The emotional impact of sexual violence research on participants

Interviewing Male Survivors of Sexual Violence and Abuse: Ethical and Methodological Considerations

Existing research explores ethical and methodological considerations associated with interviewing men, including male survivors of domestic abuse, and interviewing female survivors of domestic and sexual abuse. However, there is no comparable body of research that specifically considers interviewing male survivors of sexual violence and abuse. Reflecting upon our experiences of interviewing 32 male survivors of female-perpetrated sexual violence, we critically discuss four key ethical and methodological issues that arose; the challenges around recruiting male survivor participants; the interview process; the impacts of gender dynamics between interviewers and participants; and the importance of research to participants. Based on our reflections we make a number of recommendations for scholars who are conducting future research with male survivors of sexual violence and abuse.

Engagement of Sexual Violence Survivors in Research: Trauma-Informed Research in the THRIVE Study

Given the potential for retraumatization among survivors of sexual violence engaged in research, we aimed to provide pertinent knowledge and exemplification of the integration of trauma-informed practice to research with survivors. Grounded in trauma-informed care, we discuss the need for trauma-informed research, drawing upon experiences and data from a longitudinal case-control study on sexual violence. Through trauma-informed research settings, we can improve research experiences for survivors of sexual violence, as demonstrated by positive experiences of participants in The THRIVE Study. By meeting the needs of survivors, researchers can increase participation while maximizing the research quality and advancement of research.

The Impact of Participation in Research About Abuse and Intimate Partner Violence: An Investigation of Harms, Benefits, and Regrets in Young Adolescents in the Western Cape of South Africa

There is very little evidence whether recalling and answering questions about abuse or interpersonal violence has a positive or negative impact on participants of such research. This is an important ethical dilemma to ensure an appropriate risk-benefit ratio in research with young people is maintained. We assessed reported harms, benefits, and regrets of young adolescents who participated in a sensitive research project, and compared the harms and benefits in those who had and had not been victims and/or perpetrators of abuse or intimate partner violence. Participants were 3,264 adolescents aged 12 to 15 years in 41 public schools in the Western Cape, South Africa, who completed a survey about intimate partner violence, verbal, physical, and sexual abuse, as part of an HIV prevention cluster randomized controlled trial. The majority of participants reported research participation as beneficial (70.3%), while 27.7% reported harms and 14% regrets. Victims of abuse were more likely than non-victims to report benefits (71.9% vs. 67.1%; p = .02) and harms (31% vs. 20.9%; p < .01) and were less likely to report regret (13.1% vs. 16.7%; p = .02). Perpetrators of abuse were less likely than non-perpetrators to report benefits (67.4% vs. 72.8%; p = .01) and more likely to report harms (36.4% vs. 26.1%; p < .01) and regrets (17.4% vs. 13.3%; p = .01). Our findings suggested that research participation was more likely to have a positive rather than a negative emotional impact on young adolescents and that relatively few regretted participating. Victims and perpetrators of abuse were more likely to report benefits than harms, supporting the ethical appropriateness of ongoing research on abuse and violence. We recommend that further research is required to clarify and standardize terminology and instruments to quantify these kinds of evaluations, including measurement of the severity and intensity of reported benefits, harms and regrets, and the longer term impact of participation in sensitive research.

A Trauma-Informed Approach to Sexual Violence Research Ethics and Open Science

The practice of ethics in social science research is a reflexive process of self-review to define a profession's collective responsibility in the face of changing norms and expectations. In recent years, we have seen transformative changes in how society thinks about supporting sexual assault survivors, and how the scientific community thinks about our obligations to society. Decades of research on trauma and its impact has raised awareness about the needs of victimized individuals, giving rise to the trauma-informed practice movement, which emphasizes that service providers must center survivors' well-being in all interactions, decisions, and program practices. The field of sexual assault research helped give rise to this movement and provides empirical support for its guiding tenets, and in this article, we explore how to bring these ideas full circle to begin articulating trauma-informed principles for research. A trauma-informed perspective on research challenges scientists to go beyond the requirements of the Belmont Report (1979) and institutional review boards' (IRB) regulations to develop research procedures that fully support survivors' choice, control, and empowerment. Such reflection on participants' rights is particularly important given the open science movement sweeping academia, which calls on scientists to share their data publicly to promote transparency, replication, and new discoveries. Disseminating data could pose significant safety, privacy, and confidentiality risks for victims of sexual assault, so we need to evaluate what open science means within a trauma-informed framework. In this article, we examine three key stages of the research process-participant recruitment, data collection, and dissemination-and consider how trauma-informed principles could help, but also could complicate, research practices. We explore these tensions and offer potential solutions so that research on sexual trauma embodies trauma-informed practice.

