The Prevalence of Sexual Revictimization: A Meta-Analytic Review

Estimating Aggregate Environmental Risk Score in Psychiatry: The Exposome Score for Schizophrenia

To understand the role of environment in the pathoetiology of psychosis spectrum disorders, research has thus far mainly investigated the effects of single exposures in isolation, such as the association between cannabis use and schizophrenia. However, this approach fails to acknowledge the complexity of the exposome, which represents the totality of the environment involving many exposures over an individual's lifetime. Therefore, contemporary research adopting the exposome paradigm has aimed at capturing the combined effect of different environmental exposures by utilizing an aggregate environmental vulnerability score for schizophrenia: the exposome score for schizophrenia. Here, we attempt to provide a comprehensive overview of studies applying the exposome score for schizophrenia. First, we describe several approaches estimating exposomic vulnerability for schizophrenia, which falls into three categories: simple environmental sum scores (sum of dichotomized exposures), meta-analysis-based environmental risk score (sum scores weighted by estimates from meta-analyses), and the exposome score (sum score weighted by estimates from an analysis in an independent training dataset). Studies show that the exposome score for schizophrenia that assumes interdependency of exposures performs better than scores that assume independence of exposures, such as the environmental sum score and the meta-analysis-based environmental risk score. Second, we discuss findings on the pluripotency of the exposome score for schizophrenia and summarize findings from gene-environment studies using the exposome score for schizophrenia. Finally, we discuss possible scientific, clinical, and population-based applications of exposome score for schizophrenia, as well as limitations and future directions for exposome research to understand the etiology of psychosis spectrum disorders.

Systematic Review of Risk and Protective Factors for Revictimization After Child Sexual Abuse

Child sexual abuse (CSA) is a widespread public health problem in the United States. It has been associated with multiple long-term deleterious outcomes including revictimization in adulthood. This systematic review of 25 studies synthesizes research examining possible risk and protective factors that might explain the established link between CSA and future victimizations. Specific risk factors identified included co-occurring maltreatment in the home, risky sexual behavior (particularly in adolescence), post-traumatic stress disorder, emotion dysregulation, and other maladaptive coping strategies. Only one protective factor was identified: perceived parental care. The review also revealed considerable variability in definitions and measurement of both CSA and adult victimization, particularly in terms of how researchers conceptualized age. Many of the studies were limited in generalizability by including only college-age women. These findings have clinical and research implications. Public health interventions working to prevent revictimization among CSA survivors can utilize these findings when designing programs. For researchers, the results highlight the need for standardized definitions of both CSA and revictimization, for well-validated and consistent measurement, and for inclusion of additional population groups in future research.

Alcohol and Sexual Risk among American College Students Studying Abroad

Recent studies show that during study abroad experiences, college students greatly increase their drinking behavior, experience multiple alcohol-related consequences, engage in sexual risk behaviors, and are at-risk for sexual violence victimization. These studies, however, have been limited by small sample sizes of students from single institutions who are often studying in a particular country or region. To better understand the extent of the risks experienced by college students studying abroad, we conducted a longitudinal survey study of 2630 students from 65 different US colleges and universities studying in 12 diverse locations abroad. Total drinks per week and heavy drinking days more than doubled while students were abroad, with heavier predeparture drinkers, men, and students under age 21 experiencing the greatest increases. There were few observed overall changes in alcohol-related consequences and risky sexual behaviors; however, specific groups, such as those with heavier predeparture consequences and sexual risk behaviors, men, and those on longer abroad programs reported greater consequences and risky sex abroad. One in five students (21%) experienced sexual violence abroad, with non-consensual physical contact the most prevalent form. Women, those under age 21, and those with a history of sexual violence were most likely to experience sexual violence abroad. Findings indicate that study abroad students may warrant targeted predeparture programming to help prevent heavy drinking and sexual violence experiences abroad.

