The impact of sociocultural contexts on mental health following sexual violence: A conceptual model

How do young men narrate the redemption story of a sexual assault perpetrator?

Background: Little is known about how young men who have committed sexual assault might acknowledge wrongdoing and eventually change and make amends. There are practical barriers to seeking the real redemption stories of perpetrators.Objective: To explore hypothetical pathways to young men's accountability-taking and amends (i.e. redemption) after perpetration of sexual assault.Method: In a pre-registered, qualitative story completion study, we presented heterosexual, cisgender college men (N = 54) with a date-based sexual assault story written by a fictional male perpetrator. Participants were prompted to complete the story so that the protagonist, who initially denies wrongdoing, eventually changes and becomes a violence prevention advocate.Results: A thematic analysis of the redemption stories revealed that this study's speculative task was a challenging one. Half of the stories did not provide an explanation for how the perpetrator was able to acknowledge wrongdoing. Overall, individualistic themes (e.g. he introspected) were more common than relational, community, or societal facilitators of redemption.Conclusions: Without infrastructure for accountability-taking and repair, or narrative exemplars to draw from in public life, it is difficult to envision redemption from violence. Rare gender-based, structurally attuned analyses of sexual violence in the stories point the way towards a more transformative vision of redemption.

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

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

Trauma of the Shared Environment: A Qualitative Analysis of the Experiences of Survivors of College Campus Sexual Assault

Survivors of campus sexual assault are often tasked with healing while sharing an environment with their perpetrators. However, little is known about the effects of a shared environment on survivor well-being. A qualitative thematic analysis design was employed to address this gap. We conducted semi-structured interviews with nine female survivors who identified their perpetrators as fellow students at a large state university in the southeastern U.S. The five themes that emerged are situated within an ecological framework, which is also used to guide our recommendations for supporting survivors' well-being within higher education.

The Indirect Effects of Proximal Stressors Associated with Posttraumatic Stress Symptoms Severity among Sexually Victimized Sexual Minority Women: A Cross-Sectional Path Analysis

Sexual minority women (SMW) are at risk for sexual victimization and stressors specifically related to their minority identity (e.g., discrimination). However, SMW experience posttraumatic stress disorder (PTSD) at rates beyond what may be explained by elevated risk for sexual victimization alone. This study aimed to examine the impact of stigma on PTSD symptoms among SMW survivors of sexual victimization. Results indicate that in relation to minority-specific distal stressors (i.e., heterosexist experiences), both minority-specific and general proximal stressors (i.e., internalized heterosexism, negative posttraumatic cognitions) indirectly affected PTSD symptom severity among this cross-sectional sample of sexually victimized SMW.

Characteristics of Sexual Assault Among Men Receiving a Forensic Medical Examination

Sexual assault is a form of violence disproportionately perpetrated against women by men; however, men also experience high rates of sexual victimization. While recent research exploring victimization of sexual assault among men does exist, little is known about situational characteristics and consequences surrounding men's assault experiences. Therefore, the current study examines narratives of men's sexual assault to further understand the unique experiences of men receiving a sexual assault medical forensic examination. To accomplish this, we conducted a retrospective medical chart review of sexual assault narratives from N = 45 men receiving a sexual assault medical forensic examination at a large academic medical institution in the southeastern United States. Three general constructs were identified within the records: a) Perpetrator use of coercive tactics, b) Memory loss, and c) Contextual factors. Nested within these constructs, five specific themes emerged, including: a1) Use of weapons and physical force; a2) Tactical administration of alcohol and drugs; b1) Difficulties remembering assault; c1) Consensual sexual activity turned non-consensual; c2) Incarceration. Findings from the present study common identified characteristics of sexual assaults among men receiving a sexual assault medical forensic examination, including coercive tactics used by perpetrators, consequences of sexual assault, and high-risk settings for male victimization.

