Immediate Coping Strategies Among Rape Victims

Associations Among Online Social Reactions to Disclosure of Sexual Victimization, Coping and Social Isolation

Social reactions to the disclosure of sexual victimization are critical to post-assault recovery. The popular social media hashtag "#MeToo" resulted in numerous survivors of sexual victimization disclosing their experience online. Whereas previous research has examined the association between social reactions to in-person disclosure of sexual victimization and factors commonly associated with adjustment among survivors - such as coping and social support - research is needed to examine correlates of social reactions to online disclosure of sexual victimization. Accordingly, the current study investigated the relationship between online social reactions to the disclosure of sexual victimization via #MeToo and engagement in various coping strategies (problem-focused coping, emotion-focused coping) and social isolation among a sample of 195 adults with a history of sexual victimization. Results indicated that the provision of online resources was associated with lower use of problem-focused and emotion-focused coping strategies. Receipt of online emotional and informational support was associated with increased use of emotion-focused coping strategies. Further, receipt of online social reactions that turned against the survivor and receipt of online social reactions that "made fun of you, insulted you, or said something to hurt you" were associated with higher levels of social isolation. Lastly, online unsupportive acknowledgment and "sharing your tweet with other people" were associated with lower levels of social isolation. Results highlight how online social reactions to disclosure of sexual victimization via #MeToo intersect with coping and social support among survivors of sexual victimization and help to give context to the experience of online disclosure of sexual victimization.

Perception and prevalence of rape: A survey among in-school adolescents in rural Southwest Nigeria

INTRODUCTION

Rape has fast become an issue of relevance to global health cutting across geographical and cultural divides. Most studies on the subject are urban based and among adults. This study was conducted to assess the perception, prevalence and perpetrators among in-school adolescents which represent a unique group and in a rural setting.

METHODS

A cross-sectional study was conducted using a two-stage cluster sampling technique. A total of 640 respondents completed a pretested interviewer-assisted semi-structured questionnaire. Perception and knowledge scores for rape were calculated and data was analyzed using SPSS version 21.

RESULTS

The mean age of respondents was 15.5 (±2.1) years and M: F ratio of 1:1.2. About one-half (46.9%) had poor overall knowledge of rape in the domains assessed. A significant proportion, 266 (41.6%) still subscribe to victim blaming in rape and 336 (52.5%) had negative perception of rape. Eight-five (13.3%) had been raped at least once while 36 (5.6%) self-reported to be perpetrators of rape. The respondents' sex (p=0.015) and present class (0.012) of respondents showed statistically significant association with knowledge of rape.

CONCLUSION

The perception of in-school adolescents on rape still leaves much to be desired. Perpetration and experience of rape remain important global health issues.

Factors Associated with Growth in Sexual Violence Survivors: A Systematic Scoping Review

Sexual violence has been defined as any sexual act perpetrated against someone's will. Sexual violence has many negative consequences for the victims. The most prevalent mental health issue in victims is posttraumatic stress disorder. However, a new trend in positive psychology suggests that many survivors of traumatic events, in addition to negative repercussions, adapt and develop positive personal changes, i.e., Posttraumatic growth (PTG), to mitigate their impact. This review explores the literature on posttraumatic growth among survivors of sexual violence. The review follows 5 stages of Arksey and O'Malley's framework of scoping review. 6 databases were searched using indexed terms. Approximately 65 articles were initially identified and evaluated in the preliminary search using the specified keywords. Of those retrieved, 16 met the criteria and were included in this study. Posttraumatic stress, Control over Recovery, Social Support, and Spirituality/Religiosity were the significant factors for PTG. The results suggest that fostering social support, spirituality, and a sense of control over recovery can facilitate PTG, highlighting the importance of holistic approaches in promoting resilience after trauma. Implications for practice, policy, and future directions are discussed.

"Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence

Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.

The Role of Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.