Latent class analysis of post-traumatic stress symptoms and complex PTSD in child victims of sexual abuse and their response to Trauma-Focused Cognitive Behavioural Therapy

Background: PTSD symptoms are frequent in child victims of sexual abuse. Yet, authors have argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed Complex PTSD as an alternative diagnosis encompassing difficulties in affect regulation, relationships and self-concept. Objective: To delineate profiles in child victims of sexual abuse and explore whether profiles are associated with treatment response to Trauma-Focused Cognitive Behavioural Therapy. Method: Latent class analysis was used to identify symptom profiles at baseline assessment of 384 children ages 6 to 14, recruited in a Child Advocacy Centre following disclosure of sexual abuse. Dimensions of Complex PTSD diagnosis as proposed by the ICD-11 were derived from self-report questionnaires. Results: Latent class analysis identified a best fitting model of three classes: Classic PTSD regrouping 51% of children, Complex PTSD describing 23% of children, and Resilient describing 25% of children. Trauma-focused therapy was associated with a significant reduction of dissociation, internalizing, and externalizing problems for children of all three classes. Trauma-focused therapy was also linked to a significant reduction of PTSD symptoms with larger effect size (d = .90; 95%CI: 0.63-1.16) for children classified in the Complex PTSD class. Conclusion: These findings highlight the utility of a person-oriented approach to enhance our understanding of the diversity of profiles in child victims. The results offer empirical support for the ICD-11 PTSD and Complex PTSD distinction in a clinical sample of sexually abused children and the relevance of this distinction in foreseeing treatment outcomes.

Prospective Risk for Incapacitated Rape Among Sexual Minority Women: Hookups and Drinking

Sexual minority women (SMW), including lesbian and bisexual women, are at greater risk for heavy drinking and sexual victimization than heterosexual women. Risk factors for alcohol-related sexual victimization, such as incapacitated rape (IR), include frequent heavy drinking and hookups among heterosexual women, but it is less clear whether these risk factors extend to SMW. This current study was designed to address this gap. In a national sample of SMW (N = 1,057), logistic regressions were used to test whether heavy drinking and hookups in the first year of the study were risk factors for IR during the second year. After controlling for history of prior sexual victimization, subsequent IR was predicted by an interaction between heavy drinking and the number of male hookup partners. Specifically, more frequent heavy drinking was associated with increased risk for subsequent IR, but only among SMW who reported more than one male hookup partner, indicating exposure to more potential perpetrators. When examined separately, this finding held for bisexual women, but was not significant for lesbian women, likely because they reported fewer male hookup partners. Overall, findings from this longitudinal study highlight that in combination, heavy drinking and hookups with multiple men elevate risk for IR.

Comparing the onset of child sexual abuse perpetration from adolescence into adulthood: Are there unique risks, and what does this mean for prevention?

BACKGROUND

There are no known studies that have directly compared factors associated with the onset of child sexual abuse (CSA) perpetration during emerging adulthood, with CSA perpetration in other life-stages.

OBJECTIVE

This study investigated common and distinct factors associated with the onset of CSA perpetration (i.e., age at first child sexual offense) across the life course to inform, and tailor, current prevention efforts.

PARTICIPANTS AND SETTING

The sample comprised 354 males, from custodial and community corrections, and sentenced for sexual offenses against children.

METHODS

Using self-report and official data, the sample was stratified into three age groups: adolescence (n = 214; 10-17 years), emerging adulthood (n = 39; 18-25 years) and later adulthood (n = 101; 26+ years). Bivariate analyses were conducted to compare developmental and contextual factors associated with CSA perpetration. A multinomial logistic regression was then performed to examine distinct risk factors for CSA-onset in emerging adulthood, compared to the other onset age groups.

RESULTS

Bivariate analyses identified similarities and differences among the groups. The multinomial regression identified several factors distinguishing the emerging-adulthood group from the adolescence and later-adulthood onset groups. The combined results point to some notable differences in the emerging-adulthood group, including the disproportionate number of offenses perpetrated against male children, strangers, and in public.

CONCLUSIONS

Implications for existing prevention and rehabilitation strategies are discussed in light of these findings, especially the need for a developmental lens to prevention and intervention efforts. Research to further delineate risks unique to onset of CSA in emerging adulthood is also warranted.

