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Isaac S, McLindon E, Hegarty K, Tarzia L. Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood. Violence Against Women 2024; 30:3140-3162. [PMID: 37203171 PMCID: PMC11380362 DOI: 10.1177/10778012231176198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.
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Affiliation(s)
- Sandra Isaac
- The University of Melbourne, Victoria, Australia
| | - Elizabeth McLindon
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Laura Tarzia
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
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2
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Leclerc S, Martin LA. Overcoming Rape: A Mixed-Methods Approach to Understanding Psychological and Physical Health Functioning of Male Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241277275. [PMID: 39223877 DOI: 10.1177/08862605241277275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
When examining sexual assault, men are often hidden from the literature. The current study employed a mixed-methods, convergent parallel design to examine the experiences of 22 male survivors of sexual assault (mean age = 44.19, SD = 13.28, range 18-65; 91% European American; 50% heterosexual). Survivors were administered an online survey using quantitative and qualitative questions to assess rape myths, gender roles, self-esteem, self-efficacy, resiliency, coping, overall mental and physical health, and diagnostic criteria for alcohol abuse, post traumatic stress disorder (PTSD), and sexual dysfunction. Three key themes emerged from the integration of quantitative and qualitative data: (a) Help is Elusive, (b) Internal Struggles and External Strengths, and (c) Living with Clinical Diagnoses. This study adds to an important area of the literature that increases understanding of men's experiences with sexual violence and honors the voices of these survivors.
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Haugen T, Halvorsen JØ, Friborg O, Mork PJ, Mikkelsen G, Schei B, Hagemann C. Early Intervention after Rape to prevent post-traumatic stress symptoms (the EIR-study): an internal pilot study of a randomized controlled trial. Pilot Feasibility Stud 2024; 10:118. [PMID: 39223617 PMCID: PMC11367763 DOI: 10.1186/s40814-024-01541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Rape is one of the trauma incidents with the highest risk of subsequent post-traumatic stress disorder. Early interventions, such as prolonged exposure therapy (PE), have shown promise in preventing PTSD following a sexual assault. The primary objective of this internal pilot trial was to examine the feasibility of the EIR study protocol, which used modified prolonged exposure therapy (mPE) as a preventive intervention after rape. METHODS This parallel two-arm clinical pilot study involved three sexual assault centers (SACs) in Trondheim, Oslo, and Vestfold, with data collected between June 2022 and March 2023. Women seeking assistance at one of these three SACs within 72 h after rape or attempted rape received acute medical treatment and forensic examinations. Women who wanted further psychosocial treatment were, if eligible and consenting, recruited to complete baseline assessments and a clinical interview before being randomized to one of two study arms. The intervention group prescribed up to five sessions of modified PE (mPE) in addition to treatment as usual (TAU), starting within the first 14 days after the rape incident, followed by weekly sessions. The other group received TAU. The present pilot evaluation is based on 22 participants, i.e., nine mPE + TAU and 13 TAU alone. Primary outcomes were predefined progression criteria regarding recruitment, retention, intervention implementation, a harm reporting system, and applying biological measurements and actigraphy. RESULTS During the 6-month recruitment period, 235 women visited the three SACs. After eligibility screening and consent, 22 (9.4%) women were randomized. Three months later, 14 (63.6%) participants completed the final assessments. Intervention implementation was successful using trained SAC personnel to deliver mPE. The harm reporting system was used according to the study's plan, and adverse and serious adverse events were detected during the trial. The biological measurements and actigraphy had substantial missing data but were still considered usable for statistical analyses. CONCLUSION It may be feasible to conduct a full-scale RCT of early intervention after rape by comparing mPE + TAU to TAU alone. Minor design refinements were made to the protocol to enhance the main study outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05489133. Registered on 15 July 2022, retrospectively.
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Affiliation(s)
- Tina Haugen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Joar Øveraas Halvorsen
- Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddgeir Friborg
- Department of Psychology, The Arctic University of Norway (UiT), Trondheim, Norway
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gustav Mikkelsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Chemistry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cecilie Hagemann
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Draughon Moret J, Wilson M, Humphrey-Staub J, Porter T, Wellington J, Anderson JC. Readiness for HIV Postexposure Prophylaxis (PEP) Decision Making Following Sexual Violence. Issues Ment Health Nurs 2024; 45:937-947. [PMID: 39173124 DOI: 10.1080/01612840.2024.2366324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
HIV post-exposure prophylaxis (PEP) can reduce the risk of acquiring HIV infection following sexual assault. However, only about half of people offered HIV PEP will initiate the medication. Factors associated with patient readiness for HIV PEP following sexual assault have been attributed to structural and clinical barriers. This study utilized the Theory of Reasoned Action and Planned Behavior to better understand how personal factors, cognitive factors, mental health, barriers and facilitators that could influence a patient's decision to start HIV PEP post sexual assault. A web-based cross sectional survey was conducted from October 2017 to January 2020 and a total of 228 responses were included from participants that had experienced sexual assault in the previous 3 months. Using linear regression modeling fear of HIV, post-traumatic stress symptoms, validating social responses to disclosure, and having someone else pay for HIV PEP were all associated with feeling better prepared for HIV PEP decision making. Results indicate that structural, social, and individual factors impact patient decision making. These findings highlight opportunities for health systems and providers to improve HIV education and the importance of initiating HIV PEP following sexual assault.
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Affiliation(s)
| | - Machelle Wilson
- Clinical and Translational Science Center Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Jacke Humphrey-Staub
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - Tequila Porter
- Betty Irene Moore School of Nursing, University of California, Davis, Davis, CA, USA
| | - Jessica Wellington
- Nese College of Nursing, Penn State University, University Park, PA, USA
| | - Jocelyn C Anderson
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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5
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Wilson LC, Newins AR. The Role of Gender, Sexual Assault History, and Sexism in Endorsement of Rape Myths Among College Students. Violence Against Women 2024; 30:3032-3054. [PMID: 37009725 DOI: 10.1177/10778012231166406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
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.
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Affiliation(s)
- Laura C Wilson
- Department of Psychological Science, University of Mary Washington, Fredericksburg, VA, USA
| | - Amie R Newins
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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6
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Merry OJ, Whitfield KC. The Landscape of Sexual Harm in the Video Game, Streaming, and Esports Community. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241271349. [PMID: 39169727 DOI: 10.1177/08862605241271349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
While sexual harm has been studied across a range of contexts, it has not yet been considered within the video game, streaming, and esports community. This study aimed to explore the landscape of sexual harm in this community, specifically, where it has been committed by esports professionals and video game live streamers. Fifty-five victim statements were extracted from online sources (such as Twitter/X and Reddit) and coded into variables relating to offender and victim demographics, offense characteristics, the offense process, and platform(s) used. Descriptive statistics were generated for each variable and Fisher's exact tests were conducted to examine the differences between adult-on-adult and adult-on-child cases. The findings reveal diverse offense outcomes across the sample, ranging from rape to sexual communication with a child. Some offense patterns can be seen in wider sexual offending literature, such as pre-offense alcohol consumption, offending against incapacitated victims (e.g., sleeping), and offending within an established romantic relationship. However, several offense process characteristics unique to the video gaming community were identified. These included offenders using their position of fame within the community to access victims and bypass the need for other coercive behaviors. Online offenses were more common with children and offenders demonstrated a preference for "live" methods, such as voice chat and video calling, rather than instant messaging or sharing images of themselves. This limits the digital evidence left behind and indicates the offenders' greater technological literacy. The study's findings shed light on the sexual harm that exists within this previously unexplored context and highlight areas where esports organizations, live-streaming platforms, and educational providers can do more to safeguard players, fans, and viewers in this community.
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Haim-Nachum S, Amsalem D, Lazarov A, Seedat S, Neria Y, Zhu X. Childhood maltreatment and its associations with trauma-related psychopathology: disentangling two classification approaches. NPJ MENTAL HEALTH RESEARCH 2024; 3:39. [PMID: 39152276 PMCID: PMC11329716 DOI: 10.1038/s44184-024-00082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
Childhood maltreatment (CM) is associated with various mental health disorders, including PTSD, depression, and anxiety. This study explores how specific classifications - dichotomous (abuse versus neglect) and dimensional (physical, emotional, sexual) - relate to distinct psychopathologies. We recruited 642 individuals, screening them for CM history and symptoms. ANOVA, regression, and SEM analyses compared CM approaches and symptom associations. The dichotomous approach showed significant effects of abuse and neglect on all symptoms. In the dimensional approach, sexual and physical CM were primary features for PTSD, while sexual and emotional CM were primary for depression and anxiety. Overall, the dimensional approach outperformed the dichotomous approach in capturing symptoms, suggesting its importance in understanding psychopathologies and guiding therapeutic interventions. Our findings highlight the differential associations of CM experiences with PTSD, depression, and anxiety symptoms. The findings suggest the importance of a dimensional CM approach for understanding psychopathologies and possibly informing targeted therapeutic interventions.
