Cohen's ds 0.21-0.97). Military-involved women were also more likely than civilian women to endorse the perceived barrier of hard physical exercise (P < .05; Cohen's d = 0.25). This study identified perceived benefits and barriers to exercise, along with willingness to engage in exercise programs, and exercise preferences among men and women survivors of SV with military involvement. Targeting these factors in intervention planning will be important for physical activity promotion and program engagement among veterans to reduce the disproportionate impact of SV and disease burden among U.S. service members and veterans.

Resistance of Women Survivors of Sexual Violence in Social Media

Resistance of Women Survivors of Sexual Violence in Social Media

Exercise preferences among women survivors of sexual violence by PTSD and physical activity level: Implications and recommendations for trauma-informed practice

BackgroundThis analysis reported (1) interest in exercise programs made for women survivors of sexual violence (SV), (2) preferences for the structure and content of these programs, and (3) comparisons of interest and preferences by physical activity and PTSD. Methods: A cross-sectional study was conducted among women aged 18–65, who had self-reported a history of SV, and were in the United States. Willingness to participate in exercise programs, and preferences for content and structure, were assessed and compared by PTSD and physical activity status. Results: Of 974 respondents, 528 met the inclusion criteria, and 355 met data quality requirements to be included in the analysis. Most women indicated they were interested (n = 197) or may be interested (n = 137) in exercise programs. Women with PTSD and who were active were most likely to be interested (ps < 0.05; Cramer's Vs = 0.15–0.25). Women reported favoring exercising at home, alone or in group formats, and with female instructors. They also preferred moderate intensity, sessions lasting 30 min to an hour, 3–4 times per week. Insufficiently active survivors were more likely to prefer at home locations, low-moderate intensities, and shorter durations when compared to active survivors (ps < 0.05; Cramer's Vs = 0.16–0.20). Women with PTSD were more likely to prefer at home options, with women instructors, moderate-high intensity, longer sessions, and longer program durations, compared to women without PTSD (ps < 0.05; Cramer's Vs = 0.18–0.50). Top endorsed modes were walking, jogging, and yoga. Conclusion: Results add new knowledge on understanding best practices for integrating trauma-informed physical activity into trauma recovery programs for women survivors of SV.

Training in Person Centered Trauma Informed Care: A Strategy to Enhance Care Delivery in Older Trauma Survivors

Person Centered Trauma Informed Care (PCTIC) is a form of care delivery that was developed over the last few decades to improve the ability of institutions and organization to provide sensitive care to survivors of trauma. Most of the research in the field of PCTIC and its implementation was conducted with young adults in the foster care and juvenile court system, with women survivors of sexual violence and in long term institutional settings for the chronically mentally ill. Very little attentions was paid to the needs of older adults until about 5 years ago, when several grants were funded to support the work of agencies providing services to ageing Holcaust Survivors with the aim to implement the delivery of care according to the PCTIC model. The Division of Geriatric Psychiatry at Montefiore Medical Center in the Bronx, NY has been involved in training staff on this model of care delivery and on the interface of trauma care and geriatric syndrome for several years. The current presentation focuses on the development of a series of curricula and lectures specifically aimed at increasing the overall level of competence of the general medical practitioners in the delivery of PCTIC to older adults. This was accomplished both by training the staff of a community mental health clinic and by developing ongoing curricula to deliver to medical students and residents.

\u201cI\u2019m not alone, my story matters\u201d: Incarcerated women\u2019s perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories

BackgroundAlthough it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments – exposure therapy – should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others’ trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; SurvivorsHealing fromAbuse:Recovery throughExposure) while incarcerated. We assessed women’s reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability.ResultsTreatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting “it depends”). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others’ trauma narratives (i.e., exposures) in the SHARE group context as helpful—making them feel less alone and normalizing their experiences. Sharing one’s own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function).ConclusionsOur findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae—those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)—should be offered to incarcerated women as part of standard of care.

Percepción del suelo pélvico en mujeres supervivientes de violencia sexual. Estudio cualitativo

ObjectiveTo know the perceptions of a group of women survivors of sexual violence about the state and function of their pelvic floor. To recognize the presence of dysfunctions and their relationship to sexual violence, and their perspective on the quality of care for these sequelae. MethodsQualitative phenomenological study. Semi-structured interviews were conducted, and a self-administered online survey was developed based on the 5th version of the Diagnostic and Statistical Manual of Mental Disorders to collect data related to sexual dysfunction, in four women survivors of sexual violence. The discourses were analysed, and relevant information was coded to obtain the key statements of the participants. ResultsFour categories emerged (sexual violence, pelvic floor, health care, and support), showing the psychological, sexual, and physical effects of sexual violence, the lack of knowledge about the pelvic floor, and the health care and support obtained and needed. ConclusionsPelvic pain and difficulties in penetration, among other gynaecological and psychological problems, stand out as effects of sexual violence. The women reported a lack of knowledge about the pelvic floor, and lack of awareness of contraction and relaxation of this muscle, and of its possible relationship with sexual dysfunction. In addition, they were unaware of the work of the health professional in addressing physical problems related to the pelvic floor resulting from an episode of sexual violence.

Implementing and Sustaining SHARE: An Exposure-Based Psychotherapy Group for Incarcerated Women Survivors of Sexual Violence.

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well-established implementation science framework. Participants (N=22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter-organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure-based therapy, is possible to implement and sustain in carceral settings. Community-academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women.

Trauma-informed exercise for women survivors of sexual violence.

Compared to their male counterparts, women experience alarmingly high rates of sexual violence (SV). Nearly 20% of women in the USA have been victims of SV, and prevalence of sexual assault among female service members is reported to be even higher, up to 50%. SV results in negative health outcomes like posttraumatic stress disorder, depression, obesity, poor body image, and pain-related disability. Exercise has been shown to positively impact both mental and physical health outcomes in populations experiencing posttraumatic symptoms, yet women survivors of SV are often excluded from exercise trials in trauma-affected populations. The purpose of this paper is to comment on the importance of incorporating women-specific trauma-informed principles in the content and delivery of exercise interventions in trauma-affected populations, particularly as it relates to SV. Researchers discuss the implications of female-specific and trauma-informed exercise considerations for SV survivors. This commentary highlights the need for trauma-informed implementation efforts and outcome measurements in exercise interventions involving women affected by SV. Researchers call for (a) increased qualitative work on trauma-specific implementation efforts across exercise intervention domains and (b) increased assessment of trauma-specific outcomes in exercise trials.