Isn't high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms

Germinal studies have described the prevalence of sex-based harassment in high schools and its associations with adverse outcomes in adolescents. Studies have focused on students, with little attention given to the actions of high schools themselves. Though journalists responded to the #MeToo movement by reporting on schools’ betrayal of students who report misconduct, this topic remains understudied by researchers. Gender harassment is characterized by sexist remarks, sexually crude or offensive behavior, gender policing, work-family policing, and infantilization. Institutional betrayal is characterized by the failure of an institution, such as a school, to protect individuals dependent on the institution. We investigated high school gender harassment and institutional betrayal reported retrospectively by 535 current undergraduates. Our primary aim was to investigate whether institutional betrayal moderates the relationship between high school gender harassment and current trauma symptoms. In our pre-registered hypotheses (https://osf.io/3ds8k), we predicted that (1) high school gender harassment would be associated with more current trauma symptoms and (2) institutional betrayal would moderate this relationship such that high levels of institutional betrayal would be associated with a stronger association between high school gender harassment and current trauma symptoms. Consistent with our first hypothesis, high school gender harassment significantly predicted college trauma-related symptoms. An equation that included participant gender, race, age, high school gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal also significantly predicted trauma-related symptoms. Contrary to our second hypothesis, the interaction term was non-significant. However, institutional betrayal predicted unique variance in current trauma symptoms above and beyond the other variables. These findings indicate that both high school gender harassment and high school institutional betrayal are independently associated with trauma symptoms, suggesting that intervention should target both phenomena.

Sexual Revictimization: A Routine Activity Theory Explanation

Research has shown that victims of sexual assault are at a significant risk of revictimization. We use routine activity theory to predict how sexual victimization in adolescence relates to depression, substance use, and ultimately revictimization as a young adult. We frame our research within routine activity theory and predict that sexual victimization increases substance use and depressive symptoms, both of which increase the likelihood of revictimization. We test the hypotheses with three waves of data from the Longitudinal Study of Violence Against Women. Using structural equation modeling, we examine the direct and indirect effects of previous sexual victimization, depressive symptoms, and substance use on the odds of victimization during the sophomore year of college. Results suggest that sexual victimization during the sophomore year of college is predicted directly by previous sexual victimization and also indirectly through depressive symptomology, though not substance use. Although understudied in the literature, depression is shown to mediate the relationship between victimization and revictimization, and this finding is consistent with routine activity theory, as well as the state dependence perspective on revictimization. Our findings suggest that depressive symptoms, a long acknowledged consequence of sexual victimization, should also be understood as a source of revictimization risk, indicating the importance of depression screening and intervention for decreasing sexual victimization.

Sexual violence against women in Sweden: Associations with combined childhood violence and sociodemographic factors

Aims: This cross-sectional, population-based study aimed to investigate the prevalence of violence polyvictimization during childhood and sexual violence in adulthood among women, and how childhood violence exposure and sociodemographic factors associate with women's risk of experiencing sexual violence in adulthood. Methods: A survey regarding lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women aged 18-74 years, of which 56% participated. Data were analysed using Chi-square analyses and logistic regression. Results: Sexual violence before 18 years of age was reported by 16.3% and rape/attempted rape in adulthood by 10.2% of the women. In univariate analyses, sexual, physical, and psychological violence during childhood was associated with rape/attempted rape in adulthood (odds ratio 4.5, confidence interval 3.2-6.2; odds ratio 2.5, confidence interval 1.3-4.6; and odds ratio 2.5, confidence interval 1.8-3.2, respectively). Associations were stronger for combined exposure to sexual and physical (odds ratio 5.5, confidence interval 2.5-12.3), sexual and psychological (odds ratio 9.2, confidence interval 6.7-12.8) or sexual, physical, and psychological violence (odds ratio 14.1, confidence interval 10.4-19.2) during childhood. Rape/attempted rape after 18 years of age was more common among women who were single, those with college-level education and those who had been unemployed or had received social welfare payments. Most associations remained relatively unchanged when including all exposure and background variables in multivariate analyses. Conclusions: Although several of the sociodemographic factors studied showed significant associations, multiple exposure to violence during childhood was found to be the most potent risk factor for sexual violence in adulthood among adult women.