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Affiliation(s)
- Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- School of Social Work, Tel Aviv University, Tel Aviv, Israel.
| | - Doron Amsalem
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African PTSD Research Programme, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Mills AH, Canning L, Fitzke RE, Davis JP, Clapp JD, Pedersen ER. Sexual Violence Victimization and Pregaming Protective Behavioral Strategies Among College Students. Subst Use Misuse 2024:1-7. [PMID: 39138840 DOI: 10.1080/10826084.2024.2383975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Sexual violence is a major public health concern that has a detrimental impact on mental health, physical health, and academic performance. College students represent a population that is at an increased risk of experiencing sexual violence. Alcohol use, and more specifically, heavy drinking during pregaming events, is associated with increased risk of sexual violence. Studies have demonstrated that protective behavioral strategies have effectively reduced heavy drinking and the risk of alcohol-related consequences, including sexual violence victimization. OBJECTIVES This study aims to examine the association between experiences of sexual violence in college and subsequent use of pregaming protective strategies. RESULTS Data from 468 college students (67% female, 33% male) were analyzed. Over 42% of participants reported experiencing sexual violence in college. While adjusting for pregaming frequency and sex, results revealed that those who reported experiencing sexual violence in college were significantly less likely to use pregaming protective behavioral strategies compared to those without such experiences. Specifically, survivors of sexual violence were less likely to report using the protective behavioral strategies of minimizing intoxication, as well as behaviors related to safety and familiarity (e.g., using a designated driver after pregaming). CONCLUSIONS The findings have important implications for interventions aimed at empowering survivors of sexual violence. Future research should focus on understanding survivor's motives and mechanisms to use pregaming protective behavioral strategies to reduce the risk of re-victimization.
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Affiliation(s)
- Alexandra H Mills
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Liv Canning
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Reagan E Fitzke
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - John D Clapp
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Eric R Pedersen
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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9
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Bernstein E, Kanefsky R, Cook M, Newins AR. Acceptance of rape myths and psychological symptoms: the indirect effect of self-blame. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1641-1645. [PMID: 35728073 DOI: 10.1080/07448481.2022.2086005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/01/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Objective: The current study examined the influence of rape myth acceptance on self-blame and psychological symptoms following a sexual assault. Participants: The sample included 280 female sexual assault survivors in college. Methods: In an online survey, participants completed the Sexual Experiences Survey - Short Form Victimization, Updated Illinois Rape Myth Acceptance Scale, Posttraumatic Cognitions Inventory, Patient Health Questionnaire - 9 item scale, and PTSD Checklist for DSM-5. Results: A significant indirect effect was found between acceptance of rape myths and PTSD symptoms via self-blame; acceptance of rape myths was positively associated with self-blame, which in turn was positively associated with PTSD symptoms. Conclusions: Clinicians working with survivors of sexual assault should assess for endorsement of rape myths and self-blame, as challenging posttraumatic cognitions has been shown to reduce symptoms of trauma.
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Affiliation(s)
- Emily Bernstein
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Rebekah Kanefsky
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Matthew Cook
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Amie R Newins
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Prego-Meleiro P, Recalde-Esnoz I, Sordo L, Del Castillo H, García-Ruiz C, Montalvo G, López-Cuadrado T. Drug-facilitated sexual assault in youth nightlife contexts in Spain. Public Health 2024; 233:157-163. [PMID: 38901300 DOI: 10.1016/j.puhe.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/10/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study aimed to provide epidemiological information on drug-facilitated sexual assault in Spanish youth partying, with a focus on prevalence rates and associated sociodemographic factors. STUDY DESIGN Cross-sectional study. METHODS Quota sampling was used to recruit 1601 young people aged 18-35 years in Spain from a digital panel. A validated questionnaire on drug-facilitated sexual assault was used to assess five types of lifetime victimisation experiences while partying. Chi-square and the exact Fisher tests were used to describe the prevalence of victimisation, drug use patterns, and perpetrator profiles. Generalised ordered logistic regression was used to explore factors associated with victimisation, analysed by gender. RESULTS Half of young women and one-quarter of young men had experienced drug-facilitated sexual assault in their lifetime. Female victimisation due to touching and kissing was notably high, whereas men comprised almost half of the victims of more invasive DFSA experiences involving masturbation, penetration, and oral sex. Opportunism prevailed as the assault tactic, consisting of taking advantage of the victims' incapacity derived from voluntary alcohol use. Among women, risk of victimisation was associated with a lower education level, foreign-born status, and being non-heterosexual. Male victimisation risk was highest among non-heterosexual men. CONCLUSIONS Drug-facilitated sexual violence in youth nightlife contexts is a serious public health issue in Spain, which requires urgent action. Most assaults involve taking advantage of victims who are incapacitated by the effects of voluntary alcohol consumption. This sexual violence primarily affects women with lower educational levels or those who are foreign-born and non-heterosexual men and women.
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Affiliation(s)
- P Prego-Meleiro
- Department of Public-Health and Maternal-Child, Faculty of Medicine, Complutense University, Madrid, Spain; Universidad de Alcalá, Observatorio Universitario de Violencia Sexual Facilitada por Drogas, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain
| | - I Recalde-Esnoz
- Universidad de Alcalá, Observatorio Universitario de Violencia Sexual Facilitada por Drogas, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Departamento de Ciencias de la Educación, C/ San Cirilio, s/n, 28804, Alcalá de Henares, Madrid, Spain
| | - L Sordo
- Department of Public-Health and Maternal-Child, Faculty of Medicine, Complutense University, Madrid, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Health Research Institute, San Carlos University Hospital (IdISSC), Madrid, Spain.
| | - H Del Castillo
- Universidad de Alcalá, Observatorio Universitario de Violencia Sexual Facilitada por Drogas, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Departamento de Ciencias de la Educación, C/ San Cirilio, s/n, 28804, Alcalá de Henares, Madrid, Spain
| | - C García-Ruiz
- Universidad de Alcalá, Observatorio Universitario de Violencia Sexual Facilitada por Drogas, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Departamento de Química Analítica, Química Física e Ingeniería Química, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain
| | - G Montalvo
- Universidad de Alcalá, Observatorio Universitario de Violencia Sexual Facilitada por Drogas, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Departamento de Química Analítica, Química Física e Ingeniería Química, Ctra. Madrid-Barcelona km 33.6, 28871, Alcalá de Henares, Madrid, Spain
| | - T López-Cuadrado
- National Center for Epidemiology, Carlos III Health Institute, 28029, Madrid, Spain
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Gesser N, Katz BW, Chiu T, Burmeister EM, Anderson RE. "I Think You Covered the Three Levels of Drugs and Consent": Qualitatively Testing Different Operationalizations of an Alcohol and Other Drugs-Involved Sexual Violence. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02947-w. [PMID: 39039340 DOI: 10.1007/s10508-024-02947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024]
Abstract
Substance-involved rape is increasing among college students, particularly women (Koss et al., 2022). Addressing rape requires first measuring it accurately in surveys to understand its true scope and nature. We used cognitive interviews with 40 young adults to qualitatively test the construct validity of an alcohol- and other drugs (AOD)-involved rape item in the Sexual Experiences Survey by asking participants to comment on different operationalizations of this construct. Our findings revealed that different phrasings elicited different interpretations of the items by participants. Specifically, the results indicated that (1) respondents viewed the different operationalizations as a sequence of events with varying severity; (2) some participants focused on the intentionality and responsibility of the perpetrator as opposed to opportunistic perpetration; and (3) study participants consistently chose one of the operationalizations as describing "being roofied" (being drugged without consent). Participants also contributed additional scenarios not described in the questionnaire and shared their interpretations of the items. The results underscore the importance of refining survey language to properly measure AOD-involved rape and allow us to understand how to tailor appropriate questions for best comprehension. The findings indicate the benefit in including several items about AOD-involved rape in questionnaires such as the Sexual Experiences Survey, with each item addressing different scenarios of victim intoxication. The results could also have important implications for sexual violence prevention programs, which should discuss consent, intentions, and responsibility specifically in the context of AOD consumption.
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Affiliation(s)
- Nili Gesser
- Department of Criminology and Justice Studies, Drexel University, 3401 Market Street, Philadelphia, PA, 19122, USA.
| | - Benjamin W Katz
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Tiffany Chiu
- Health & Behavior Studies, Department of Education, University of North Dakota, Grand Forks, ND, USA
| | - Ellei M Burmeister
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Alluma, Crookston, MN, USA
| | - RaeAnn E Anderson
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
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12
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Lausi G, Cricenti C, Mari E, Burrai J, Quaglieri A, Giannini AM, Barchielli B. An explorative study on consequences of abuse on psychological wellbeing and cognitive outcomes in victims of gender-based violence. Front Psychol 2024; 15:1367489. [PMID: 39100559 PMCID: PMC11294214 DOI: 10.3389/fpsyg.2024.1367489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/03/2024] [Indexed: 08/06/2024] Open
Abstract
Background The issue of gender-based violence has been a public health problem for years. Considering its systemic nature, the possible consequences at the individual level on the psychological and cognitive wellbeing of victims have been examined. The present research aims to explore the differences in the various types and forms of violence. Methods A non-probability and convenience sample was used; a total of 83 participants joined the research. Inclusion criteria were minimum age of 18 years, female gender, and knowledge of the Italian language. Two non-parametric One-Way ANOVAs (Kruskal-Wallis) were performed according to the type of violence experienced and the type of self-reported abuse (i.e., no victimization, single victimization, complex victimization). Results and discussion Results showed that victims of violence scored higher overall than non-victims on all subscales of the Depression, Anxiety, Stress Scale. Analyses among the three groups-no violence, single violence, and complex violence-showed no differences in any of the dimensions between those who experienced single and complex violence, while differences emerged between the "no victimization" group and the other groups. The results were discussed in relation to the existing literature on the topic, highlighting the limitations and future applications of the collected data.