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

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

Accessing care services after sexual violence: A systematic review exploring experiences of women in South Africa

BACKGROUND

 Sexual violence against women is a global phenomenon. This is a particular issue in South Africa, where it is estimated with evidence provided that up to half of all women will encounter gender-based and/or sexual violence from a partner during their lifetime. Therefore, evidence suggests that addressing the needs of women in South Africa is a priority.

OBJECTIVE

 This qualitative review aimed to explore the experiences of women seeking care from first contact healthcare facilities in South Africa after sexual violence and during follow-up care.

METHOD

 This systematic review was conducted using the PRISMA checklist for systematic reviews and in line with a published protocol (PROSPERO, CRD42019121580) and searched six relevant databases in 2022. A total of 299 sources were screened, with 5 forming the overall synthesis.

RESULTS

 Two synthesised themes of women's experiences emerged at the time of reporting and during attendance at follow-up healthcare services.

CONCLUSION

 South Africa does have an established legal framework for prosecution and can provide support for survivors of sexual violence through established Thuthuzela Care Centres (TCCs). The review identifies that survivors' needs are not clearly established when seeking medical attention initially nor identifying support or appropriate pathways.Contribution: The review has the potential to characterise the support available for women, the type and nature of sexual violence and interventions that may be used by healthcare professionals to support survivors especially during follow-up care.

Sexual Violence-Related Stigma, Mental Health, and Treatment-Seeking: A Multimodal Assessment in a Population-Based Study of Young Adults

Sexual violence (SV) is a stigmatized form of trauma, yet the stigma experiences of those reporting SV are often assumed rather than explicitly measured. We adapted a measure that quantified three key features of SV stigma across three levels: negative self-image (individual), disclosure concerns (interpersonal), and concerns about public attitudes (structural). We administered this measure to a population-based sample of Swedish young adults (N = 453) who reported a history of either sexual assault (SA) or intimate partner sexual violence (IPSV). Among both groups, 89% endorsed at least one item on the stigma scale. Experiences of SV-related stigma were associated with significantly higher symptoms of generalized anxiety, depression, and posttraumatic stress disorder, with greater perceived need for mental health treatment, and with more shame (measured implicitly via a reaction-time task). Experiences of stigma were negatively associated with symptoms of alcohol misuse. Results suggest that exposure to SV stigma may be a critical, but often overlooked, correlate of post-assault recovery.

Facilitators of Sexual Assault Disclosure: A Dyadic Study of Female Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to others at some point following sexual assault, but little in-depth research has addressed factors facilitating disclosure. In the current study, a diverse sample of 45 female sexual assault survivors (75% racial/ethnic minorities) and their 45 informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following assault. Disclosure facilitation was expressed by 40 survivors and 31 SPs, of which 28 were matched S/SP dyadic pairs. Narrative data on the overarching thematic category of sexual assault disclosure facilitation was analyzed using descriptive thematic analysis methods. Several themes emerged from the analysis of quotes specific to the facilitation of disclosure, including: individual (e.g., survivor psychological, behavioral, and disclosure recipient factors), interpersonal (e.g., SP-solicited disclosures, helping others, mutual disclosures), and societal (e.g., lack of barriers, formal supports, media). Implications are drawn for future research on facilitators of sexual assault disclosure. Clinical practice implications are provided for professionals supporting survivors and their informal support networks.

Post-Rape Experiences of Undocumented Mexican Women in the U.S.-Mexico Border Region: A Critical Ethnography

Introduction: Numerous undocumented immigrant women in the United States have survived rape, and many have experienced physical and psychological consequences. Although rape disclosure can facilitate early intervention and improve health outcomes, most undocumented immigrant women do not disclose rape, and little is known about their post-rape experiences. Methods: This critical ethnography explored the post-rape experiences of undocumented immigrant women of Mexican (UIWM) origin living in the U.S. Mexico border region. Data collection and analysis were guided by Carspecken's framework for critical qualitative research. Six women, who identified as UIWM participated in the study. Each was interviewed using a semistructured approach. Results: Interview data revealed three domains: Glimpses of Support, Barrier After Barrier, and Overcoming. In accordance with Carspecken's framework, a theoretical lens was applied to these domains. The application of Feminist Intersectional Theory and Standpoint Theory united the domains into the theme Struggling to Heal. Conclusion: This study suggests that the marginalization of these survivors detrimentally impacts their post-rape experiences and describes the intersections of multiple forces on their experiences, including the cultural and sociopolitical context of the border region. This study lays the foundation for future research aimed at mitigating disclosure and help-seeking barriers for this marginalized group.