Lower Sexual Satisfaction and Function Mediate the Association of Assault Military Sexual Trauma and Relationship Satisfaction in Partnered Female Service Members/Veterans

Little is known about the association of military sexual trauma (MST) and relationship satisfaction among partnered female service members/veterans (SM/Vs). Extant civilian literature shows a strong association between sexual trauma and poorer relationship outcomes, and theory suggests that sexual function and satisfaction may mediate this association. Given that as many as 40% of female SM/Vs report MST and roughly half of female veterans are partnered and in their peak sexual years, it is critical to understand the association of MST, relationship satisfaction, sexual function, and sexual satisfaction in this population. Female SM/Vs (N = 817) completed a demographic inventory, self-report measures of MST, relationship satisfaction, sexual function, and sexual satisfaction. One hundred fifty-one (18.48%) participants did not experience MST. Three hundred eighty-eight (47.49%) reported that they experienced harassment-only MST, and 278 (34.03%) reported assault MST. At the bivariate level, lower relationship satisfaction was associated with lower sexual function and satisfaction with large effect sizes. Assault MST was associated with lower relationship satisfaction and sexual function and satisfaction with small-to-medium effect sizes. No differences in relationship satisfaction, sexual satisfaction, and function between those with harassment-only and no MST were observed. Mediation analyses demonstrated that lower sexual function and satisfaction mediated the association of assault MST and relationship satisfaction. Couples' therapy offered to SM/Vs with MST should screen for type of MST, sexual function, and satisfaction. Addressing the sequelae of MST and increasing sexual function and satisfaction in these partnerships may be critical treatment targets.

Child Maltreatment and Adult Sexual Assault Victimization: Genetic and Environmental Associations

Despite the pervasiveness of adult sexual assault (ASA), evidence-based knowledge on the risk factors for sexual victimization is insufficient. Here, we investigated the etiology of ASA in a population-based Finnish twin sample. Specifically, we estimated the extent of the genetic and environmental influences on the risk of ASA, and we examined its phenotypic and genetic associations with five types of child maltreatment (CM). We found large unique environmental, but also small genetic influences on the risk of ASA, motivating further research on situational and behavioral conditions potentially exploited by sexually motivated perpetrators. The prevalence of ASA was highest among victims of severe child sexual abuse. However, when accounting for the co-occurrence of multiple types of CM, emotional abuse was the strongest predictor of ASA. We further examined, and could not entirely rule out, the possibility of common genetic and environmental pathways underlying CM and ASA. Lastly, we focused on sex differences. Emotional and physical abuse were the strongest predictors of ASA in women and men, respectively, and genetic influences on the risk of ASA were larger in women than men. However, such higher heritability did not reflect sex-limited genetic effects, but, rather, women's systematic exposure to environmental risk of ASA.

Sexual assault trauma: Does prior childhood maltreatment increase the risk and exacerbate the outcome?

BACKGROUND

Some individuals who have been sexually assaulted as adolescents or adults have also been abused in childhood, although it is not clear how different forms of childhood maltreatment are related to adolescent/adult sexual assault, and how earlier abuse alters the relationship between sexual assault and current symptomatology.

OBJECTIVE

We sought to determine which types of child maltreatment are associated with adolescent or adult sexual assault, whether such child maltreatment interacts with sexual assault to predict more severe symptoms, and if sexual assault has unique symptom correlates after controlling for prior child maltreatment.

PARTICIPANTS AND SETTING

Participants were 398 women recruited online.

RESULTS

A total of 36 % of women had experienced unwanted sexual contact at age 13 or younger (childhood sexual abuse [CSA]), 32 % had experienced unwanted sexual contact at age 14 or later (adolescent/adult sexual assault), and 24.4 % had experienced both. Of all forms of child maltreatment, only CSA was associated with sexual assault, doubling the risk relative to those without a history of CSA. CSA and sexual assault were each uniquely associated with current symptomatology, however there was no interaction between sexual assault and CSA on psychological symptoms.

CONCLUSIONS

CSA is associated with a greater risk of later sexual assault, and both CSA and sexual assault have additive effects on adult symptomatology. However, prior sexual abuse does not appear to exacerbate the effects of sexual assault, and sexual assault is associated with lasting psychological sequelae even when controlling for sexual abuse.