How women experience and cope with daily hassles after sexual abuse - a retrospective qualitative study

The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of 'protecting armor in daily life' emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three-phase process: (1) avoiding and escaping-coping after experiencing sexual abuse; (2) accepting and disclosing-starting a process of recovery; and (3) reconciling and repossessing-living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowledge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life.

Japanese Students Do See the Value of Asking About Child Abuse and Trauma in the Research Setting

Despite evidence regarding the impact of childhood abuse perpetrated by close others, or high betrayal trauma, a number of barriers continue to impede research efforts, including concerns that research may do more harm than good. Research conducted with Western samples has indicated that contrary to such concerns, participants rate the benefit of participating in trauma research as outweighing costs, even when they have a history of high betrayal trauma. Certain non-Western values, such as interpersonal harmony, could play a role in perceptions regarding trauma research participation. The current study evaluated perceptions of 79 Japanese undergraduate students who participated in an online study of child abuse. Japanese students rated the importance of participating in trauma research as greater than any immediate distress it caused. Interpersonal harmony was not related to perceptions of participating in trauma research, nor was a history of high betrayal child trauma. Taken together, these findings support continued research on childhood abuse in non-Western samples.

Ethical Considerations in Sexual Health Research: A Narrative Review

Background:

There is an assumption that sexual health research has great influence on the quality of human life through elevating sexual health standards, and their results will eliminate the burden of sexual health challenges on family relationships. The aim of this study was to review ethical considerations in sexual health research.

Materials and Methods:

This narrative review was conducted between January 1990 and December 2017 based on the five-step approach of York University. The keywords used to search for the studies included ethical issues, research, sexual health, reproductive health, and sensitive topics. The language of the literatures was English and the search process was performed on PubMed, Elsevier, Ovid, Springer, Google Scholar, ResearchGate, SAGE Publishing, ProQuest, WHO website, Kinsey Confidential, and Worldsexology.

Results:

After assessing the quality and eligibility of 94 articles, 13 were selected. The results of the present study showed that the most important ethical considerations were protecting the confidentiality and privacy of participants, obtaining informed consent, and paying attention to vulnerable people.

Conclusions:

The review of literature exhibited several considerations that sexual health researchers are faced with. In order to manage these considerations, the researcher should have sufficient understanding of them. The important matter is that strategies to manage these challenges should be completely rational and practical according to each context. These strategies can also be applied in other societies with great similarities in their context.

Women's experience of being interviewed about abuse: a qualitative systematic review

WHAT IS KNOWN ON THE SUBJECT?: There is disagreement about the costs and benefits of asking women about their abuse experiences in practice and research settings. No known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: This review adds robust qualitative evidence that interviewing women about their abuse experiences can be a beneficial and healing experience for them. Mental health nurses are in an ideal position to create a therapeutic environment to interview women about their abuse experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are strongly encouraged to ask about and document abuse in all of their interviews and assessments, as well as act as advocates and discuss reported abuse within their interdisciplinary teams, to provide individualized, trauma-informed care. The mental health nurse should listen attentively, avoid judgement, offer reassurance, make appropriate referrals and provide resources for women, including those with both past and current abuse histories. Nurses are strongly encouraged to ask about abuse in all settings in which they encounter women, including in psychiatric and mental health settings.