The Impact of Avoidant/Disengagement Coping and Social Support on the Mental Health of Adolescent Victims of Sexual Violence in Eastern Congo

INTRODUCTION

Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear.

METHODS

The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure.

RESULTS

For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms.

CONCLUSIONS

These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.

Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

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

Even 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). Discussions include 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).

Social Network Clustering of Sexual Violence Experienced by Adolescent Girls

We used data on 3,139 female social network friendship dyads from 3 waves of the National Longitudinal Study of Adolescent to Adult Health (wave I: 1994-1995; wave II: 1996; and wave IV: 2007-2008) to assess whether friends' reports of experiencing sexual violence (SV) and friends' substance use risk scores predicted whether adolescents and young adults would experience SV themselves. We also used longitudinal analyses to test the associations of combined wave-I and -II risk factors with wave-IV reports of SV and of combined wave-I and -II SV with network connectivity at wave II. After adjustment for a participant's substance use risk score, each 1-point increase in a friend's substance use risk score increased a respondent's odds of experiencing SV by 1.19 (95% confidence interval: 1.03, 1.36). Having a friend who reported SV increased a respondent's odds of reporting SV by 1.95 (95% confidence interval: 1.25, 3.07), although not after we included school-level fixed effects. Having a friend who experienced SV in adolescence did however increase the respondent's odds of reporting SV as a young adult by 1.54 (95% confidence interval: 1.00, 2.37). Respondents who reported SV by wave II had less network connectedness at wave II. Experiences of SV and substance use within adolescent girls' friendship networks are linked to risk for SV into young adulthood, which suggests that network-focused SV prevention and intervention approaches may be warranted.

General and Culturally Specific Factors Influencing Black and White Rape Survivors' Self-Esteem

Grounded in a culturally inclusive ecological model of sexual assault recovery framework, the influence of personal (e.g., prior victimization), rape context (e.g., degree of injury during last assault), and postrape response factors (e.g., general and cultural attributions, rape related coping) on self-esteem of Black and White college women, who were survivors of attempted and completed rape, were examined. As predicted, Black and White women identified similar general variables (e.g., general attributions) as important in the recovery process. Black women, however, identified a cultural factor (i.e., cultural attributions) as more important in influencing their reactions to the last rape compared to their White counterparts. Using path analysis, findings from this cross-sectional study indicated that severity of the last assault and prior victimization were related to lower self-esteem indirectly through avoidance coping strategies, and victim blame attributions for the latter. Results also suggested that the link between cultural attributions and self-esteem was explained through victim blame attributions, primarily for Black participants. The model accounted for 26% of variance in self-esteem.

Coping with the Experience of Rape

The coping strategies that a victim of a rape engages in can have a strong impact on the development and persistence of psychological symptoms. Research provides evidence that victims who rely heavily on avoidance strategies, such as suppression, are less likely to recover successfully than those who rely less heavily on these strategies. The present study utilized structural path analysis to identify predictors of avoidance coping following rape and examined factors in the assault itself (e.g., force, alcohol use), sequelae of the assault (e.g., self-blame, loss of self-worth), and social support as potential direct and indirect predictors of avoidance coping. From a sample of 1,253 university women, the responses of 216 women who endorsed an experience of rape were examined. Results suggested that sequelae of the assault such as feelings of self-blame and negative reactions received from others are potentially important predictors of avoidance coping. Implications of the results for future rape recovery research are discussed.

Structural Models of the Relations of Assault Severity, Social Support, Avoidance Coping, Self-Blame, and PTSD Among Sexual Assault Survivors

A number of studies have identified which survivors of sexual assault are more likely to develop symptoms of posttraumatic stress disorder (PTSD). Most correlates that have been identified have been at the individual level. Insufficient attention has been given to whether survivors' social interactions impact their individual responses to assault and subsequent levels of psychological symptomatology. In this study, a large, diverse sample of community-residing women ( N = 636) was surveyed. Structural equation modeling was used to examine the relationships between assault severity, global support, negative social reactions, avoidance coping, self-blame, traumatic life experiences, and PTSD symptoms. The results suggest that negative social reactions and avoidance coping are the strongest correlates of PTSD symptoms and that the association typically observed between victim self-blame and PTSD symptoms may be partially due to the effect of negative social reactions from others. These reactions may contribute to both self-blame and PTSD. Implications for future research and clinical practice are discussed.