Self- and Other-Directed Violence as Outcomes of Deployment-Based Military Sexual Assault in Iraq/Afghanistan-era Veteran Men and Women

Although military sexual assault (MSA) has been well-established as a risk factor for psychopathology (e.g., PTSD, depression), little research has examined the association between MSA and self- and other-directed violence. Furthermore, there has been a growing empirical focus on potential gender differences in the effects of MSA, but few of these studies have examined gender differences in self- and other-directed violence. In a sample of 1571 Iraq/Afghanistan-era veterans (21.0% women), we examined the effect of MSA on difficulty controlling violent behavior and attempting suicide among veteran men and women, above and beyond the influence of childhood sexual abuse, combat trauma, PTSD, and major depressive disorder. Results of a logistic regression revealed that MSA increased risk of attempting suicide and difficulty controlling violence among women but not men. Thus, the results suggest that MSA may be a risk factor for both types of violence in women. Furthermore, because PTSD was associated with both types of violence in both men and women, MSA may also confer risk of violence via PTSD.

The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review

BACKGROUND

Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice.

METHODS

A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.

RESULTS

We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.

CONCLUSIONS

This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.

The Impact of PTSD-Linked Strain Sensitivity on Violent Offending: Differences in Effects During Adolescence Versus Early Adulthood

OBJECTIVES

Investigate the relevance of post-traumatic stress disorder (PTSD)-linked strain sensitivity associated with exposure to violence for predicting violence outcomes among juvenile offenders during adolescence and early adulthood.

METHODS

This study uses the Pathways to Desistance data and to test relevant relationships. Two series of negative binomial regression models were estimated to test hypotheses, one corresponding to each period of the life course.

RESULTS

Results indicated that witnessed violence interacted with PTSD status in adolescence, indicating that individuals afflicted with PTSD demonstrated heightened sensitivity to this strain, manifested in increased violent offending.

CONCLUSIONS

Results indicate that witnessed violence may act as a trigger during adolescence, resulting in juvenile offenders with PTSD responding with violence. This may have treatment implications for individuals suffering from PTSD.

Post-Traumatic Growth, Dissociation, and Sexual Revictimization in Female Childhood Sexual Abuse Survivors

BACKGROUND

Childhood sexual abuse (CSA) survivors are at high risk of sexual revictimization. At the same time, some survivors report positive transformations resulting from the traumatic experience, a phenomenon known as post-traumatic growth (PTG). Although one might expect PTG to be related to reduced risk of revictimization, the link between PTG and revictimization has not been investigated. Furthermore, mixed findings regarding the associations between PTG and distress imply that the effects of PTG are multifaceted. One potential explanation may be that dissociation shapes the implications of PTG, making it more like denial than adaptive processing of traumatic experience. This longitudinal study explores (a) the associations between PTG and sexual revictimization and (b) the moderating role of dissociation within the associations between PTG and revictimization.

METHOD

Participants were 111 female CSA survivors who participated in a 6-month efficacy trial evaluating the effectiveness of group psychotherapy for CSA survivors with HIV risk factors.

RESULTS

Dissociation moderated the associations between PTG and revictimization: Whereas PTG had nonsignificant effects on revictimization in participants with low dissociation, it predicted elevated levels of revictimization in participants with high dissociation.

CONCLUSIONS

Reports of PTG among some CSA survivors might mirror dissociative beliefs that increase their risk of revictimization.

Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study

We performed a cross-sectional study using a self-reporting survey to assess lifetime violent and non-violent victimization in people with severe mental illness experienced both inside (i.e., any service providing mental health care such as psychiatric hospitals, psychosocial rehabilitative programs, or outpatient care) and outside (i.e., in the personal life of the participants) of the mental health care system. We recruited 170 participants from 20 community mental health facilities. We built logistic regression models to assess potential risk factors for victimization inside the mental health care system. Outside of the mental health care system, the most commonly reported events were theft (n=93, 54.7%), physical violence without use of a weapon (n=87, 51.2%), and sexual harassment (n=82, 50.6%). Within the mental health care system, most commonly reported incidents were theft (n=68, 40.0%), sexual assault (n=18, 10.6%), and physical violence (n=47, 27.7%) by other patients or staff. Significant risk factors for specific victimization events inside the mental health care system were psychotic disorder, victimization in childhood and youth, female gender, number of hospitalizations, and duration of illness. Findings call for increased attention to victimization of people with severe mental illness, especially within the mental health care system as such victimization events may severely impact patients' trajectories.