ABSTRACT

Introduction Collections of quantitative data exist outlining the costs and benefits of asking female research participants about their abuse experiences; however, no known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. Aim/Question The purpose of this qualitative systematic review was to analyse and interpret qualitative findings regarding asking women about their abuse experiences with the intention of understanding risks and benefits. Method The sample (N = 11) was derived from an expansive search of peer-reviewed literature using multidisciplinary electronic databases. Qualitative findings were extracted, coded and categorized. Reflective memos were developed, and themes emerged. Results While initially distressing, being interviewed about abuse is more beneficial than harmful for women, due to the therapeutic process of talking about abuse. Discussion To maximize the therapeutic impact of discussing abuse, women must maintain autonomy and feel they are in a safe and confidential environment. Within this supportive atmosphere, very few women report any regret after discussing abuse and are able to identify positive outcomes. Implications for practice Findings from this review support the need for mental health nurses and other clinicians to create an optimal environment for discussing abuse and offer relevant practice recommendations. Researchers are encouraged to include women in studies that involve asking about abuse experiences.

Empirically Assessing Participant Perceptions of the Research Experience in a Randomized Clinical Trial: The Women's Self-Defense Project as a Case Example

A growing body of empirical literature has systematically documented the reactions to research participation among participants in trauma-focused research. To date, the available data has generally presented an optimistic picture regarding participants' ability to tolerate and even find benefit from their participation. However, this literature has been largely limited to cross-sectional designs. No extant literature has yet examined the perceptions of participants with psychiatric illness who are participating in randomized clinical trials (RCTs) designed to evaluate the efficacy or effectiveness of novel trauma treatments. The authors posit that negative experiences of, or poor reactions to, the research experience in the context of a trauma-focused RCT may elevate the risk of participation. Indeed, negative reactions may threaten to undermine the potential therapeutic gains of participants and promoting early drop out from the trial. Empirically assessing reactions to research participation at the pilot-study phase of a clinical trial can both provide investigators and IRB members alike with empirical evidence of some likely risks of participation. In turn, this information can be used to help shape the design and recruitment methodology of the full-scale trial. Using data from the pilot study of the Women's Self-Defense Project as a case illustration, we provide readers with concrete suggestions for empirically assessing participants' perceptions of risk involved in their participation in behaviorally oriented clinical trials.

Balancing the Needs of the Scientist and the Subject in Trauma Research

All participants in research are vulnerable to some extent. Survivors of trauma are often sought as participants for research studies and may be at an increased risk of emotional or psychological distress as a result of research participation. Scientists need to pay careful attention to issues of informed consent and the potential harm and benefits from research participation. This article explores challenges of selecting a sample, informed consent, and study continuation when conducting research with survivors of trauma.

Sexual Assault Victims Participating in Research: Causing Harm When Trying to Help?

For fear of causing unnecessary distress, ethical concerns have been raised in regard to asking vulnerable persons e.g. sexually traumatized victims to participate in scientific research studies. The current study investigates how victims of sexual assault perceived participating in scientific research in regard to victims' psychological and/or physiological distress and potential beneficial outcomes from participation (N=51). Results from interviews with victims indicated that the majority of victims of sexual assault who had taken part in the study considered their participation in research a positive experience causing little short- or long-term psychological or physiological distress. In addition, over half of the respondents reported some benefits from participation.

Adolescents' and adults' experiences of being surveyed about violence and abuse: a systematic review of harms, benefits, and regrets

The neuroscience and psychological literatures suggest that talking about previous violence and abuse may not only be beneficial, as previously believed, but may also be associated with risks. Thus, studies on such topics introduce ethical questions regarding the risk-benefit ratio of sensitive research. We performed a systematic review of participants' experiences related to sensitive research and compared consequent harms, benefits, and regrets among victims and nonvictims of abuse. Thirty studies were included (4 adolescent and 26 adult studies). In adolescent studies, 3% to 37% of participants (median: 6%) reported harms, but none of these studies measured benefits or regrets. Among adults, 4% to 50% (median: 25%) reported harms, 23% to 100% (median: 92%) reported benefits, and 1% to 6% (median: 2%) reported regrets. Our results suggest that the risk-benefit ratio related to sensitive research is not unfavorable, but there are gaps in the evidence among adolescents.

Female survivors of child sexual abuse: finding voice through research participation

It is unclear whether survivors of trauma are at risk of emotional or psychological distress when they participate in research because there is little data on the subjective experience of research study participants and how they make meaning from their participation in research. This qualitative descriptive study explored the experience of research participation by survivors of childhood sexual abuse. We interviewed 12 female survivors and identified themes. Participants noted both positive personal and societal benefits of study participation and reported no harm due to their research participation. Study findings can help researchers understand the perspectives of participants regarding the benefits of taking part in violence research and can help allay concerns over causing participants undue psychological distress.