Social Reactions, Coping Strategies, and Self-Blame Attributions in Adjustment to Sexual Assault

The present study investigated the impact of social reactions of others to sexual-assault victims on disclosure of their victimization. A convenience sample of adult sexual-assault victims ( N = 155) completed a mail survey in which they reported information about their sexual assaults and postassault experiences. As expected, all negative social reactions were strongly associated with increased psychological symptoms, whereas most positive social reactions were unrelated to adjustment. The only social reactions related to better adjustment were being believed and being listened to by others. Victims experiencing negative social reactions also reported poorer adjustment even when other variables known to affect psychological recovery were controlled. Avoidance coping mediated the association of negative social reactions with adjustment. Implications of these findings for research and treatment of sexual-assault survivors are discussed.

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria

OBJECTIVES

Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status.

METHODS

We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies.

RESULTS

Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83).

CONCLUSION

History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

Posttraumatic Growth and Sexual Violence: A Literature Review

Posttraumatic growth (PTG) is the positive psychological growth that a person might experience after enduring a traumatic event. PTG is a relatively new area of research identified by researchers because it represents a shift in thinking. Rather than focusing on the negative consequences of trauma, it explores the potential for positive outcomes associated with trauma. Although PTG is well documented across different types of traumas, it is unclear how this kind of growth stems from sexual violence, specifically. This review provides an overview of the literature concerning PTG that is associated with sexual violence. Results across the literature indicate that sexual violence is consistently associated with PTG. However, given the inconsistency in research designs, assessment, and operational definitions used to study PTG, many researchers suggest that it might be difficult to determine how and when PTG occurs. This study provides a literature review of the research on PTG in the aftermath of sexual violence. Important implications for future directions and trauma-based therapy are discussed and include the identification of relevant predictors, the importance of context, and how service providers might benefit from a better understanding of PTG.

Labeling of sexual assault and its relationship with sexual functioning: the mediating role of coping

Little research has examined the relationship between women's labeling of their sexual assault experiences and sexual functioning, as well as identification of variables that may mediate the labeling-trauma outcome relationship. The purpose of this study was to fill this gap in the literature, by examining the potential mediating role of coping strategies in response to sexual assault in the relationship between labeling and sexual functioning. The sample included 135 college women with a history of adolescent/early adulthood sexual assault. Labeling was not bivariately related to sexual functioning outcomes; however, anxious coping mediated the relationships between labeling and both sexual lubrication and sexual satisfaction. This suggests that correlational analyses between labeling and trauma outcomes may not capture the complexity of this relationship, as it may be more indirect. Furthermore, results suggest that labeling is part of the coping process in response to sexual assault; some women who consider their experience to be sexual assault may engage in anxious coping efforts, contributing to difficulties with sexual lubrication and sexual dissatisfaction. Victims actively working to integrate their sexual assault experience with prior beliefs and self-concept may benefit from treatment focused on decreasing anxious coping, especially as it relates to sexual functioning.

Examining adversarial growth in illness: the factor structure of the Silver Lining Questionnaire (SLQ-38)

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.