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Affiliation(s)
- Giulia Lausi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Emanuela Mari
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Jessica Burrai
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Benedetta Barchielli
- Department of Dynamic, Clinical Psychology and Health, Sapienza University of Rome, Rome, Italy
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Stockman D, Van Parys H, Uzieblo K, Littleton H, Keygnaert I, Lemmens G, Verhofstadt L. Coping with sexual violence as a post-assault formed couple: A dyadic phenomenological interview analysis. JOURNAL OF SEX & MARITAL THERAPY 2024:1-24. [PMID: 38962932 DOI: 10.1080/0092623x.2024.2374245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Increasing evidence shows that survivors of sexual violence frequently experience relationship difficulties following their victimization. Little is known regarding how couples which formed post-assault cope with the impact of the prior assault. Hence, the aim of the current study was to gain insight into post-assault formed couples' experiences in coping with the impact of sexual violence. To this end, an interview study was conducted with five female survivors and their male partners who began their romantic relationship post-assault. A dyadic phenomenological interview analysis revealed that sexual victimization is a dyadic stressor but is not always considered as such by the couple. In addition, disclosure is described as a potential bonding experience. Flexibility and creativity from both partners are required as they adapt to the post-assault impact. In addition, meaningful communication and considering the perspective of one's partner seemed to be key to dyadically cope successfully. The current study also identified challenges couples had to manage, including caregiver burden and role confusion. Results suggest that interventions supporting couples in their continuous efforts toward mutual understanding can foster trust and growth.
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Affiliation(s)
- Dagmar Stockman
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
- Expertise Network People and Society, Artevelde University College of Applied Sciences, Ghent, Belgium
- Faculty of Psychology and Educational Sciences Campus Kulak, Catholic University Leuven, Kortrijk, Belgium
| | - Hanna Van Parys
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Kasia Uzieblo
- Department of Criminology, Vrije Universiteit Brussel, Brussels, Belgium
- Helpline 1712, Centre for General Well-being, Leuven, Belgium
| | - Heather Littleton
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, USA
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Women's clinic, Ghent University Hospital, Ghent, Belgium
| | - Gilbert Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- Department Head and Skin - Psychiatry, Ghent University, Ghent, Belgium
| | - Lesley Verhofstadt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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14
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Brannock MK, Sullivan OA, Beatty KE. Availability of Certified Sexual Assault Nurse Examiners in Appalachian States. J Emerg Nurs 2024; 50:544-550. [PMID: 38775771 DOI: 10.1016/j.jen.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Sexual assault nurse examiners are crucial care providers in cases of sexual assault. However, it is not clear whether sexual assault nurse examiner availability differs throughout the 13 states that comprise the Appalachian region of the United States. Therefore, this cross-sectional analysis identified sexual assault nurse examiner availability in 13 states and determined differences in availability by both county-level Appalachian status and county-level rurality status. METHODS Data were downloaded from 2 public sexual assault nurse examiner registries for the included 13 states. Descriptive statistics of sexual assault nurse examiner certification type and availability by state were calculated. In addition, bivariate analyses of sexual assault nurse examiner availability by rurality and by Appalachian status were performed using 2-sample z-tests for equality of proportions. RESULTS State-level sexual assault nurse examiner availability ranged from 0.34 to 0.86 sexual assault nurse examiners per 100,000 residents. Sexual assault nurse examiner availability in these 13 states did not differ by Appalachian status. However, rural areas had significantly lower sexual assault nurse examiner availability than urban areas in these 13 states. DISCUSSION These data support previous literature on the need for stronger sexual assault nurse examiner programs in rural areas in the United States. Future research should take sexual assault prevalence into account to determine whether local sexual assault nurse examiner access needs, as well as appropriate support for sexual assault nurse examiners, are being met throughout Appalachian states.
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Kolbuszewska MT, Tavares IM, Nobre PJ, Dawson SJ. Using network analysis to model associations between psychological symptoms, sexual function, and sexual distress in women. Int J Clin Health Psychol 2024; 24:100479. [PMID: 39040481 PMCID: PMC11262177 DOI: 10.1016/j.ijchp.2024.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background Psychological difficulties, including depression, anxiety, and somatization, are among the most important predictors for women's sexual function (i.e., arousal, desire, lubrication, pain, and satisfaction) and sexual distress. These associations have largely been studied at the construct level, with little research examining which specific symptoms might be most important for maintaining links between psychological difficulties and domains of sexual function. The present research sought to establish and characterize networks of women's psychological symptoms, sexual function, and sexual distress, and identify potential bridge symptoms that connect them. Methods In a cross-sectional study, 725 women reported on their sexual function, sexual distress, and depressive, anxiety, and somatization symptoms. A series of network analyses was used to identify central symptoms and connections between psychological symptoms, sexual function domains, and sexual distress. Results Across the modeled networks, sexual distress and pain during sex were consistent bridges between other sexual function domains and psychological symptoms. Discussion Overall, our models revealed sexual distress as an important potential mediator between sexual function problems and psychological symptoms that might contribute to the development and maintenance of comorbid sexual function and psychological problems.
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Affiliation(s)
- Marta T. Kolbuszewska
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Inês M. Tavares
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pedro J. Nobre
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Samantha J. Dawson
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada
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16
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Briere J, Runtz M, Rodd K. Child and Adolescent Exposure to Sexual Harassment: Relationship to Gender, Contact Sexual Abuse, and Adult Psychological Symptoms. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2981-2996. [PMID: 38281113 PMCID: PMC11127504 DOI: 10.1177/08862605231225524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
In contrast to adults, there is considerably less research on childhood or adolescent exposure to sexual harassment (CAESH), its lasting psychological correlates, and whether such experiences should be included in definitions of childhood sexual abuse. The current study examined the prevalence and symptomatic sequels of unwanted flirting, being "checked out" sexually, unwanted sexual attention, sexual comments, propositions, and related noncontact behaviors that occurred before age 18, as well as the multivariate relationship between CAESH and contact child sexual abuse (C-CSA) in a diverse online sample of 528 individuals. CAESH was very common, with over 95% of women and 64% of men reporting at least one experience of noncontact sexual harassment before age 18. When childhood sexual abuse was operationalized as the presence of either C-CSA or a total CAESH score of 18 or higher (corresponding to an average score of "3-5 times" prior to age 18), the prevalence was 67% for women and 26% for men, more than three times higher than C-CSA alone. This expanded definition was associated with significantly more anxiety, depression, and posttraumatic stress relative to C-CSA alone. These results suggest that CAESH is a significant source of symptoms in adults and support the emerging perspective that childhood sexual abuse may be best understood as including both contact and noncontact events.
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Affiliation(s)
- John Briere
- University of Southern California, Los Angeles, USA
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17
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Hirai M, Vernon LL, Dials AE. A serial Mediation Model of Depression and Drinking Motives Underlying Problem Drinking Among Hispanic College Women Following Rape. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2997-3015. [PMID: 38279685 DOI: 10.1177/08862605241226636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Problem drinking and depression are common following sexual assault. The current study applied a coping motives model of drinking and examined the association between rape experiences and problem drinking serially mediated by depression symptoms and coping-depression drinking motives among Hispanic college women. A total of 330 college women were classified into a single rape experience (SGL) group (n = 44), a multiple rape experiences (MLT) group (n = 70), and a no sexual assault experience group (n = 221). Participants completed self-report measures online. Serial mediation analyses with multi-categorical predictors found that significantly increased alcohol consumptions in rape survivors compared to individuals with no sexual assault experience were largely explained by the serially connected underlying mechanisms of depression symptoms and coping-depression drinking motives. The prevalence rates of rape experiences in this Hispanic female sample are alarming, suggesting Hispanic college women as a particularly vulnerable group for rape. The current results contribute to a greater understanding of the effects of rape experiences on behavioral and emotional outcomes among young Hispanic women who have been underrepresented in sexual victimization research. The findings emphasize the importance of assessing depression symptoms and coping-depression drinking motives in Hispanic rape survivors to reduce risks for hazardous drinking behavior.
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Affiliation(s)
- Michiyo Hirai
- University of Texas Rio Grande Valley, Edinburg, TX, USA
| | | | - Andrew E Dials
- University of Texas Rio Grande Valley, Edinburg, TX, USA
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18
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Sell NM, Testa M. Precollege Risk Markers for College Rape and Verbal Sexual Coercion: Same or Different? JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3261-3281. [PMID: 38345012 DOI: 10.1177/08862605241229722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Verbal sexual coercion (VSC) and rape are common experiences among college women. Although they have been theorized to involve different risk markers, few prospective studies have examined predictors of VSC and rape separately. The present prospective study was designed to identify precollege risk markers for VSC and rape in first-year college women, with the goal of considering the degree to which they overlap or differ. Women (N = 449) recruited from the community just prior to high school graduation completed measures of sexual victimization (SV) since age 14 but prior to college, sexual refusal assertiveness, high school heavy episodic drinking (HED), college drinking intentions, and sociosexuality. Follow-up surveys at the end of the first and second college semesters assessed VSC and rape. Using the Sexual Experiences Survey's severity scoring method, women were classified into one of three groups according to the most severe type of SV reported in the first year of college: neither VSC nor rape (71%), VSC (16%), and rape (13%). Most women who experienced rape (73%) also experienced VSC. Precollege SV and college drinking intentions predicted both rape and VSC. Sexual refusal assertiveness and high school HED did not independently predict either form of victimization. Sociosexuality predicted rape but not VSC. Findings suggest a substantial overlap in the predictors of VSC and rape and support the severity continuum underlying many conceptualizations of SV.
