Reasons for and Experiences of Sexual Assault Nondisclosure in a Diverse Community Sample

The Process of Online Disclosures of Interpersonal Victimization: A Systematic Review

Theory and research on disclosure of interpersonal victimization, including intimate partner violence, sexual assault, and child abuse, has produced rich scholarship promoting a greater understanding of the challenges and implications of disclosure for survivors. However, in the last decade, social media platforms have opened new online disclosure opportunities that diverge from and overlap with offline disclosure. This highlights the need for adaptation and elaboration of theorizing in this growing area of study. Thus, the study aimed to systematically review the studies published in scientific literature. The following databases were accessed Criminal Justice Abstracts, Medline PsychInfo, Social Work Abstracts, Sociological Abstracts, Web of Science database, and Google Scholar. Twenty-seven studies met the inclusion criteria of peer-reviewed status and focused on the disclosure process. A thematic analysis revealed that online disclosure of interpersonal victimization is a multi-phase (decision-making and disclosure aftermath) and multifactorial (individual, interpersonal, social, and technological) experience for survivors. Specifically, survivors' motivation was related to therapeutic goals, social support, and a desire to advocate for social change. Survivors faced numerous facilitators (e.g., inspiration from other online disclosures) and barriers (e.g., fear of triggering other survivors) to disclosure. The impact of online disclosure was divided into benefits (e.g., empowerment) and risks (e.g., undermining survivors' security). The conceptual and empirical limitations of the current research are discussed, including a need for quantitative methods with larger samples and longitudinal designs to better understand how survivors can best benefit from processes of online disclosure, while avoiding harm or re-traumatization.

Coming across a hidden problem in an excluded population in Sweden: professionals' experiences of young migrants' disclosures of sexual violence

Growing evidence suggests that young migrants are particularly vulnerable to sexual violence. As young migrants often lack family and social networks, professionals are often the recipients of disclosures of sexual violence. This study aimed to explore how professionals experience young migrants' disclosures of sexual violence. A qualitative design was used, based on 14 semi-structured interviews with a range of professionals from the public sector and civil society in southern Sweden. The data were analysed using qualitative content analysis. The overarching theme developed was 'coming across the hidden problem of sexual violence in an excluded population' supported by three sub-themes: 'linking structural marginalisation and vulnerability to sexual violence'; 'realising that sexual violence is one among many other concerns'; and 'taking pride in backing up young people betrayed by society'. Professionals expressed a strong sense of responsibility due to the complex vulnerabilities of young migrants and their lack of access to services. This, coupled with the lack of clarity about how to respond to disclosures of sexual violence, can lead to moral distress. There is a need to strengthen support for professionals, including recognition of ethical dilemmas and the establishment of formal connections between organisations making access more straightforward and predictable.

Are They Really Helping Them to "Get Over It"? Bystander Behavior After Sexual Harassment Incidents in the Fashion Industry

Sexual harassment is a problem that continues to confront mostly women in the American workforce. One of the primary ways to reduce its prevalence and impact is through bystander intervention. A bystander is familiar with the incident and ultimately decides whether to proactively intervene, do nothing, or actually cause further damage to the victim by siding with the perpetrator. While bystanders can become engaged both prior to and during a sexually harassing event, or at the primary and secondary levels of prevention, they can also be involved after the incident, or at the tertiary level of prevention. This present study addressed tertiary prevention in real-life sexual harassment cases drawn from the fashion industry, whereby female models-as independent contractors represented by agencies and with few labor rights-were the victims, powerful men in the business were the key perpetrators, and other actors were the bystanders. Using thematic analysis to understand 18 accounts of harassment, this research identified bystander support from personal associates and some modeling agencies as institutions in the form of emotional resources and action-oriented advocacy. However, other modeling agencies more commonly engaged in bystander opposition, whereby they silenced their models who complained of harassment or continued to send models to work with known perpetrators in the business. This study thus draws attention to the ways in which some bystanders can help, but others can cause further harm through their particular employment relationships with victims that promote worker precarity. Implications for practitioners and public policy reforms for this industry are discussed.