Social reactions to disclosure of sexual victimization and adjustment among survivors of sexual assault

How a support provider responds to disclosure of sexual victimization has important implications for the process of recovery. The present study examines the associations between various positive and negative social reactions to sexual assault disclosure and psychological distress, coping behavior, social support, and self-esteem in a sample of college women (N = 374). Social reactions to assault disclosure that attempted to control the survivor's decisions were associated with increased symptoms of posttraumatic stress, depression, and anxiety and lower perceptions of reassurance of worth from others. Blaming social reactions were associated with less self-esteem and engagement in coping via problem solving. Social reactions that provided emotional support to the survivor were associated with increased coping by seeking emotional support. Contrary to expectations, social reactions that treated the survivor differently were associated with higher self-esteem. Implications are discussed.

Responsibility attribution of HIV infection and coping among injection drug users in Malaysia

This study explored responsibility attribution (RA) of HIV/AIDS infection (i.e., how an individual perceives the cause of their HIV/AIDS infection) and its relationship to coping styles among injection drug users (IDUs) with HIV/AIDS. In addition, this study investigated whether self-esteem, social support, and religiosity mediate the relationship between RA and coping styles of IDUs with HIV/AIDS. Participants were 201 adult IDUs with HIV/AIDS participating in the National Drug Rehabilitation Center in Malaysia. Five measures were used to assess the above constructs. Cluster analysis, analysis of variance, and mediation analyses were conducted. Results of this study indicated that IDUs with HIV/AIDS in Malaysia can be classified into four homogenous attribution groups: external, fatalistic, internal, and indeterminate. Mediator analyses revealed that combination of self-esteem, social support, and religiosity mediate the relationship between RA and coping behaviors. Clinicians working with IDUs with HIV/AIDS need to address the role of RA, self-esteem, religiosity, and social support as these psychosocial constructs are linked to coping with HIV/AIDS. Future researchers should investigate whether enhancing self-esteem, social support, and religiosity can promote active problem-solving coping and reduce the use of avoidance coping behaviors.

Exploring self-perceived growth in a clinical sample of severely traumatized youth

OBJECTIVE

The aims of this study were threefold: (1) examine the prevalence of Posttraumatic Growth (PTG) among severely traumatized youth, (2) systematically describe the PTG reported, and (3) study the course of PTG from pre- to post-treatment.

METHOD

The sample consisted of 148 severely traumatized Norwegian youth (M age=15, SD=2.2, 79.1% girls) receiving treatment in child mental health clinics. The Clinician Administered PTSD Scale for Children (CAPS) was used to assess level of posttraumatic stress symptoms (PTSS) pre- and post-treatment. One of the questions in CAPS: "How do you think (traumatic event) has affected your life?" formed the basis for our analysis of PTG. Words and phrases indicative of PTG were identified using the Consensual Qualitative Research method.

RESULTS

Pre-treatment, the prevalence rate of PTG was low compared to previous findings, and reports of PTG were not related to levels of PTSS. The main PTG themes identified were: personal growth, relational growth, and changed philosophy of life. A sub-theme of personal growth; greater maturity/wisdom, was the most salient theme identified both pre- and post-treatment. Age was significantly related to reports of PTG; older participants reported more growth. Reports of PTG increased significantly from pre- to post-treatment, but were not related to decrease in PTSS.

CONCLUSIONS

The findings suggest that PTG is not only possible for youth, but quite similar to that observed among adults. However, we need to carefully consider whether reports of self-perceived positive change among traumatized youth actually are indicative of growth, or simply indicative of increased vulnerability.

Uptake to HIV post-exposure prophylaxis in Haiti: opportunities to align sexual violence, HIV PEP and mental health