Hope and Fulfillment After Complex Trauma: Using Mixed Methods to Understand Healing

Research has shown that the experience of Childhood Sexual Abuse (CSA) can increase the rates of physical and emotional sequela, including depression, anxiety, PTSD, and physical pain. However, little is known about the healing journeys for those women who, after surviving CSA, also experience unwanted sexual experiences (USE) as a young adult. The goal of this mixed method study is to compare identity, distress, and positive health outcomes for survivors of CSA and USE with those of women who have survived USE alone. First, 206 women completed a survey that evaluated mental health distress, trauma centrality, and health indicators, and these women were invited to take part in an additional interview. A subsample of 24 women agreed to be interviewed with a narrative interview that examined trauma recovery from a holistic perspective. Thematic analysis of the interview data revealed contextual and internal barriers and facilitators of healing. Eight qualitative dimensions were derived from code frequencies of the emerging 50 qualitative codes, including Normalization, Denial, Negative Impact, Positive Coping, Rumination, Identity Healing, Hope, and Fulfillment Healing, and Engagement Healing. We then used t-tests to compare the mean code frequencies of these code complexes for survivors of CSA/USE and USE alone, and the significant findings revealed hypotheses to be tested in the larger quantitative sample. H1: Survivors of CSA will have less denial than USE alone; H2: Survivors of CSA will have higher Negative Impact scores than USE alone, and H3: Survivors of CSA will have more Hope and Fulfillment than USE alone. H1 was supported; survivors of both CSA and USE had a significantly higher mean Centrality Scores than Survivors of USE alone. H2 was supported, and all negative impact scores were significantly higher for the survivors of both CSA and USE than survivors of USE alone. H3 was partially supported. Survivors of both CSA and USE had significantly higher mean Post-Traumatic growth scores. However, survivors of USE alone had significantly higher means for Sense of Coherence and Self-Compassion scores. Implications for practice are discussed.

Childhood Sexual Abuse, Sexual Behavior, and Revictimization in Adolescence and Youth: A Mini Review

Childhood sexual abuse (CSA) is considered as an activity aimed at providing sexual pleasure, stimulation, or sexual gratification to an adult who uses a minor for this purpose, taking advantage of the situation of superiority. CSA can have devastating consequences for the child. Previous studies have concluded that those who suffer an episode of CSA perform more risky sexual behaviors and are more likely to experience further episodes of sexual victimization during adolescence and early youth. There are two theoretical contributions that, although they offer partial views, can help to understand the association between CSA, sexual behavior, and revictimization in adulthood: the traumagenic dynamics model and the information-motivation-behavioral skills model. This short review provides an overview of the problems and theoretical explanations that have been presented up to the present, underlining the importance of prevention and sex education as of childhood, as well as the need to continue investigating in order to develop specific theoretical models that help to understand and prevent CSA and its consequences.

Occupational Well-Being in Sexual Assault Victims and Survivors

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

Are trauma memories state-dependent? Intrusive memories following alcohol-involved sexual assault

Background: Sexual assault (SA) frequently occurs under the influence of alcohol, and is often followed by both drinking and posttraumatic stress symptoms, including intrusive memories. Although many theories attempt to explain the co-occurrence of alcohol use and posttraumatic stress, one possibility not yet considered is that SA memories may be more likely to occur when there is an encoding-retrieval match in alcohol intoxication state. Objective: The aim of this study was to examine the potential for intrusive memories of SA to be state-dependent, such that intrusive memories for alcohol-involved SA may be more likely to occur in the context of subsequent alcohol intoxication. Method: Participants were 100 college women (age range = 18 to 24 years; 73% White/Caucasian, 89% heterosexual) with a history of alcohol-involved SA (67%) or other, non-alcohol-involved SA (33%). Participants completed daily questionnaires for 30 days assessing past-day drinking and intrusion symptoms. Results: A random-intercept, negative binomial multilevel model revealed that, after controlling for overall frequency of drinking and perceived threat during SA, women with a history of alcohol-involved SA reported more severe intrusion symptoms on drinking days than on non-drinking days. No such difference in intrusions was observed for women who were not intoxicated at the time of the assault. Conclusions: Findings are consistent with the possibility of state-dependent intrusive memories. Additional research is needed to determine whether alcohol intoxication might serve as a discriminative cue preceding intrusive memories of alcohol-involved SA.