Conducting Virtual Interviews With Sexual Assault Survivors and Their Informal Supports During COVID-19 and Beyond

The current paper describes the author's experience conducting virtual interviews with sexual assault survivors and their informal supports (e.g., family, friend, partner) during the COVID-19 pandemic, drawing on past and present interviewing experiences with this population, and the recent literature on best practices for virtual interviewing and survivor/trauma-informed research methods. The experience of pivoting from past projects using face-to-face interview methods to doing virtual interviews with this population is presented and critically analyzed. Potential advantages and drawbacks of various methods and adaptations for doing virtual interviews in a dyadic sample of survivors and their informal supports are described to facilitate future research using virtual methods with sexual assault survivors and their informal supporters. Issues related to access (e.g., e.g., age, gender, race, ability, poverty) to interview participation are also noted as in need of more consideration. Finally, the impact on interviewers of doing this work in virtual versus face-to-face contexts is discussed.

Diagnosing and Discussing Sexual Abuse: A Scoping Review on Training Methods for Health Care Professionals

Purpose

Sexual abuse is a health issue with many consequences. Recognizing and discussing past sexual abuse has proven to be challenging for health care professionals. To improve overall quality of health care for sexual abuse victims, health care professionals need to be properly trained. The aim of this paper is to provide an overview of training methods for health care professionals and to report on their effectiveness.

Methods

A scoping review was conducted. A broad search was executed in six databases in December 2022. Study selection was performed by two independent reviewers, followed by quality assessment and data extraction.

Results

After screening of titles and abstracts and later full-text assessment for quality appraisal, seven articles were selected, consisting mostly of non-randomized trials, performed among a total of 1299 health care professionals. All studies were assessed to be of moderate to poor quality. The participants attended training courses with a wide variety of durations, settings, formats and methods. The outcomes showed improvements in self-perceived or measured knowledge, skills and confidence to discuss sexual violence. Changes in clinical practice were scarcely investigated. Training courses were most effective when a mix of didactic passive methods, such as lectures and videos, and active participatory strategies, such as discussions and roleplay, were applied. Timely iteration to reinforce retention of gained knowledge and skills also contributed to effectiveness. Participants most enjoyed incorporating opportunities for receiving feedback in small settings and sharing personal experiences.

Conclusion

This scoping review summarizes on how to effectively train health care professionals. Flaws and difficulties in measuring the effectiveness of training courses were discussed. Recognition and discussion of past sexual abuse by health care providers can be effectively trained using an alternating mix of multiple active and passive training methods with room for feedback and personal experiences.

Cross-sectional examination of correlates of sexual victimization disclosure via #MeToo

Background: Sexual victimization is a serious public health problem, with a range of negative impacts on mental and physical health. Responses that individuals get to disclosure of sexual victimization play an important role in recovery. With the increased use of social media, more survivors are talking about their experiences of sexual victimization online. Research is needed to document the correlates of online disclosure of sexual victimization.Objective: The current study examined the role of demographic characteristics, assault severity, coping strategies, and social isolation as putative correlates of disclosing sexual victimization online via the hashtag #MeToo.Methods: A sample of 637 adults recruited via social media who reported a history of sexual victimization since the age of 14 completed self-report surveys using online survey software to assess disclosure of sexual victimization, assault severity, coping strategies, and social isolation.Results: Multivariate analyses suggest that levels of emotion-focused coping were positively associated with the disclosure of sexual victimization online via #MeToo. Further, individuals who had experienced completed rape by verbal coercion were less likely to disclose via #MeToo, compared to individuals who experienced other forms of assault.Conclusion: Coping strategies and assault severity play an important role in determining whether survivors disclose sexual victimization online via #MeToo. Findings suggest that individuals may disclose via #MeToo to seek support or express their emotions. Further, individuals whose sexual victimization experiences do not conform to 'typical' sexual victimization experiences are less likely to disclose via #MeToo.