Sexual violence is a public health problem in Haiti, potentially augmenting HIV transmission. Reports from L'Hôpital de l'Université d'État d'Haiti (HUEH) suggest severe underutilization of antiretroviral post-exposure prophylaxis (ARV-PEP) among rape survivors. Cross-sectional design using mixed methods. Informational interviews were conducted with HUEH personnel to learn about post-rape service offerings. HUEH surveillance data were used to estimate the sexual assault reporting rate/100,000 and to examine the proportion of survivors receiving ARV-PEP within 72 hr, stratified by age (<18 years, ≥18 years). Informational interviews revealed that survivors were navigated through two hospital algorithms to receive post-rape care; however, <5% of victims sought mental health services. Surveillance data show that 2193 sexual assault survivors (adult and pediatric) reported a rape to HUEH personnel between 2004 through first quarter of 2010. Annual estimates suggest a twofold increase comparing cases in 2004 versus 2009. Between 2008 and 2009, uptake to ARV-PEP within 72 hr was lower for pediatric (38.4%; N = 131/341) compared with adult survivors (60.1%; N = 83/138) (χ(2)  = 18.8, P < 0.001). The prioritization of funding and comprehensive interventions that align sexual violence, HIV, and mental health is crucial to support the timely uptake to ARV-PEP.

To Whom Do College Women Confide Following Sexual Assault? A Prospective Study of Predictors of Sexual Assault Disclosure and Social Reactions

A prospective methodology was used to explore predictors of sexual assault disclosure among college women, identify who women tell about sexual victimization, and examine the responses of informal support providers ( N = 374). Women most often confided in a female peer. Increased coping via seeking emotional support, strong attachments, and high tendency to disclose stressful information predicted adolescent sexual assault disclosure and disclosure over the 7-month interim. Less acquaintance with the perpetrator predicted disclosure over the follow-up, including experiences of revictimization. Victim and perpetrator alcohol use at the time of the assault also predicted disclosure over the follow-up. Implications are presented.

Telling stories without the words: ‘Tightrope talk’ in women’s accounts of coming to live well after rape or depression

Narratives and language available within a cultural context reflect and reify power structures that are reproduced in everyday social interactions. In this article, we explore the narrative challenges and possibilities that emerged in our respective research programmes with women who have faced depression or rape. These experiences are, at least in part, products of patriarchy and are regulated by hegemonic discourses that individualize and depoliticize women’s experiences. In our studies, we faced significant challenges of conducting research when dominant narratives fail the storytellers, and came to understand these as products of what Marjorie DeVault has termed ‘linguistic incongruence’. We examine women’s attempts to negotiate the telling of their stories without adequate language and framings, and our attempts to listen carefully to the emergence of counterstories. We introduce the notion of ‘tightrope talk’ to refer to participants’ attempts to make meaning of their experiences, as they negotiate both agency and blame in ways that dominant narratives fail to do. We conclude by discussing the potential dangers of these efforts.

Resilience in trauma-exposed refugees: the moderating effect of coping style on resilience variables

Research with survivors of torture has generated considerable variability in prevalence rates of posttraumatic stress disorder (PTSD). Multiple risk and resilience factors may affect this variability, increasing or decreasing the likelihood of experiencing psychological distress. This study sought to investigate the effect of several such resilience factors, coping style, social support, cognitive appraisals, and social comparisons on PTSD symptom severity. Furthermore, this study examined whether coping style moderated the relationship between resilience variables and PTSD symptoms. Seventy-five torture survivors completed an intake interview and several self-report measures upon entry into a treatment program for survivors of torture. Results indicated that emotion-focused coping styles significantly moderated the relationship between cognitive appraisal and social comparison variables and PTSD, and usually increased the likelihood of developing severe symptoms. These results indicate that the salience of resilience variables may differ depending on the individual's coping style, which present implications for clinical practice with torture survivors.

The structure of adversarial growth in a sample of cancer patients 8 years post-diagnosis: a revision of the SLQ-38

Stressful and traumatic events may trigger positive life changes, so-called adversarial growth. Despite growing interest in this topic, the structure and dimensionality of this concept has not been established. Recently, empirical reviews have suggested that the factors underlying this construct are highly related. Currently, the use of confirmatory factor analysis to test this hypothesis is advocated. Using data from cancer patients (n = 206), this study investigated the dimensionality of a Dutch translated version of the Silver Lining Questionnaire (SLQ-38). A 16-item SLQ (SLQ-16), with three subscales or first-order factors (enhanced personal relationships, changes in life philosophy and changes within the self) loading on a second-order general adversarial growth factor, was a good fitting model. In conclusion, the SLQ-16 may prove useful in the assessment of adversarial growth following illness.