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19
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Bergenfeld I, Anderson KM, Trang QT, Cheong YF, Minh TH, Hoover AT, Yount KM. Development of the Vietnamese Rape Myths Acceptance Scales: A Web-Based Survey of Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2629-2652. [PMID: 38886249 DOI: 10.1007/s10508-024-02893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/20/2024]
Abstract
Rape myths-false but widely held beliefs that serve to deny and justify sexual aggression-present a major barrier to reporting and prevention of sexual violence in Vietnam and globally. Based on a parent study aimed at reducing sexual violence at two universities in Hanoi, we developed and assessed a contextualized measure of rape myths among young people in Vietnam. Items from previously validated rape myth acceptance (RMA) scales and data from qualitative research informed the development of 50 items, which were administered to Vietnamese 18-24-year-olds (n = 2,756 total, n = 1,798 cisgender women) via an anonymous link in February 2021. We used factor analysis to explore and test factor structure and multi-group factor analysis to assess measurement equivalence across gender. We calculated item-level discrimination and difficulty parameters and visualized information curves using item response theory analysis, informing the development of a short form. Four hypothesized subconstructs identified in the qualitative data emerged as factors: (1) "He didn't mean to"; (2) "She asked for it"; (3) "It wasn't really rape"; and (4) "Rape is a deviant event." A fifth factor, "She didn't protect herself," included four items from formative data. Confirming formative findings and prior literature, cisgender women had lower RMA than cisgender men, particularly on items related to victim-blaming. The Vietnamese Rape Myths Acceptance Scales were internally consistent and equivalent between cisgender men and women, capturing elements specific to the Vietnamese context and providing a tool for campus climate surveys and evaluations of sexual violence prevention programs.
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Affiliation(s)
- Irina Bergenfeld
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Katherine M Anderson
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Quach Thu Trang
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | - Yuk Fai Cheong
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | | | - Kathryn M Yount
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA.
- Department of Sociology, Emory University, Atlanta, GA, USA.
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20
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Zvi L, Rachimi A. Adult attachment style, perceived social support, and post-traumatic stress among female victims of sexual assault. Int J Clin Health Psychol 2024; 24:100481. [PMID: 39040480 PMCID: PMC11262163 DOI: 10.1016/j.ijchp.2024.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
The present study aimed to investigate the interplay between adult attachment style, perceived social support, and post-traumatic stress (PTS) symptoms among adult female victims of sexual assault)SA(. While prior research has established the link between insecure attachment style and PTS, the underlying mechanisms are not well understood. The potential role of perceived social support as a mediator in this relationship has been largely neglected and there is a dearth of studies investigating this mediation among victims of SA. The present study sought to address this gap in literature. Two hundred twenty-six women who have endured SA completed self-report measures of attachment style, perceived social support, and PTS, using an online survey. The results confirmed the anticipated pattern, showing a positive correlation between insecure attachment styles and PTS, as well as a negative correlation with perceived social support. A mediation analysis indicated that perceived social support may be a mechanism linking attachment styles to PTS. Following SA, insecurely attached women, especially those with avoidant attachment, have difficulties relying on and utilizing support from their environment, which may render them more susceptible to PTS. Nevertheless, the mediation was partial, indicating that attachment anxiety and attachment avoidance independently contribute to the development and maintenance of PTS.
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Affiliation(s)
- Liza Zvi
- Department of Criminology, Ariel University, Israel
| | - Avia Rachimi
- Department of Criminology, Ariel University, Israel
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21
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DeFazio C, Moyers-Kinsella SI, Claydon EA, Hand MD, Lilly C, Zullig KJ, Davidov DM. A Scoping Review of Bystander-Based Sexual Violence Prevention Training for College Students in Fraternities and Sororities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:797. [PMID: 38929043 PMCID: PMC11204108 DOI: 10.3390/ijerph21060797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.
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Affiliation(s)
- Caterina DeFazio
- Department of Social and Behavioral Health Sciences, West Virginia University, Morgantown, WV 26506, USA
| | | | - Elizabeth A. Claydon
- Department of Social and Behavioral Health Sciences, West Virginia University, Morgantown, WV 26506, USA
| | - Michelle D. Hand
- Department of Social Work, George Mason University, Fairfax, VA 22030, USA
| | - Christa Lilly
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV 26506, USA
| | - Keith J. Zullig
- Department of Social and Behavioral Health Sciences, West Virginia University, Morgantown, WV 26506, USA
| | - Danielle M. Davidov
- Department of Social and Behavioral Health Sciences, West Virginia University, Morgantown, WV 26506, USA
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22
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Jarnecke AM, Saraiya TC. Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review. Front Psychiatry 2024; 15:1380102. [PMID: 38957738 PMCID: PMC11217329 DOI: 10.3389/fpsyt.2024.1380102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV. Methods A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD). Results Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics. Discussion Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.
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Affiliation(s)
- Amber M. Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Tanya C. Saraiya
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, Piscataway, NJ, United States
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23
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Vandervoort M, Liosatos A, Aladhami H, Suschinsky KD, Lalumière ML. Victim Sexual Arousal During Nonconsensual Sex: A Scoping Review. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2305-2318. [PMID: 38724699 DOI: 10.1007/s10508-024-02852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/14/2024]
Abstract
Sexual arousal in male and female victims during nonconsensual sex is an understudied phenomenon with many potential psychological, clinical, and legal implications for survivors. The aim of this scoping review was to assess the literature to determine whether we could estimate the frequency and circumstances of physiological sexual arousal (e.g., erection, lubrication, ejaculation, orgasm) among victims during nonconsensual sex. Six reference database and hand searches led to the screening of 13,894 articles and other reports. Eight articles and one book published between 1977 and 2019 included relevant data from 136 male survivors and 250 female survivors. Results confirmed that physiological sexual arousal (only genital responses were mentioned) can occur in both male and female victims during nonconsensual sex. The frequency of these responses could not be determined because of the widely different methodologies used. In addition, it was not possible to determine the circumstances in which victim sexual arousal was more likely to occur although some were inferred. The results of the scoping review highlight that physiological sexual arousal during nonconsensual sex does occur for victims but has not been studied systematically. There is a clear need to properly assess the type, circumstances, consequences, and frequency of sexual arousal during nonconsensual sex in large and diverse populations of male and female survivors.
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Affiliation(s)
- Mariève Vandervoort
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | - Andrea Liosatos
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | - Haybet Aladhami
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | | | - Martin L Lalumière
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada.
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24
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Spaducci G, Oram S, Thiara R, Robson D, Peeren S, Gibbs A, Trevillion K. The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence. Int J Ment Health Nurs 2024; 33:546-559. [PMID: 38131433 DOI: 10.1111/inm.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence.
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Affiliation(s)
- Gilda Spaducci
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sian Oram
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Siofra Peeren
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Kylee Trevillion
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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Safiri S, Mousavi SE, Nejadghaderi SA, Noori M, Sullman MJM, Kolahi AA, Shekarriz-Foumani R. The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019. Acta Neuropsychiatr 2024; 36:139-152. [PMID: 37690795 DOI: 10.1017/neu.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI). METHODS Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals. RESULTS In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI. CONCLUSION The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.
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Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shekarriz-Foumani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Walsh K, Short N, Ji YY, An XM, Witkemper KD, Lechner M, Bell K, Black J, Buchanan J, Ho J, Reed G, Platt M, Riviello R, Martin SL, Liberzon I, Rauch SAM, Bollen K, McLean SA. Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault. J Psychiatr Res 2024; 174:54-61. [PMID: 38615545 PMCID: PMC11151166 DOI: 10.1016/j.jpsychires.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.
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Affiliation(s)
- Kate Walsh
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA; Department of Gender & Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Nicole Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Yin Yao Ji
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Xin Ming An
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Kristen D Witkemper
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Megan Lechner
- University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA
| | - Kathy Bell
- Tulsa Forensic Nursing, Tulsa Police Department, Tulsa, OK, USA
| | | | | | - Jeffrey Ho
- Hennepin Assault Response Team (HART), Hennepin Healthcare, Minneapolis, MN, USA
| | | | | | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences Texas A&M University, Bryan, TX, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Veterans Affairs Atlanta Healthcare System, Atlanta, GA, USA
| | - Kenneth Bollen
- Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
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27
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Rowland GE, Purcell JB, Lebois LM, Kaufman ML, Harnett NG. Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae. MENTAL HEALTH SCIENCE 2024; 2:e51. [PMID: 39006552 PMCID: PMC11244653 DOI: 10.1002/mhs2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 07/16/2024]
Abstract
Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.
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Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
| | - Juliann B Purcell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Lauren M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Milissa L Kaufman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Sall KE, Miller JC, Jansen E, Shonrock AT, Byrd R, Carels RA. Sexual Assault Among College Women: The Role of Survivor Acknowledgment, Rape Myth Acceptance, Weight Bias, and Body Appreciation. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2687-2707. [PMID: 38189155 DOI: 10.1177/08862605231223993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Approximately one in five college women experience a sexual assault (SA), though a meaningful percentage of survivors do not acknowledge or label their experience as such. Research indicates that acknowledgment status is often influenced by how closely SA incidents align with the "real rape" script and degree of survivor rape myth acceptance (RMA). However, studies evaluating acknowledgment paired with other attitudes and health outcomes among survivors is sparse. The current study examined the relation between acknowledgment status, RMA, weight-related constructs, and psychological well-being among three groups of college women (N = 584): non-survivors, unacknowledged survivors, and acknowledged survivors. Findings indicate that, among survivors, acknowledged compared to unacknowledged SA is significantly associated with diminished body appreciation, self-esteem, and increased internalized weight bias, though no differences in psychological distress were found.