Aspects of Selective Sexual Assault Disclosure: Qualitative Interviews With Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to informal supports (e.g., friends, family, partners) at some point following sexual assault, but little in-depth research has addressed specific aspects of disclosure. In the current study, a diverse sample of 45 sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following the assault. Narrative data on the overarching thematic category of selective disclosure were analyzed using thematic analysis methods. Several subthemes emerged specific to (a) the circumstances of disclosure (prompted or coerced), (b) withholding details (framing disclosures to avoid rape myths and blame, strategic use of language, protecting others by not disclosing or limiting details), and (c) sharing details (selecting who was told, selecting trusted others for disclosure, selective details told to specific people, sharing with strangers easier). Implications are drawn for future research on aspects of selective disclosure of sexual assault and clinical practice implications for supporting survivors and their informal support networks.

Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial

BACKGROUND

Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa.

OBJECTIVE

This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group.

METHODS

In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples.

RESULTS

Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant.

CONCLUSIONS

Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.

Beyond a deficit-based approach: Characterizing typologies of assets for cisgender and transgender female sex workers and their relationship with syndemic health outcomes

Female sex workers (FSWs) live and work at the intersection of multiple marginalized identities that place them at greater risk for various negative health outcomes. Resilience theory asserts that an individual or community needs assets from which they can draw in response to stressors, such as chronic discrimination and abuse. This study characterizes and compares patterns of assets among cisgender and transgender FSWs living with HIV in the Dominican Republic and their relations with syndemic health outcomes. With Latent Class Analysis, we used companion cross-sectional datasets comprised of cisgender and transgender FSWs (N = 211 and 100, respectively) to estimate typologies of interpersonal, community, and institutional assets. We used multivariate logistic regression to model the relationship between class membership and HIV care and treatment, mental health, violence exposure, and substance use outcomes, respectively. Among cisgender FSWs, we identified three classes: Internal and External Multilevel Assets (Class 1); External Institutional Assets (Class 2); and Low Reported Assets (Class 3). Compared to Class 3, Class 1 membership among cisgender FSWs was significantly associated with ART adherence and marginally associated with viral suppression, and Class 2 membership was marginally associated with currently taking ART. We identified two classes in the transgender sample: Internal and External Multilevel Assets (Class 1) and External Institutional Assets (Class 2). Class 1 membership among transgender FSWs was significantly associated with ART adherence and marginally associated with current ART use and physical or sexual violence, compared to Class 2. Having a variety of assets may explain the ability of some FSWs to more effectively engage with healthcare and maintain their HIV medication regimen. Future interventions should seek to expand FSWs' interpersonal and community assets, both from within and outside of the sex worker community, to bolster their ability to care for themselves and their community.

The stronger and the weaker sex - gender differences in the perception of individuals who experienced physical and sexual violence in childhood. A scoping review

BACKGROUND

Violence against children is an issue of serious concern. Stigma impacts coping with childhood trauma. A central aspect regarding disclosing trauma and seeking help is the social perception of the victim and survivor's gender.

OBJECTIVE

This review aims to synthesize qualitative and quantitative research about the impact of the victim and survivor gender on the societal perceptions of individuals who have experienced sexual and/or physical violence in childhood.

PARTICIPANTS AND SETTING

This review considered both society's and victims and survivors' perspectives on gender-linked perceptions concerning individuals with childhood trauma.

METHODS

The initial search was conducted in November 2021 and involved the databases Web of Science, PubMed, and PsychInfo. All studies, published in English or German, that reported study design, sample characteristics, and gender-linked perceptions of individuals with a history of sexual and/or physical violence in childhood were included.