An ecological model of the impact of sexual assault on women's mental health

This review examines the psychological impact of adult sexual assault through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology contribute to post-assault sequelae. Using Bronfenbrenner's (1979, 1986, 1995) ecological theory of human development, we examine how individual-level factors (e.g., sociodemographics, biological/genetic factors), assault characteristics (e.g., victim-offender relationship, injury, alcohol use), microsystem factors (e.g., informal support from family and friends), meso/ exosystem factors (e.g., contact with the legal, medical, and mental health systems, and rape crisis centers), macrosystem factors (e.g., societal rape myth acceptance), and chronosystem factors (e.g., sexual revictimization and history of other victimizations) affect adult sexual assault survivors' mental health outcomes (e.g., post-traumatic stress disorder, depression, suicidality, and substance use). Self-blame is conceptualized as meta-construct that stems from all levels of this ecological model. Implications for curbing and/or preventing the negative mental health effects of sexual assault are discussed.

PTSD Symptoms and Self-Rated Recovery Among Adult Sexual Assault Survivors: The Effects of Traumatic Life Events and Psychosocial Variables

Prior research has demonstrated that self-blame is predictive of more posttraumatic stress disorder (PTSD) symptoms and poorer recovery ( Frazier, 2003 ; Koss, Figueredo, & Prince, 2002 ), and perceived control over recovery is associated with less distress ( Frazier, 2003 ) in adult sexual assault (ASA) survivors. A structural equation model was tested to examine the role of traumatic events, self-blame, perceived control over recovery, and coping strategies on PTSD symptoms and self-rated recovery in women ASA survivors. Adaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on PTSD symptoms and showed a small positive association with increased PTSD symptoms. As hypothesized, maladaptive coping partially mediated the effects of other traumas, self-blame, and perceived control over recovery on both PTSD symptoms and self-rated recovery; greater maladaptive coping was associated with increased PTSD symptoms and lower self-rated recovery. Implications and directions for future research are discussed.

Disclosing sexual assault to parents: the influence of parental messages about sex

Without frank discussion of what sex is, women may not learn what sex is not and what experiences constitute sexual assault. This qualitative study explores the relation between parental discussion and messages about sex and women's decisions of whether to disclose sexual assault to parents. Participants were 18 women from diverse ethnic backgrounds. Data were analyzed using a grounded theory approach. Findings indicate that women more often disclosed sexual assault to parents who discussed sex with them in a frank and positive manner. In addition to the role of disclosure in recovery, implications for sex and parent education are discussed.

Psychological outcomes and measurement of maternal posttraumatic stress disorder during the perinatal period

For many parents, labor, delivery, and/or the perinatal and neonatal periods present significant stressors that result in clinically significant parental feelings of psychological distress or trauma. This review article identifies known preexisting risk, and protective, factors for such distress, focusing on individual variables and familial or other social support networks. Research describing the full range of possible psychological reactions is also presented, loosely categorized as representing psychological outcomes of resiliency or growth, externalized distress, and internalized distress. These outcomes are viewed as neither linear nor mutually exclusive, and specific implications for each outcome are presented. The primary focus of this review is on the most well understood internalizing distress outcome during the perinatal period, maternal posttraumatic stress reactions. The utility of a brief, freely available measure quantifying such distress is also overviewed, including standards for its usage. Healthcare and particularly nursing staff are encouraged to attend to the range of possible psychological outcomes that may emerge during the perinatal period, identifying distressed mothers, so that they may be referred for care. The review concludes by presenting recommended future directions for research regarding the measurement of posttraumatic stress disorder in parents.

Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community

Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.