Disclosure Recipients' Perceptions Related to Helping Victims of Dating and Sexual Violence

To date, research on social reactions to dating and sexual violence (DSV) disclosure has largely neglected the perspective of disclosure recipients. Moreover, few studies have explored disclosure recipients' perceptions of the victim and perceptions of their own effectiveness in helping as well as the correlates of these perceptions. The purpose of this study was to address these gaps in the literature. Participants were 783 college students (73.0% female) who reported receiving a DSV disclosure in the past 6 months. Participants who provided more negative social reactions to victim disclosures were less likely to empathize with the victim and more likely to feel victim blame/burdensomeness and confusion/ineffectiveness in their responses. Conversely, those providing more positive social reactions were more likely to empathize with the victim and were less likely to report victim blame/burdensomeness and confusion/ineffectiveness. Further, recipients with a DSV victimization history were more likely to report empathy for the victim. Being a man and having higher post-traumatic stress symptoms were associated with greater victim blame/burdensomeness, while the victim approaching the recipient to disclose and DSV experiences that occurred long ago were associated with lower victim blame/burdensomeness. Finally, depressive symptoms, receiving disclosures from a stranger/casual friend, and less frequent discussion about the incident were significantly associated with increased confusion/ineffectiveness. These findings suggest that perceptions of the victim and helping effectiveness, and factors associated with them, may be promising targets of programs seeking to reduce negative and increase positive social reactions to DSV disclosures.

Military sexual trauma in context: Ethnoracial differences in ecological resources among treatment-seeking veterans

Veterans who have experienced military sexual trauma (MST) are at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depressive disorders, and substance use disorders. Previous studies have shown racial differences in MST exposure, namely that Black veterans experience MST more frequently than White veterans. One way to help clinicians and researchers understand the impact of these ethnoracial differences in MST exposure is through an applied theory of ecological resources, which has demonstrated ecological factors (e.g., aspects of identity, beliefs, and environmental stressors) contribute to veteran well-being in the aftermath of MST. The present study aimed to examine ethnoracial differences in ecological resources (i.e., available social support, spiritual coping, past-year interpersonal violence, financial sufficiency, and stable living environment). Participants (N = 505) were U.S. veterans who sought care at a Veterans Healthcare Administration clinic in the midwestern United States for mental health issues related to MST. Results demonstrated Black veterans were more likely than White veterans to report being financially insecure, U = 18,091.50, z = -2.04, p = .042, r = .10. Black veterans were also more likely to report spiritual beliefs that assisted with coping, Cramer's V = .19, but less likely to report having a social support system, Cramer's V = .16. These findings highlight the importance of assessing and addressing disparities illuminated by ethnoracial differences in ecological resources and barriers in veterans seeking care for MST.

Social Network Changes and Disclosure Responses after Sexual Assault

Social support after sexual assault is important for recovery, but violence and recovery may also challenge relationships. We examined functional and structural social support changes following sexual assault and their association with mental health. College women (N=544) with and without a sexual assault history completed a cross-sectional survey assessing current and past egocentric social networks. Functional support (perceived global support, assault disclosure, perceived helpfulness of responses) and structural support (network density, size, retention) were examined. Multilevel models revealed that, relative to non-survivors, survivors reported smaller, less dense past networks, but similarly sized current networks. Survivors retained less of their networks than non-survivors, and network members who provided unhelpful responses to disclosure were less likely to be retained. Structural equation modeling revealed that, among survivors, perceived unhelpful responses to disclosure and a greater loss of network members were associated with worse mental health. Findings suggest that survivors may experience a restructuring of social networks following sexual assault, especially when network members respond in unhelpful ways to disclosure. Although survivors appeared to build new relationships, this restructuring was associated with more mental health problems. It is possible that interventions to improve post-assault social network retention may facilitate recovery.