RESULTS

A total of 10,373 studies were identified, of which 20 studies were eligible for review. Six studies reported no significant victim gender effect. However, when significant victim gender effects were present, males were characterized with considerably more stigmatizing attributes regarding the blame category while females were exposed to considerably more stigmatizing attributes regarding the harm category.

CONCLUSIONS

Females and males experience stigmatization reflecting typical stereotypes of femininity and masculinity. Thus, females are perceived as more vulnerable, more burdened, and with a higher need for security than males. Males are seen as more blameworthy and less trustworthy than females due to their presumed capability to physically resist or escape abuse.

"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.

Rape Myth Acceptance and Other Barriers to Formally Reporting Sexual Assault Among College Students With and Without Sexual Assault Histories

Low rates of reporting sexual assault to law enforcement have been attributed to a culture of rape myth acceptance. Yet, rape myth acceptance rates and specific barriers to reporting have not been examined by sexual assault and reporting histories. This study compared the rape myth acceptance levels of reporting survivors, non-reporting survivors, and individuals without sexual assault histories. The sample consisted of 579 undergraduate students (68.0% White, 72.5% women) at a public university in the southeastern U.S. Differences in non-reporting survivors' experienced barriers to reporting and the perceived barriers of those without sexual assault histories were also examined. Results indicate differences in rape myth endorsement by sexual assault and reporting status, with the highest rape myth adherence rates endorsed by individuals without a sexual assault history and the lowest endorsed by reporting survivors. While non-reporting survivors and those without sexual assault histories shared two of the top three barriers to reporting (i.e., wanted to avoid thinking or talking about it, did not want family or friends to find out), non-reporting survivors were more likely to endorse personal reasons for not reporting, and those without sexual assault histories were more likely to endorse concerns about the law enforcement response to rape. Several barrier factors were identified among non-reporting survivors (i.e., fear of law enforcement involvement, personal reasons, ambiguity of the event, responsibility) and among individuals without sexual assault histories (i.e., risks outweigh benefits, victim blaming, ambiguity). Although both survivors and individuals without sexual assault histories acknowledge the personal, social, and legal risks of reporting a sexual assault to law enforcement, survivors' experienced barriers differed in nuanced ways from the presumed barriers of individuals without sexual assault histories. Findings may enhance sexual assault prevention trainings and awareness campaigns by targeting both rape myth beliefs and specific barriers to reporting of those with and without sexual assault histories.

The Role of Gender, Sexual Assault History, and Sexism in Endorsement of Rape Myths Among College Students

The present study examined the roles of sexual victimization history, sexism toward women, and sexism toward men in the gender difference in rape myth acceptance. The data were obtained from 2,011 male and female college students who completed an online survey. The results suggested that gender had a significant indirect effect on rape myth acceptance via sexual assault history and several forms of sexist beliefs. The findings supported the importance of considering additional antecedents of rape myths in research, as well as in programming geared toward preventing sexual assault and improving support for survivors.

Online Disclosure of Sexual Victimization: A Systematic Review

We map the available scientific literature on how and why victims of sexual violence use digital platforms in the aftermath of victimization. Twenty-four empirical studies on sexual victimization and online disclosure were identified by systematically searching Web of Science and PsycINFO, checking reference lists, and consulting authors about relevant publications. The literature on online disclosure of sexual victimization does not yield a coherent picture. International literature pays limited attention to the various components of online disclosure like the characteristics of victims who disclosure online and the characteristics of the disclosure messages. Most studies focused on motivations for and reactions to online disclosure. Victims of sexual violence disclose sexual victimization online to seek support for clarification and validation, unburdening, documenting, seeking justice, informing others, or commercial goals (individual-oriented disclosure) and to provide support, educate, and as a form of activism (other-oriented disclosure). Responses to online disclosure are predominantly positive. Negative responses are rare. This review provides a comprehensive overview of multidisciplinary empirical information and displays knowledge gaps in victimological research. Future research should use robust quantitative and/or qualitative designs with substantial sample sizes, comparing victims who do disclose their sexual victimization online to victims who do not and comparing disclosure on different online platforms to increase generalizability. Potential for online support is identified, in which online disclosure can serve as a relatively safe alternative to off-line disclosure. This offers points of intervention for assistance and victim support in facilitating the use of the internet for support for victims of sexual violence.