Growth following adversity: theoretical perspectives and implications for clinical practice

A number of literatures and philosophies throughout human history have conveyed the idea that there is personal gain to be found in suffering, and it is an idea central to the existential-humanistic tradition of psychology. However, it is only relatively recently that the topic of growth following adversity has become the focus for empirical and theoretical work. In this paper, we review theoretical models of growth, and discuss the implications of growth for clinical practice. Three main theoretical perspectives are reviewed, the functional-descriptive model, the meta-theoretical person-centered perspective, and the biopsychosocial-evolutionary view. It is proposed that these three approaches to theory offer different but complementary levels of analysis, and that theoretical integration between them is possible. We then go on to explore the implications of this theoretical integration for clinical practice, and conclude with a consideration of the role of therapy in facilitating growth following adversity.

Mothers’ perceptions of benefit following pediatric stem cell transplantation: a longitudinal investigation of the roles of optimism, medical risk, and sociodemographic resources

BACKGROUND

This longitudinal study investigated the course and predictors of benefit finding among 144 mothers of children undergoing hematopoietic stem cell transplantation (HSCT), a severely stressful and life-threatening medical procedure.

PURPOSE

Children's medical risk and mothers' dispositional optimism and sociodemographic resources were examined as predictors of benefit finding. The association between benefit finding and mothers' psychosocial adaptation was also investigated.

METHODS

Assessments occurred during hospitalization for HSCT (Time 1 [T1]) and 6 months later (Time 2 [T2]).

RESULTS

Hierarchial multiple regression analyses revealed that predictors of benefit finding differed systematically across assessments, with optimism and medical risk predicting benefit finding at both time points but sociodemographic resources predicting only T2 benefit findings. Benefit finding did not predict psychosocial adaptation until optimism was considered as a moderator of their relation: T1 benefit finding was positively associated with T2 adaptation only for mothers high in optimism.

CONCLUSION

The need for longitudinal research on posttrauma adaptation and the utility of considering the natural history of the trauma are discussed.

Correlates of Levels and Patterns of Positive Life Changes Following Sexual Assault

This study builds on previous work suggesting that many survivors report positive life changes soon after a sexual assault and that those who retain those changes over time report the least distress 1 year post-assault (P. Frazier, A. Conlon, & T. Glaser, 2001). The purposes of this study were to assess correlates of early reports of positive life changes and individual trajectories of self-reported positive changes over time among female sexual assault survivors (n = 171) using hierarchical linear modeling. The factors most related to reporting positive life change soon after the assault were social support, approach and religious coping, and perceived control over the recovery process. Increases in these factors also were associated with increases in self-reported positive life changes over time. The relations between social support and positive change also were mediated by coping strategies and control appraisals, particularly perceived control over the recovery process.

Conceptualizing the harm done by rape: applications of trauma theory to experiences of sexual assault

Based on a review of theory and evidence, this article highlights the limitations of trauma response models and applications of posttraumatic stress to characterize the experiences of women who are raped. There are two primary problems with trauma response theories. First, traditional notions of trauma are likely too narrow to accurately capture the complexities of women's experiences of sexual violence in a gendered society. Second, the symptoms emphasized by clinical applications of the trauma model may legitimate one sociocultural manifestation of distress while excluding others. Alternative conceptualizations are presented to stimulate more ecologically grounded and culturally inclusive study of sexual violence. Using the rape of women as an example, this article illustrates the limitations of Western views of trauma and encourages researchers and practitioners to expand notions of survivors' responses to painful events.

Positive and negative life changes following sexual assault

A longitudinal study was conducted to investigate (a) the timing and course of posttraumatic growth and (b) the relations between positive and negative life changes and posttraumatic distress among recent female sexual assault survivors (N = 171). Most survivors reported positive change even at 2 weeks postassault. Positive changes generally increased over time and negative changes decreased, although change in different domains followed different courses and there was significant individual variability in change patterns. Both positive and negative changes were associated with distress in expected ways, although the relations with negative changes were stronger. The least distress at 12 months was reported by those who noted positive life changes at both 2 weeks and 12 months postassault. Implications for theory and research on posttraumatic growth are discussed.