Ethical issues in trauma-related research: a review

ETHICAL DECISION-MAKING ABOUT TRAUMA-RELATED STUDIES requires a flexible approach that counters assumptions and biases about victims, assures a favorable ethical cost-benefit ratio, and promotes advancement of knowledge that can benefit survivors of traumatic stress. This paper reviews several ethical issues in the field of traumatic stress: benefit and risks in trauma-related research, whether trauma-related research poses unique risks and if so what those might be, informed consent and mandatory reporting, and supervision of trauma-related research. For each topic, we review potential ethical issues, summarize the research conducted thus far to inform ethical practice, and recommend future practice, research questions and policies to advance the field so that research on trauma can continue to be a win-win situation for all stakeholders in the research enterprise.

A mixed methods study of participant reaction to domestic violence research in Jordan

Research on domestic violence against women has increased considerably over the past few decades. Most participants in such studies find the exercise worthwhile and of greater benefit than emotional cost; however, systematic examination of participant reaction to research on violence is considerably lacking, especially in the Middle East region. This study begins to fill this gap by examining women's reactions to domestic violence research in Jordan and whether a personal history of violence is associated with unfavorable experiences. This sequential exploratory mixed methods study included 17 focus group discussions (FGD) with women in Amman followed by a survey conducted in reproductive health clinics throughout the country (pilot n = 30; survey n = 517). Open coding was used to identify the theme related to participant reaction in the FGD data. This construct was further examined by the subsequent survey that included dichotomous questions inquiring whether the respondent thought the study questions were important and whether they were angry or felt resentment as a result of the survey. One open-ended question on the survey provided additional qualitative data on the theme that was combined with the FGD data. Themes identified in the qualitative data pertained to expressions of gratitude and comments on the survey's value. Findings of this study indicate that Jordanian women's responses to the research process are similar to women currently represented by the extant literature in that a vast majority of its participants felt that the study was important (95%) and it did not evoke anger or resentment (96%). Many even found the study to be useful to them personally or to society. Among those who had a negative emotional reaction, most still found the research to be important. This study's findings highlight the safety and potential benefits of ethically conducted violence research.

Talking therapy services for adult survivors of childhood sexual abuse (CSA) in Scotland: perspectives of service users and professionals

This study aimed to elicit perceptions and experiences of talking therapy services for CSA survivors and professionals utilizing qualitative interviews and analyzing transcripts using Interpretative Phenomenological Analysis. Participants included 13 adult survivors and 31 professionals in statutory and voluntary services in Scotland. Main themes were benefits from and challenges of the therapeutic process. Benefits included a trusting therapeutic relationship, feeling safe to disclose, breaking isolation, enhancing self-esteem and self-worth, contextualizing the abuse, and moving toward recovery. Challenges included trauma-focused work, supportive contact, continuity and consistency of services, accessibility during acute episodes, hearing and managing disclosures, child protection issues, and availability and accessibility of services. The findings support a greater emphasis on relational models, supervision, and training.

Recruiting for end of life research: lessons learned in family research

A main hurdle for end of life research is recruitment of patients. Researchers can enroll interested patients and their families for end of life studies by gaining the trust of the hospice staff, who can make valuable referrals of patients nearing the end of life. Participants in the study should be made as comfortable as possible and not be coerced into the interview process. Once the patients have confidence in the researchers, they are more than willing to be a part of the research process because it can prove to be cathartic to many of the patients and their family members.

"What has it been like for you to talk with me today?": the impact of participating in interview research on rape survivors

The purpose of this project was to conduct a qualitative study of how participating in in-depth interviews impacted rape survivors. These interviews contained both open-ended, free response section and closed-ended, standardized assessments. The implementation of the interviews was informed by principles of feminist interviewing, which emphasized reducing hierarchy between the interviewer and interviewee, providing information and resources, and creating an emotionally supportive and compassionate setting. Narrative data were analyzed from rape survivors (N = 92) regarding how they were affected by participating in these interviews. Results suggested that the overwhelming majority of survivors found the interview to be a helpful, supportive, and insightful experience. Additional analyses revealed that the feminist interviewing principles were noticed and appreciated by the participants and contributed to their overall positive participation outcomes.