Preexisting Mental Health Illness Among Victims of Sexual Assault: Case Studies to Inform Sexual Assault Nurse Examiner Practice

BACKGROUND

Sexual assault is a pervasive problem associated with negative long- and short-term consequences related to mental health consequences, educational function, physical health, and sexual and relationship functioning. People with mental illness, particularly those with psychotic disorders, have a significantly higher risk of becoming victims of violence compared with the general population.

METHODS

Three case studies of women with preexisting mental health problems who were sexually assaulted and requested a sexual assault examination are presented. These cases illustrate common mental health problems, how mental health problems can be associated with an increased risk for sexual assault, and things the sexual assault nurse examiner (SANE) should consider in the care and treatment of these patients.

RESULTS

These cases illustrate important ideas regarding the care of people who have been sexually assaulted: prioritizing safety, ethical issues related to consent, the importance of empathetic communication, and the need for SANEs to expand their knowledge to improve care of patients with mental health disorders.

DISCUSSION

Being sexually assaulted can contribute to destabilization, prolongation, and exacerbation of existing mental illness, placing patients at an increased risk for sexual assault, beginning a vicious cycle of mental illness and violence. Working effectively with the interdisciplinary team, the SANE can help break this devastating cycle of violence.

Exploring Correlates of Social Reactions to Disclosure Among Latina Sexual Assault Survivors

Social reactions to sexual assault (SA) disclosure are well-documented in the literature, but less is known about disclosure and reactions received by Latina survivors. The current study analyzed correlates of positive and negative social reactions to sexual assault disclosure in a community sample of Latina survivors (n = 239). Compared to White survivors, Latina survivors were more likely to report turning against and acknowledgement without support reactions. Among Latina survivors, contrary to hypotheses, both "stereotypical" (e.g. more violent assaults) and "non-stereotypical" (e.g. pre-assault substance use) assault characteristics were associated with acknowledgement without support negative social reactions. Furthermore, total number of sources Latina survivors disclosed to were associated with turning against social reactions. Implications for future research on disclosure/social reactions and Latina survivors are discussed.

Prospective Predictors of Receiving Disclosures of Intimate Partner Violence and Sexual Assault Among College Students

OBJECTIVE

Previous research has indicated that many undergraduates receive disclosures of sexual assault and intimate partner violence (IPV) from their peers; however, much of this research has been cross-sectional. The present study assessed the extent to which demographic characteristics and victimization history predicted whether participants received disclosures over the subsequent 6 months. Directional hypotheses assessed whether psychological symptoms and attitudes predicted, or were consequences of, disclosures at follow-up.

METHOD

College students (n = 867) from a broader treatment intervention study completed pretest (Time 1) and 6-month follow-up surveys (Time 2).

RESULTS

Individuals who reported new disclosures at follow-up (56%) were more likely to be women, have previous experience receiving either sexual assault or IPV disclosures, and have experienced sexual assault or IPV victimization in their lifetime and across the follow-up period. Sexual orientation did not predict receipt of disclosures at follow-up; intervention group did not moderate these relationships. Results of longitudinal structural equation models found that although higher Time 1 posttraumatic stress disorder symptoms and depressive symptoms predicted disclosure status at follow-up, Time 1 disclosure status did not predict subsequent increases in posttraumatic stress disorder and depressive symptoms. Attitudinal variables were not significantly associated with disclosures reported at Time 1 or follow-up.

CONCLUSIONS

Findings suggest the importance of attending to personal experiences of victimization within interventions aiming to improve responses to disclosure. Although individuals with higher distress are more likely to receive subsequent disclosures, disclosure does not appear to lead to increases in long-term psychological distress.