The impact of child sexual abuse and stigma on methods of coping with sexual assault among undergraduate women

OBJECTIVE

The aim of the current study was to determine whether a prior history of child sexual abuse increased the likelihood of using disengagement methods of coping with a sexual assault that had occurred within the past year. Once this was established, a mediational model was tested in which it was hypothesized that specific traumagenic dynamics and changed world views would mediate the association between child and/or adolescent sexual abuse and increased use of disengagement coping methods in response to a recent sexual assault.

METHOD

One thousand and fifty women undergraduates from a New England state university completed a survey for research credit. Respondents were asked detailed questions regarding experiences of sexual assault within the past year, histories of child and/or adolescent sexual abuse, traumagenic dynamics, and world assumptions. Analyses were based on 106 participants who had experienced a sexual assault within the past year.

RESULTS

Sexually assaulted young women with a history of child sexual abuse used more disengagement methods of coping to deal with the adult sexual assault than women without this history. In addition, the relationship between prior sexual abuse and the use of disengagement coping strategies was mediated by feelings of stigma, but not by feelings of betrayal and powerlessness or beliefs in the meaningfulness and benevolence of the world.

CONCLUSIONS

This is the first study to find that sexually revictimized young women may be particularly at-risk of relying on disengagement methods of coping with sexual assault. Furthermore, this association is mediated by feelings of shame or stigma. Directions for further research and clinical implications are discussed.

Positive by-products of the struggle with chemical dependency

Focus groups were conducted to identify ways persons in recovery from chemical dependence think they have benefited from their struggles with addiction. Categories of positive by-products were identified independently by two sets of readers. Several of the positive by-products discussed by the focus group participants are commonly reported from other kinds of challenging life experiences. These include increases in self-efficacy, family closeness, closeness with others, compassion and spirituality, and changes in life priorities. Additional positive by-products were discussed by the focus group participants that may be more unique to substance abuse and other similar stressors, including increased self-knowledge, enhanced ability to help offspring with substance abuse-related issues, and decreased naïveté. Ways to incorporate knowledge about these positive by-products into substance abuse treatment programs are introduced.

An evaluation of stress symptoms associated with academic sexual harassment

It is clear that sexual assault can precipitate posttraumatic stress disorder. Some theorists have suggested that less severe sexually harassing behaviors may also have trauma-like sequelae. In a study evaluating this hypothesis, 69 female participants completed self-report measures of instances of sexual harassment, basic beliefs, psychological distress/symptoms, and PTSD symptoms. Participants watched videotapes depicting sexual harassment, emotional arousal (not sexual in nature), and a neutral interaction while their heart rate was monitored, and they were interviewed using the SCID for PTSD. Results revealed that those who had been sexually harassed reported more negative basic beliefs, more general distress, and more negative state mood after watching the sexual harassment video, relative to those who had not been harassed. The severity of sexual harassing behaviors experienced was positively correlated with PTSD symptoms. Heart rate reactivity to the videotapes did not differ across groups defined by sexual harassment status.

Preparing for community violence: mood and behavioral correlates of the second Rodney King verdicts

This prospective investigation applied the Experience Sampling Method to examine the mood and behavioral responses of individuals facing the risk of community violence (in anticipation of the second Rodney King verdicts). Threatened participants experienced more negative affect and were less stable in behavioral involvement than individuals not under threat. Threatened participants also avoided social contact except for well-known individuals, and were more likely to be traveling than nonthreatened participants. Social contact with family or close friends and being at home (one's own home or the home of familiar individuals) were associated with large reductions in negative affect for those at risk for urban violence. The findings are discussed in terms of risk factors for trauma following community-wide stressors.