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Affiliation(s)
| | | | | | | | - Rhonda Byrd
- East Carolina University, Greenville, NC, USA
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29
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Stewart SH, Khoury JMB, Watt MC, Collins P, DeGrace S, Romero-Sanchiz P. Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender? Front Psychol 2024; 15:1386264. [PMID: 38882518 PMCID: PMC11178137 DOI: 10.3389/fpsyg.2024.1386264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes. Methods N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving). Results Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men. Discussion Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women.
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Affiliation(s)
- Sherry H Stewart
- Mood, Anxiety, and Addiction Comorbidity Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Margo C Watt
- Department of Psychology, Saint Francis Xavier University, Antigonish, NS, Canada
| | - Pamela Collins
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sarah DeGrace
- Mood, Anxiety, and Addiction Comorbidity Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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30
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Behl R, Umunna I, Edem B, Mphamba D, Baiocchi M, Sarnquist C. Acceptability and feasibility of implementing the Enhanced Assess, Acknowledge, Act (EAAA) sexual assault prevention intervention on a U.S. university campus: Themes from qualitative interviews and written reflections. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38754093 DOI: 10.1080/07448481.2024.2351411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
Objectives: Assess the acceptability of and self-reported behavioral change from participation in a sexual assault prevention intervention on a U.S. university campus. Participants: Thirty-one undergraduate students who identified as women and opted-in to participating in both the intervention and research. Methods: In-depth interviews and written reflections were collected. Analysis was thematic with three investigators coding and reaching consensus. Results: The EAAA program was well-liked by most participants, with positive behavior changes reported. Five key themes reflecting strengths of EAAA were identified, including improved verbal communication, reduced sexual assault myths, empowerment, recognizing and responding to danger cues, and learning about healthy sexuality. Three key themes reflecting challenges were identified, including time commitment, use of outdated program materials, and a single gender focus. Conclusions: EAAA translates well, with a few adaptations, to a residential campus environment in the U.S. Research is needed to assess program effectiveness in reducing sexual assault.
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Affiliation(s)
- Rasika Behl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Isioma Umunna
- Stanford Prevention Research Center (SPRC), Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Blessing Edem
- Human Biology Program, Department of Humanities and Sciences, Stanford University, Stanford, CA, USA
| | - Dumisile Mphamba
- Human Biology Program, Department of Humanities and Sciences, Stanford University, Stanford, CA, USA
| | - Mike Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Clea Sarnquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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31
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Marcantonio TL, Haikalis M, Misquith C, Leone RM. Alcohol's Effects on the Bystander Decision-Making Model: A Systematic Literature Review. JOURNAL OF SEX RESEARCH 2024; 61:783-798. [PMID: 38010804 PMCID: PMC11105993 DOI: 10.1080/00224499.2023.2267547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
To decrease rates of sexual assault victimization, young people are encouraged to become involved when they see questionable sexual situations (i.e., be a prosocial bystander). Several factors can facilitate or inhibit intervention, including alcohol use. To inform bystander prevention programs that aim to address alcohol's impact on bystanders, the current study reviewed research focused on alcohol use and bystander decision making. In December 2022, the authors searched published studies from six major electronic databases. Empirical articles were deemed eligible if they examined alcohol and the bystander decision-making model within the context of sexual assault, were based in the United States or Canada, and not an intervention study; 32 studies were included in the final review. Across 32 studies published between 2015-2022, 12 assessed the proximal effects of alcohol on bystander constructs and the additional studies examined the distal effects of alcohol on bystander constructs. Alcohol use appeared to impede earlier steps of the bystander decision-making model; however, alcohol use was associated with impeding and facilitating bystander decision making at the latter half of the model. Overall, alcohol use appears to be negatively rather than positively associated with bystander constructs. Bystander intervention programs may want to move beyond the narrative of alcohol as a risk factor for sexual assault and discuss how alcohol impairs a bystanders' ability to recognize risk. More work is needed to ensure researchers assess alcohol consistently and with similar methods (number of drinks, subjective intoxication) to increase generalizability of findings to prevention programs.
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Affiliation(s)
| | | | - Chelsea Misquith
- Center for Alcohol Addiction Studies, Department of Behavioral and Social Sciences, Brown University
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Science, Georgia State University
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32
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Goodman-Williams R, Clark SL, Campbell R, Ullman SE. Longitudinal patterns of posttraumatic stress disorder symptoms among sexual assault survivors: A latent transition analysis. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2024; 16:586-595. [PMID: 36174154 PMCID: PMC10386878 DOI: 10.1037/tra0001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim of this study was to identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a community sample of sexual assault survivors whose assaults occurred varying lengths of time in the past and to explore patterns of transition between those latent classes over time. METHOD Latent class analysis was used to identify naturally occurring subgroups of PTSD symptoms in a sample of sexual assault survivors who completed two mailed surveys 1 year apart (N = 1,271). Latent transition analysis was then used to examine individuals' probabilities of transitioning into each latent class at Time 2 based on their latent class membership at Time 1. RESULTS A four-class model emerged as the best fitting model at both Time 1 and Time 2. Classes demonstrated overall severity and symptom cluster severity differences. Transition into a lower severity class was more common than transition into a higher severity class, though escalation was demonstrated by 6-20% of participants in each latent class. CONCLUSIONS The substantial heterogeneity in sexual assault survivors' PTSD symptoms highlights the variety of ways that posttraumatic stress may be experienced years after a sexual assault. Future research should explore factors that affect long-term symptoms, including cumulative lifetime trauma and social support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Sarah E Ullman
- Department of Criminology, Law, and Justice, University of Illinois at Chicago
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33
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Montenegro M, Marcantonio T, Wiseblatt A. Prevalence and Variations of Sexual Violence Victimization Among US-Based Latino Adults and Adolescents: A Systematic Literature Review. JOURNAL OF SEX RESEARCH 2024; 61:811-824. [PMID: 38088800 PMCID: PMC11105995 DOI: 10.1080/00224499.2023.2291090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Sexual violence victimization (SVV) is a significant public health concern. SVV research often focuses on college-attending White women's experiences, resulting in a knowledge gap regarding the experiences of ethnic minority groups, including the Latino community - the largest minority group in the US. To develop more culturally sensitive SV prevention efforts, the current study reviewed research focused on the prevalence rates of SVV among Latino people. The authors searched for published articles in PubMed, PsycINFO, and the reference sections of relevant articles published from 2011 to 2022. Articles were deemed eligible if they presented SVV prevalence rates for Latino participants; 39 articles were included in the review. The most frequently assessed aspect of SVV among Latino people was whether they had ever been victimized. The average prevalence rate across articles was 16.0%. Additionally, researchers examined the prevalence rates of unwanted touching, sexual coercion, and completed rape among Latino individuals. Few articles examined SVV prevalence rates among sexual and gender minority Latinos; those that did found higher SVV rates among those groups. SVV is a prevalent issue within the Latino community, with women and sexual minorities facing an even greater risk. Moving forward, studying the contextual factors of SVV among Latino people and developing culturally sensitive interventions tailored to this population are needed.
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Affiliation(s)
- María Montenegro
- Department of Spanish and Portuguese, Indiana University, Bloomington, IN, USA
| | - Tiffany Marcantonio
- Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Aria Wiseblatt
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
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Miles LW, Valentine JL, Mabey LJ, Hopkins ES, Stodtmeister PJ, Rockwood RB, Moxley ANH. A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims. J Am Psychiatr Nurses Assoc 2024; 30:480-502. [PMID: 38148646 PMCID: PMC11138126 DOI: 10.1177/10783903231216138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem. AIMS Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes. METHODS Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations. RESULTS Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored. CONCLUSIONS Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.
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Affiliation(s)
- Leslie W. Miles
- Leslie W. Miles, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Julie L. Valentine
- Julie L. Valentine, PhD, RN, SANE-A, FAAN, University of Utah, Salt Lake City, UT, USA
| | - Linda J. Mabey
- Linda J. Mabey, DNP, PMHCNS-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | | | - Paige J. Stodtmeister
- Paige J. Stodtmeister, DNP, PMHNP-BC Brigham Young University College of Nursing, Provo, UT, USA
| | - Reilly B. Rockwood
- Reilly B. Rockwood, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Alyssa N. H. Moxley
- Alyssa N. H. Moxley, DNP, CNM, WHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
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35
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Harris C, Ullman SE. Social Reactions to Disclosures of Multiple-Perpetrator Sexual Assault: Do Number of Offenders Matter? JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241245378. [PMID: 38605582 DOI: 10.1177/08862605241245378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Sexual assault (SA) victimization is a prevalent issue both in the U.S. and globally. Although SA victimization is usually perpetrated by a single-perpetrator, multiple-perpetrator sexual assaults (MPSAs) also occur. Unfortunately, there is less literature concerning MPSAs, including the well-being of survivors' post-assault. One factor that has been shown to be important in the well-being of SA survivors' post-assault are the social reactions survivors receive from others following disclosure. The current study sought to compare social reactions received by MPSA survivors to the social reactions received by single-perpetrator sexual assault (SPSA) survivors in a community sample of adult female SA survivors (N = 1,863). We examined "turning against" (TA) reactions, a type of negative social reaction in which the supporter expresses more overtly distressing reactions that focus blame on the victim. We also examined unsupportive acknowledgment reactions (UA) the second type of negative reaction in which survivors receive acknowledgment that the assault occurred but are not supported. Additionally, we examined differences in positive reactions that survivors received from their support systems. One-way Analysis of Variance showed statistically significant differences in social reactions to disclosure according to number of offenders in the SA, with MPSA survivors receiving more TA and UA negative reactions than SPSA survivors. There were no differences in positive reactions by number of offenders. Multiple regression analyses also revealed that several demographics, assault characteristics, and post-assault factors (total Post-Traumatic Stress Disorder (PTSD) symptoms, coping, attributions of self-blame) were related to the social reactions received by MPSA survivors post-assault. Implications and recommendations for support providers are discussed.