Reenacting Past Abuse - Identification with the Aggressor and Sexual Revictimization

Childhood sexual abuse (CSA) poses a risk for sexual revictimization. Additionally, according to theory CSA may lead to identification with the aggressor, expressed by adopting the perpetrator's experience concerning the abuse; identifying with the perpetrator's aggression; replacing one's agency with that of the perpetrator; and becoming hyper-sensitive to the perpetrator. Although clinical impressions suggest that identification with the aggressor underlies reenactment of trauma, this linkage between identification with the aggressor and sexual revictimization remains largely uninvestigated. This study assessed (a) the relationship between identification with the aggressor (total score and four subscales) and sexual revictimization; (b) the unique associations between identification with the aggressor (total score and four subscales) and sexual revictimization, above and beyond chronicity of abuse and PTSD symptoms. Participants were Israeli women students who reported a history of CSA (n = 174). Analyses indicated significant correlations between two subscales of identification with the aggressor - replacing one's agency with that of the perpetrator and becoming hyper-sensitive to the perpetrator - and sexual revictimization. These subscales of identification with the aggressor were associated with sexual revictimization, above and beyond the effects of chronicity of the abuse and PTSD symptoms. Nevertheless, these associations were in opposite directions - while replacing one's agency with that of the perpetrator was related with higher occurrence of sexual revictimization, becoming hyper-sensitive to the perpetrator was related with lower levels of revictimization. These results imply that identification with the aggressor may serve as a multifaceted phenomenon in the context of sexual revictimization, comprised of both adaptive and maladaptive aspects.

A Comparative Effectiveness Study of a Shortened Trauma Recovery Empowerment Model and an Attachment-Informed Adaptation

Relational challenges often associated with interpersonal trauma may hinder survivors' abilities to fully benefit from group therapy. This quasi-experimental study compared clinical outcomes of a 16-week version of the Trauma Recovery and Empowerment Model (TREM) for women and an attachment-informed adaptation (ATREM). Prior findings of TREM are extended by demonstrating that both group conditions can facilitate comparable clinical outcomes, creating options for group facilitators. Only ATREM resulted in statistically significant improvement in individual attachment avoidance, and it trended toward a slightly higher completion rate. This study provides insight into the emerging concept of group attachment.

Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault

INTRODUCTION

Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA.

METHODS

Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms.

RESULTS

Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs.

CONCLUSIONS

Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.

The Indirect Effect of Child Maltreatment Severity on Adult PTSD Symptoms through Anxiety Sensitivity

Although the rate of posttraumatic stress disorder (PTSD) among survivors of child maltreatment is high, individuals differ in symptom severity and many do not experience clinically significant levels of psychopathology. The present study tested the indirect effects of child maltreatment severity on adult PTSD, suicidal ideations, and alcohol dependence via anxiety sensitivity. A sample of 336 participants (mean age of 22.81 years, SD = 8.93; 70.2% female) completed an online survey of child abuse and neglect, anxiety sensitivity, PTSD symptom severity, suicidal ideation severity, and alcohol dependence severity. The results revealed significant indirect effects of child maltreatment on PTSD symptom severity through cognitive and social concerns, but not physical concerns. No direct or indirect effects were demonstrated for suicidal ideations or alcohol dependence severity. These findings elucidate mechanisms in the robust relationship between child maltreatment and adult PTSD symptoms and can potentially inform future research on mechanisms of change in psychotherapy.

Social Support of Adolescent Survivors of Child Sexual Abuse and Sexual Revictimization in Turkey

Sexual revictimization refers to having a history of child sexual abuse and an experience of being assaulted again in adolescence or adulthood. This descriptive study examined perceived social support of nonvictim adolescents and adolescents who had survived single sexual abuse and sexual revictimization. Participants were 210 adolescent girls, all aged between 15 and 18, selected by a convenience sampling method; 70 had survived sexual revictimization, 70 had survived single sexual abuse, and 70 were nonvictims. The Perceived Social Support Scale was administered, and a one-way ANOVA was conducted for data analysis. Perceived social support from the community was lower in the sexual revictimization group than in the single sexual abuse and comparison groups. Family social support did not differ between the sexual revictimization and single sexual abuse groups but was lower in both than in the comparison group. These results indicate that victims of sexual revictimization need social support, and both sexual revictimization and single sexual abuse victims need familial support.