Overview of research addressing ethical dimensions of participation in traumatic stress studies: autonomy and beneficence

One element of the design of human research studies is ethically informed decision-making. Key issues include the safety, costs, and benefits of participation. Historically, much of this decision-making was based on opinion rather than formal evidence. Recently, however, investigators in the traumatic stress field have begun to collect data that are relevant to these decisions. In this article, the authors focus on issues emanating from the ethical concepts of autonomy and respect for persons and beneficence and nonmaleficence, and then summarize relevant evidence from studies with trauma-exposed individuals. Discussion addresses implications of this evidence for research practice and policy, and identifies some potentially informative data collections opportunities for future trauma studies.

Developing distress protocols for research on sensitive topics

Two protocols that were developed to address risks related to emotional distress in an ongoing, qualitative, community-based study of adolescent dating violence are presented. The first protocol is for use in telephone screening to identify individuals at high risk of adverse emotional reactions. The second protocol guides interviewer's responses to emotional distress expressed by participants during in-depth research interviews. The study is briefly described, and the process used to develop the protocols is discussed. The process of developing the protocols caused the authors to reconsider some previously held assumptions about human subject protections in research on sensitive topics.

Incentives for survey participation when are they "coercive"?

Monetary incentives are increasingly used to help motivate survey participation. This article summarizes several theories underlying the use of incentives and briefly reviews research demonstrating their intended and unintended effects on response rates, sample composition, response bias, and response quality. It also considers the evidence for the effectiveness of incentives in reducing nonresponse bias. Institutional review boards have begun to ask whether, and under what conditions, the use of monetary incentives to induce participation might be coercive and to question the use of such incentives in surveys of "vulnerable" populations, including surveys of injury and violence. The article reviews the ethical principles underlying the requirement for voluntary informed consent as well as current regulations and a broad theoretical and empirical literature bearing on this question, concluding that incentives are never coercive. The question of whether they exert "undue influence" in a specific situation is more difficult, but it may be the wrong question to ask. The article concludes with several recommendations designed to ensure the ethical use of incentives in surveys on violence and injury.

Manifestations of enduring during interviews with sexual assault victims

The retelling of a sexual assault, whether during sexual assault care or law enforcement interviews, or in the process of seeking social support, is an emotionally stressful event, yet there is little research describing the psychological experiences of retelling. In a study of barriers to sexual assault care, 43 survivors recounted 76 assault events during individual interviews. Although assaults occurred from 1 to 15 years prior to the interview, participants demonstrated emotional upset. Using the praxis theory of suffering as a scaffold, the author describes manifestations of enduring and emotional suffering. The separation of enduring from emotional suffering indicates potential usefulness of the praxis theory of suffering in the provision of post-sexual assault care.

Spontaneous reports of emotional upset and health care utilization among veterans with posttraumatic stress disorder after receiving a potentially upsetting survey

This study assessed the effects of a potentially distressing mailed survey on the emotional well-being and health care utilization (HCU) of 4,918 male and female veterans who applied for posttraumatic stress disorder disability benefits. Content analysis of spontaneous comments, in combination with analysis of subjects' HCU before and after receipt of the survey, suggested that spontaneously disclosed episodes of emotional upset were rare. In general, surveyed veterans' HCU decreased after receipt of the survey.

Participation in trauma research: is there evidence of harm?

Few studies have examined the impact of trauma research participation upon trauma survivors. Empirical data regarding reactions to research participation would be very useful to address the question of whether it is harmful for trauma survivors to participate in trauma studies. We examined participant reactions to different trauma assessment procedures in domestic violence (N = 260), rape (N = 108), and physical assault (N = 62) samples. Results indicated that participation was very well tolerated by the vast majority of the trauma survivors. Participants generally found that the assessment experience was not distressing and was, in fact, viewed as an interesting and valuable experience. The findings suggest that trauma survivors are not too fragile to participate in trauma research even in the acute aftermath of a traumatic experience.