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Fleming CE, Giff ST, Forkus SR, Flanagan JC. Psychosocial Sequalae of Sexual Assault in a Sample of Partnered Adults Experiencing Alcohol Use Disorder and Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241243335. [PMID: 38591145 DOI: 10.1177/08862605241243335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Research has shown that experiencing a sexual assault results in significant and lasting effects in many psychosocial domains. However, most studies on the impact of sexual assault examine university samples or the immediate aftermath of the assault, not taking into account the longer-term complexities and contexts of life for many victims. The current study seeks to evaluate the role of lifetime sexual assault history on several psychosocial outcomes in adults who are in intimate relationships that have included both intimate partner violence (IPV) and alcohol use disorder. The study included 100 adult romantic couples who were part of a larger project addressing violence and alcohol use. A majority of participants were Caucasian (74.3%) and female (53%). Participants reported on lifetime sexual assault history, depression, perceived stress, maladaptive cognitive emotion regulation, and perceived intimate relationship functioning. Multilevel analyses controlled for couple interdependence as well as current levels of alcohol use and IPV. Results indicated that the presence/absence of sexual assault was only related to perceived life stress (p = .016), while the total number of lifetime assault experiences was related to depression symptoms (p < .001), perceived life stress (p = .052), maladaptive cognitive emotion regulation (p = .048), and dyadic adjustment (p = .003). These findings underscore the importance of investigating sexual assault outcomes in complex populations, as well as the need for more thorough and regular assessment of sexual assault history. Focusing on empowerment and recovery for sexual assault victims of any age is an important tool to prevent the detrimental outcomes that particularly accompany multiple victimizations.
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Affiliation(s)
| | - Sarah T Giff
- Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Shannon R Forkus
- Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
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37
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Widanaralalage BK, Murphy AD, Loughlin C. Support or justice: a triangulated multi-focal view of sexual assault victim support in a UK sexual assault referral centre (SARC). Int J Ment Health Syst 2024; 18:15. [PMID: 38589935 PMCID: PMC11000339 DOI: 10.1186/s13033-024-00631-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite vast levels of underreporting, sexual assault remains an issue at scale in the UK, necessitating the presence of statutory and voluntary organisations in the support of victims. Understanding the experiences of all parties within this context is important for the resilience of support that can be provided at a systems level. This study examines the barriers faced by service providers when working with victims of sexual assault. METHODS Semi-structured interviews took place with eleven professionals working in or in conjunction with a Sexual Assault Referral Centre (SARC) in Southeast England, which were subsequently analysed using inductive thematic analysis. RESULTS Five themes were identified exploring SARC staff's experiences with (i) communication breakdowns with external services; (ii) delivering support in an underfunded system; (iii) tailoring support to survivors' needs; (iv) the Criminal Justice System fails victims of sexual assault; and (v) reckoning with burnouts and vicarious trauma. CONCLUSION Significant gaps in UK service provision for sexual assault victims are identified, particularly within the criminal justice system, where legal and investigative processes are cited as retraumatizing. The results emphasize the urgency of enhanced training, coordination, resources, and trauma-informed practices across organizations to better serve victims and support overwhelmed providers. Prioritizing systemic improvements is crucial to address the complex needs of both victims and service professionals.
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Affiliation(s)
| | | | - Casey Loughlin
- King's College London, London, UK
- University of Westminster, London, UK
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Bender AE, Adhia A, Ross R, Gallagher A, Mustafa A, Kroshus E, Ellyson AM. Developing and implementing survivor-centred approaches for college student-athletes: perspectives from athletic department, Title IX, and campus advocacy personnel. Eur J Psychotraumatol 2024; 15:2334587. [PMID: 38590136 PMCID: PMC11005865 DOI: 10.1080/20008066.2024.2334587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024] Open
Abstract
ABSTRACTBackground: Sexual violence (SV) is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Yet, prior research shows that many university practices can be more harmful than helpful to SV survivors and necessitates a reimagination of how institutions support SV survivors. Survivor-centred approaches may be one way to effectively address SV for students, including student-athletes, across college campuses.Objective: This qualitative study explored campus personnel experiences with and perceptions of survivor-centred SV prevention and intervention policies and practices on college campuses and examined how these approaches serve SV survivors, including college student-athletes.Methods: As part of a larger study on campus SV and student-athletes across four institutions, semi-structured interviews with 22 representatives from athletic departments, campus advocacy, and Title IX were conducted. Guided by phenomenology, a thematic analysis approach was used to identify key patterns in survivor-centred SV prevention and intervention policies and practices. Participant demographic data were analysed descriptively.Results: Most participants identified as white (72.2%), heterosexual (63.6%), women (68.2%), and were an average of 41.8 years old (SD = 10.2). The majority were in positions associated with athletic departments (63.6%), and they had been in their role for an average of 5.6 years (SD = 6.6). Through thematic analysis, three main themes were identified: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Conclusions: The findings from this study highlight clear policy and practice recommendations for survivor-centred SV prevention and intervention on college campuses, such as accessible, applicable SV training and the implementation of survivor-centred approaches. Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions and within athletic departments.
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Affiliation(s)
- Anna E. Bender
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Avanti Adhia
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Rachel Ross
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Amy Gallagher
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ayah Mustafa
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emily Kroshus
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Alice M. Ellyson
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
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Pedersen ER, Davis JP, Canning L, Tucker JS, Prindle J, Seelam R, Dunbar MS, Siconolfi D, D'Amico EJ. Longitudinal associations among experiences of sexual assault, posttraumatic stress disorder symptoms, and heavy drinking in young adults. J Trauma Stress 2024; 37:243-256. [PMID: 38109146 PMCID: PMC10984762 DOI: 10.1002/jts.23000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
Prior research with young adults has demonstrated clear associations between experiences of sexual assault, symptoms of posttraumatic stress disorder (PTSD), and alcohol use, but most studies have been cross-sectional or have not considered multiple theoretical pathways to understand these associations. Using six waves of data from a longitudinal cohort sample of 1,719 young adults, we examined associations among experiences of past-year sexual assault (i.e., rape, unwanted sexual touching, and physical intimidation in a sexual way), PTSD symptoms, and the frequency of binge drinking over time, allowing for the exploration of symptom-induced, interpersonal risk, and substance-induced pathways for male and female participants. For both male, βs = 2.84 to 6.55, and female participants, βs = 2.96 to 10.1, higher prior levels of PTSD symptoms were associated with larger increases in binge drinking over time. For female participants, higher prior levels of sexual assault were associated with larger increases in PTSD symptoms over time, βs = 3.48 to 4.25, whereas for male participants, higher prior levels of past-year binge drinking were associated with decreases in PTSD symptoms over time, βs = -2.75 to -0.53. Continued efforts are needed to prevent sexual assault among young adults and address PTSD symptoms among those who experience sexual assault. Interventions that target binge drinking are also needed for individuals who experience PTSD symptoms, especially young adults, to address potentially hazardous drinking before problems escalate and become chronic.
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Affiliation(s)
- Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Liv Canning
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | | | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Kink A, Towns JM, Fairley CK, Phillips TR, Bradshaw CS, Chow EPF. Management of acute sexual assault presenting to a large Australian sexual health clinic in 2012-2021: a retrospective clinical audit. Sex Health 2024; 21:SH23175. [PMID: 38603545 DOI: 10.1071/sh23175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
Background The incidence of sexual assault continues to rise in Australia. This study aimed to describe the nature of assault, HIV/STI positivity, and its management at a sexual health clinic. Methods We performed a chart review of 516 sexual assault cases presenting to Melbourne Sexual Health Centre between 2012 and 2021, collecting data on victim demographics, details of assault, HIV/STI testing and positivity, police involvement, and offer of counselling. Results We included 516 cases: 124 males (24.0%); 384 females (74.4%); and eight transgender (1.6%) victims. The proportion of assault cases presenting to Melbourne Sexual Health Centre increased from 0.1% (37/37,070) in 2012 to 0.2% (56/36,514) in 2021 (P trend =0.006). HIV post-exposure prophylaxis was prescribed for 64.5% (80/124) of males and 12.5% (48/384) of females. Among victims, 69.4% (358/516) were tested for HIV and no one tested positive, while 71.9% (371/516) were tested for syphilis, with 1.6% (6/371) positive. Gonorrhoea and chlamydia were tested at the oropharynx (44.8% [231/516] vs 28.7% [148/516]), genitals (83.7% [432/516] vs 92.4% [477/516]) and anorectum (35.3% [182/516] vs 35.3% [182/516]). Positivity for gonorrhoea and chlamydia were: 2.6% (6/231) vs 2.0% (3/148) at oropharynx, 1.4% (6/432) vs 2.9% (14/477) at genitals, and 5.5% (10/182) vs 7.1% (13/182) at anorectum. According to clinical records, 25.2% (130/516) of victims sought police involvement, and 71.7% (370/516) were offered counselling. Conclusions Sexual assault was an uncommon presentation at Melbourne Sexual Health Centre, with diverse circumstances surrounding assault; however, clinical documentation varied, indicating a need for a standard primary care protocol for clients presenting with acute sexual assault.
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Affiliation(s)
- Aleah Kink
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia
| | - Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and School of Translational Medicine, Monash University, Melbourne, Vic., Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and School of Translational Medicine, Monash University, Melbourne, Vic., Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and School of Translational Medicine, Monash University, Melbourne, Vic., Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and School of Translational Medicine, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and School of Translational Medicine, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
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41
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Feigelman W, Cerel J, Gorman BS, Xiao Y. Sexual Assault Victimization in Premature Female Mortalities: Evidence from the National Longitudinal Study of Adolescent to Adult Health. J Psychoactive Drugs 2024; 56:288-298. [PMID: 37061922 DOI: 10.1080/02791072.2023.2202346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/02/2023] [Indexed: 04/17/2023]
Abstract
Previous research has documented many behavioral problems associated with being a female victim of sexual assault, but little attention has been devoted to whether this experience might be related to premature mortalities. We investigated this utilizing the National Longitudinal Study of Adolescent to Adult Health survey, collected from over 10,000 adolescent females in 1995, whose premature deaths (n = 65) were noted in 2007 in National Death Index records. Significant associations were found between females with a substance misuse history and their premature deaths, but not with being a sexual assault victim. The subset of respondents (n = 208) evincing both these characteristics showed significantly higher risks of dying prematurely, as did those females with early histories of drug misuse alone. Yet, adolescent females with histories of drug misuse who also attempted suicide (n = 214) did not show similar elevated risks of dying prematurely compared to others without these experiences. This exploratory evidence points to an affinity between both being a female sexual assault victim and having an early history of misusing drugs, putting such people at heightened risks for dying prematurely, suggesting the potential benefits of counseling and supportive services for those so affected.
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Affiliation(s)
| | - Julie Cerel
- School of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | | | - Yunyu Xiao
- Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
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42
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Otterman G, Nurmatov UB, Akhlaq A, Korhonen L, Kemp AM, Naughton A, Chalumeau M, Jud A, Vollmer Sandholm MJ, Mora-Theuer E, Moultrie S, Lamela D, Tagiyeva-Milne N, Nelson J, Greenbaum J. Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries. THE LANCET REGIONAL HEALTH. EUROPE 2024; 39:100868. [PMID: 38420107 PMCID: PMC10899013 DOI: 10.1016/j.lanepe.2024.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
Background The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting. Methods We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747. Findings Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation. Interpretation A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors. Funding Funding was provided by the International Centre for Missing and Exploited Children.
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Affiliation(s)
- Gabriel Otterman
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ulugbek B. Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ather Akhlaq
- Institute of Business Management, Karachi, Pakistan
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alison M. Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Aideen Naughton
- National Safeguarding Service, Public Health Wales, Cardiff, UK
| | - Martin Chalumeau
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants malades Hospital, France
| | - Andreas Jud
- Clinic for Child and Adolescent Psychiatry, Ulm University Clinics, Ulm, Germany
| | | | - Eva Mora-Theuer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sarah Moultrie
- Pediatric Trauma Services, Benioff Children's Hospitals- Oakland, Oakland, CA, USA
| | - Diogo Lamela
- Digital Human-Environment Interaction Lab (HEI-Lab), Lusófona University, Porto, Portugal
| | - Nara Tagiyeva-Milne
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanne Nelson
- Child and Adolescent Sexual Assault Treatment Service, Barnahus West, Saolta University Health Care Group, Galway, Ireland
| | - Jordan Greenbaum
- International Centre for Missing and Exploited Children, Alexandria, VA, USA
| | - the COST Action 19106 Research Team
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Institute of Business Management, Karachi, Pakistan
- National Safeguarding Service, Public Health Wales, Cardiff, UK
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants malades Hospital, France
- Clinic for Child and Adolescent Psychiatry, Ulm University Clinics, Ulm, Germany
- Department of Forensic Sciences, Oslo University, Oslo, Norway
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Pediatric Trauma Services, Benioff Children's Hospitals- Oakland, Oakland, CA, USA
- Digital Human-Environment Interaction Lab (HEI-Lab), Lusófona University, Porto, Portugal
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, UK
- Child and Adolescent Sexual Assault Treatment Service, Barnahus West, Saolta University Health Care Group, Galway, Ireland
- International Centre for Missing and Exploited Children, Alexandria, VA, USA
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Bjørndal LD, Ebrahimi OV, Røysamb E, Karstoft KI, Czajkowski NO, Nes RB. Stressful life events exhibit complex patterns of associations with depressive symptoms in two population-based samples using network analysis. J Affect Disord 2024; 349:569-576. [PMID: 38199410 DOI: 10.1016/j.jad.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Stressful life events (SLEs) constitute key risk factors for depression. However, previous studies examining associations between SLEs and depression have been limited by focusing on single events, combining events into broad categories, and/or ignoring interrelationships between events in statistical analyses. Network analysis comprises a set of statistical methods well-suited for assessing relationships between multiple variables and can help surpass several limitations of previous studies. METHODS We applied network analysis using mixed graphical models combining two large-scale population-based samples and >34,600 randomly sampled adults to investigate the associations between SLEs and current depressive symptoms in the general population. RESULTS Numerous SLEs were uniquely associated with specific symptoms. Strong pairwise links were observed between SLEs during the past year and individual symptoms, e.g., between having experienced illness or injury and sleeping problems, having been degraded or humiliated and feeling blue, and between financial problems and hopelessness and being worried and anxious. Several SLEs, such as financial problems, sexual abuse, and having been degraded or humiliated, were associated with symptoms across more than one timepoint. More recent SLEs were generally more strongly associated with depressive symptoms. Several life events were strongly interrelated, such as multiple forms of abuse, and financial problems, unemployment, divorce, and serious illness or injury. LIMITATIONS Limitations include a retrospective SLE measure, cross-sectional data, a brief self-report measure of depressive symptoms, and possible attrition bias in the sample. CONCLUSIONS Our findings may have implications for public health efforts seeking to improve population mental health.
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Affiliation(s)
- Ludvig Daae Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.
| | - Omid V Ebrahimi
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Department of Psychology, University of Oslo, Oslo, Norway
| | - Espen Røysamb
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Nikolai Olavi Czajkowski
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ragnhild Bang Nes
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Philosophy, Classics, and History of Arts and Ideas, University of Oslo, Oslo, Norway
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Mbiydzenyuy NE, Joanna Hemmings SM, Shabangu TW, Qulu-Appiah L. Exploring the influence of stress on aggressive behavior and sexual function: Role of neuromodulator pathways and epigenetics. Heliyon 2024; 10:e27501. [PMID: 38486749 PMCID: PMC10937706 DOI: 10.1016/j.heliyon.2024.e27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Stress is a complex and multifaceted phenomenon that can significantly influence both aggressive behavior and sexual function. This review explores the intricate relationship between stress, neuromodulator pathways, and epigenetics, shedding light on the various mechanisms that underlie these connections. While the role of stress in both aggression and sexual behavior is well-documented, the mechanisms through which it exerts its effects are multifarious and not yet fully understood. The review begins by delving into the potential influence of stress on the Hypothalamic-Pituitary-Adrenal (HPA) axis, glucocorticoids, and the neuromodulators involved in the stress response. The intricate interplay between these systems, which encompasses the regulation of stress hormones, is central to understanding how stress may contribute to aggressive behavior and sexual function. Several neuromodulator pathways are implicated in both stress and behavior regulation. We explore the roles of norepinephrine, serotonin, oxytocin, and androgens in mediating the effects of stress on aggression and sexual function. It is important to distinguish between general sexual behavior, sexual motivation, and the distinct category of "sexual aggression" as separate constructs, each necessitating specific examination. Additionally, epigenetic mechanisms emerge as crucial factors that link stress to changes in gene expression patterns and, subsequently, to behavior. We then discuss how epigenetic modifications can occur in response to stress exposure, altering the regulation of genes associated with stress, aggression, and sexual function. While numerous studies support the association between epigenetic changes and stress-induced behavior, more research is necessary to establish definitive links. Throughout this exploration, it becomes increasingly clear that the relationship between stress, neuromodulator pathways, and epigenetics is intricate and multifaceted. The review emphasizes the need for further research, particularly in the context of human studies, to provide clinical significance and to validate the existing findings from animal models. By better understanding how stress influences aggressive behavior and sexual function through neuromodulator pathways and epigenetic modifications, this research aims to contribute to the development of innovative protocols of precision medicine and more effective strategies for managing the consequences of stress on human behavior. This may also pave way for further research into risk factors and underlying mechanisms that may associate stress with sexual aggression which finds application not only in neuroscience, but also law, ethics, and the humanities in general.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Basic Science Department, School of Medicine, Copperbelt University, P.O Box 71191, Ndola, Zambia
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Sian Megan Joanna Hemmings
- Division of Molecular Biology & Human Genetics, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Thando W. Shabangu
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
| | - Lihle Qulu-Appiah
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Private Bag X1, Matieland, 7602, Cape Town South Africa
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Lee A, Choi H. Effects of Social Acknowledgment and Interpersonal Shame on Complex Posttraumatic Stress Disorder Symptoms of Sexual Violence Survivors in South Korea. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241234353. [PMID: 38440809 DOI: 10.1177/08862605241234353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Sexual violence (SV) survivors face negative social reactions, which can affect their recovery. Based on the socio-interpersonal model of trauma, understanding how societal circumstances impact SV survivors' mental health is important. This study examined conditional indirect effects of interpersonal shame and social acknowledgment on the relationship between perceived SV event severity and complex post-traumatic stress disorder (CPTSD) symptoms. Cross-sectional data from 157 community-based adults who had previously experienced SV were collected from an online panel. Exploratory factor analysis of the Social Acknowledgment Questionnaire was conducted, followed by conditional indirect analyses using Models 1, 4, and 7 of PROCESS macro. First, results showed that a two-factor model of social acknowledgment consisting of "social disapproval" and "social recognition" was more suitable for this study than a three-factor model predominantly used by Western societies. Second, interpersonal shame partially mediated the relationship between perceived SV event severity and CPTSD symptoms. Third, the conditional indirect effect of social disapproval on the mediating effect of interpersonal shame was significant when the social disapproval level was high. This indicates that the indirect effect of interpersonal shame on CPTSD increases when the social disapproval level is high. This study supported the socio-interpersonal perspective of trauma and suggested that increasing social acknowledgment beyond personal-level intervention would be a critical step for recovery of SV survivors to decrease their interpersonal shame and CPTSD.
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Affiliation(s)
- Ahyeon Lee
- Chungbuk National University, Cheongju, South Korea
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46
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Kirwan M, Leone RM, Davis KC, Orchowski LM, Gilmore AK. Emotion Regulation Difficulties Moderate the Association Between Typical Drinking and Sexual Assault Victimization Among Sexual and Gender Minority University Students. Violence Against Women 2024; 30:768-790. [PMID: 36794462 PMCID: PMC10427736 DOI: 10.1177/10778012231155178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Sexual and gender minority (SGM) students report higher alcohol consumption, emotion regulation difficulties, and sexual assault victimization severity than cisgender, heterosexual individuals. A sample of 754 undergraduate students completed an online survey assessing alcohol use, emotion regulation, and sexual victimization. Regression analyses indicated that, among SGM students with higher emotion regulation difficulties, typical weekly drinking was positively associated with sexual assault victimization severity, but among cisgender, heterosexual students and SGM students with lower emotion regulation difficulties, there was no association between drinking and victimization severity. Thus, SGM students benefit from interventions targeting alcohol use and emotion regulation difficulties.
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Affiliation(s)
- Mitchell Kirwan
- Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Ruschelle M Leone
- Mark Chaffin Center for Healthy Development, Georgia State University, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, USA
| | | | - Amanda K Gilmore
- Mark Chaffin Center for Healthy Development, Georgia State University, USA
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Brøcker CM, Hansen OI, Rohde MC. The impact of COVID-19 restrictions on sexual assault in Western Denmark. Forensic Sci Med Pathol 2024; 20:166-173. [PMID: 37505320 DOI: 10.1007/s12024-023-00682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
This study sets out to investigate whether the 15-month nationwide COVID-19 lockdown in Denmark had an impact on the victim demographics, location of sexual assaults, and relationship between victim and perpetrator in the Western part of Denmark compared to the 15 months prior to the lockdown initiatives. This study is a retrospective study including a total of 596 cases. Cases were identified in the database of the Department of Forensic Medicine Aarhus, including cases labeled "rape," "attempted rape," and "later reported." 315 cases were found between March 11th 2020 and June 10th 2021 (lockdown) and 281 cases were found between December 11th 2018 and March 10th 2020(pre-lockdown). Fewer victims were in the age group 15-24 during lockdown (58.4%) than pre-lockdown (71.7%). Fewer stranger rapes occurred during lockdown (11%) than pre-lockdown (19.7%). During lockdown, more sexual assault occurred at a private site (80.1%) than pre-lockdown (60%); correspondingly, fewer public sexual assaults occurred during lockdown (10.3%) than pre-lockdown (26%). No statistically significant difference was observed regarding police reporting of the assault or alcohol intake in the victim prior to assault. We found an overall change in demographics regarding sexual assaults during the lockdown period indicating the restrictions during the lockdown could have affected the patterns of sexual assault in Denmark.
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Affiliation(s)
- Cecilie Marie Brøcker
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Ole Ingemann Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Marianne Cathrine Rohde
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Kern SG, Peterson ZD, Jozkowski KN, Gerstein ED. Psychological Symptoms Associated with Sexual Victimization Experiences: Differences as a Function of the Type and Number of Sexual Acts and Aggressive Tactics. JOURNAL OF SEX RESEARCH 2024; 61:342-358. [PMID: 36239599 DOI: 10.1080/00224499.2022.2130855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Different types of sexual victimization are associated with different outcomes; for example, on average, physically forced sex is associated with worse psychological outcomes than verbally coerced sex. This study evaluated outcomes associated with sexual victimization as a function of sexual act and aggressive tactic, expanding upon the acts and tactics examined in prior studies. Participants who had experienced sexual victimization (N = 402) completed a survey about their most upsetting victimization experience, identifying the sexual act(s) and aggressive tactic(s) that occurred. They completed measures of PTSD, depression, anger, and trauma-related cognitions. Relationships between symptom severity and most upsetting act and tactic, as well as the number of acts and tactics, were analyzed. Related to the sexual act, non-penetrative sexual acts were associated with the lowest symptom severity on several measures. Related to the aggressive tactic, sex obtained through anger/criticism and physical force were associated with the greatest symptom severity on some measures. A larger number of tactics were associated with more severe symptoms on all measures, whereas number of acts only explained unique variance in PTSD symptom severity. The pattern of severity for outcomes differed from previous conceptualizations, suggesting that current hierarchies of victimization severity may require revision.
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Affiliation(s)
- Sara G Kern
- Department of Psychological Sciences, University of Missouri-St. Louis
| | - Zoë D Peterson
- Kinsey Institute and Department of Counseling and Educational Psychology, Indiana University
| | - Kristen N Jozkowski
- Kinsey Institute and Department of Applied Health Sciences, Indiana University
| | - Emily D Gerstein
- Department of Psychological Sciences, University of Missouri-St. Louis
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Marcantonio TL, Jozkowski KN, Ham LS, Parrott D. The Association of Acute Intoxication and Threats to Masculinity on Laboratory-Based Sexual Aggression. J Stud Alcohol Drugs 2024; 85:175-182. [PMID: 38095194 PMCID: PMC10941822 DOI: 10.15288/jsad.23-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/11/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVE Men's alcohol intoxication and perceptions of their masculinity as precarious (i.e., viewing masculinity as easily threatened) are independently related to men's perpetration of sexual aggression. Yet, the interactive effects of these constructs on sexual aggression are unclear. The goal of this study was to assess if precarious masculinity-measured as a static trait-and acute alcohol intoxication-measured in a laboratory setting-were positively associated with men's perpetration of laboratory-based sexual aggression after their masculinity is threatened. METHOD Cisgender heterosexual men (n = 120, ages 21-30 years) completed a self-report measure of precarious masculinity, were randomly assigned to consume an alcoholic or nonalcoholic beverage, and engaged in the Sexual Imposition Paradigm, which assessed laboratory-based sexual aggression perpetration toward a female confederate. Immediately before the Sexual Imposition Paradigm, all participants' masculinity was threatened via feedback from an ostensible personality test that indicated they are less masculine than other men. RESULTS Self-reported precarious masculinity and the Precarious Masculinity × Beverage Condition interaction were not associated with laboratory-based sexual aggression. However, intoxicated men showed higher levels of laboratory-based sexual aggression than sober men. CONCLUSIONS Acute alcohol intoxication facilitated men's sexually aggressive responding toward women when their masculinity was threatened. Consistent with pertinent theory and research, this effect suggests that acute intoxication facilitates men's focus on salient cues (i.e., threatened masculinity), which then may proximally motivate sexual aggression. Sexual aggression prevention programs should continue to address alcohol in their programming.
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Affiliation(s)
- Tiffany L. Marcantonio
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Health Sciences, University of Alabama, Tuscaloosa, Alabama
| | - Kristen N. Jozkowski
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
| | - Lindsay S. Ham
- Department of Psychological Sciences, University of Arkansas, Fayetteville, Arkansas
| | - Dominic Parrott
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia
- Psychology Department, Georgia State University, Atlanta, Georgia
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Adhia A, Pugh D, Lucas R, Rogers M, Kelley J, Bekemeier B. Improving School Environments for Preventing Sexual Violence Among LGBTQ+ Youth. THE JOURNAL OF SCHOOL HEALTH 2024; 94:243-250. [PMID: 37859302 DOI: 10.1111/josh.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sexual violence (SV) is a serious public health concern, and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) youth report higher rates than their heterosexual and cisgender peers. This qualitative study aimed to understand LGBTQ+ students' perspectives on how middle and high school environments can better prevent and address SV. METHODS In partnership with a school-based LGBTQ+ support group in Washington State, we recruited 31 LGTBQ+ students ages 13-18 for virtual interviews (n = 24) and for providing text-based answers to interview questions (n = 7). We used inductive thematic analysis to analyze data and identify themes. RESULTS To prevent and respond to SV, students highlighted schools having: (1) access to gender-neutral spaces; (2) LGBTQ+ competency training for staff; (3) enforcement of school policies (eg, SV, anti-bullying) and accountability; (4) LGBTQ+-competent mental health support; and (5) comprehensive sexual health education that addresses LGBTQ+ relationships and SV. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Students expressed the need for changes in school physical and social environments to address SV among LGBTQ+ youth. CONCLUSIONS Incorporating youth perspectives, particularly LGBTQ+ youth at high risk of SV, can help schools implement strategies that are supported by youth and thus potentially more sustainable and effective.
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Affiliation(s)
- Avanti Adhia
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| | - Dylan Pugh
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
| | - Ruby Lucas
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | - Megan Rogers
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
| | - Jessi Kelley
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
| | - Betty Bekemeier
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA
- Northwest Center for Public Health Practice, University of Washington, Seattle, WA
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