Study Title-Based Framing Effects on Reports of Sexual Violence and Associated Risk Factors in College Students

OBJECTIVE

There are many methodological issues in studying sexual violence, including potential framing effects. Framing effects refer to how researchers communicate the purpose of a study to participants, such as, how the study is advertised or explained. The aim of this study was to investigate if framing effects were associated with differences in participants' self-reported experiences of sexual violence and related correlates.

METHODS

College students (N = 782) were recruited to participate in one of four identical studies that differed in the title: "Questionnaires about Alcohol," "Questionnaires about Crime," "Questionnaires about Health," or "Questionnaires about Sexual Assault." Participants chose one of the four studies and completed measures of sexual violence as well as attitudinal and behavioral measures in randomized order.

RESULTS

We found significantly more reports of childhood sexual abuse (33.6% vs. 18.5%), rape (33.9% vs. 21.1%), higher frequency of victimization (M = 11.35 vs. 5.44), and greater acknowledged rape for bisexual people (46.2% vs. 0.0%) in the sexual assault (SA) condition compared to other conditions. There were no differences in sexual violence perpetration or attitudinal or behavioral measures.

CONCLUSION

These results revealed that framing effects, based on the study title, affect outcomes in sexual victimization research. Rape was reported 1.6× more in the "Sexual Assault" condition than in the "Health" condition. It is unclear whether these framing effects reflect self-selection bias or framing related increased reports in the SA condition, suppression of reports in other conditions, or a combination thereof.

Supporter-focused early intervention for recent sexual assault survivors: Study protocol for a pilot randomized clinical trial

INTRODUCTION

Sexual assault is a common form of trauma that is associated with elevated risk for negative psychosocial outcomes. Although survivors' social relationships could serve as a major protective factor against negative outcomes, survivors' supporters often lack knowledge regarding effective responses and may inadvertently respond in ways that are detrimental to healing. Communication and Recovery Enhancement (CARE) is a 2-session early intervention for survivors of a past-10-week sexual assault and their supporters that aims to improve supporters' ability to respond effectively.

OBJECTIVE

In this paper, we present a study protocol for a pilot randomized clinical trial of CARE (NCT05345405). The goal of this pilot trial is to understand the feasibility, acceptability, and preliminary efficacy of two versions of CARE: a version in which survivors and supporters attend sessions together (dyadic version) and a version in which supporters attend sessions alone (supporter-only version).

METHODS

Survivors aged 14+ with elevated posttraumatic stress will enroll with a supporter of their choosing. Dyads will be randomized to dyadic CARE, supporter-only CARE, or waitlist control, and will complete self-report assessments at baseline, post-session-1, and follow-ups (1, 2, and 3 months post-baseline). We will use descriptive statistics, effect sizes, and exploratory statistical tests to characterize the acceptability of both CARE versions, impact on knowledge change from baseline to 1 month, impact on disclosure experiences at 1 month, and impact on functional outcomes at 3 months.

DISCUSSION

Results will be used to inform future changes to CARE and determine whether a fully-powered randomized controlled trial is warranted.

Crisis Work Embedded in a Global Crisis: The Early Phase Impact of COVID-19 on Survivors of Intimate Partner Violence and Service Provisions

COVID-19, as a global pandemic, was a public health inflection point for individuals affected by intimate partner violence (IPV) and those who provide IPV services. Public health guidelines that were intended to reduce risk of exposure to the virus impacted vulnerability factors for IPV survivors and associated systems of services. We aimed to (1) explore the effect of COVID-19 on survivors of IPV; (2) assess the effect of COVID-19 on IPV-related service provisions and service providers; and (3) explore challenges and opportunities in the wake of COVID-19 on broader IPV services and advocacy.

METHOD

Twelve directors of IPV shelter, criminal justice, and other advocacy services within a diverse, Midwestern metropolitan area were recruited to participate in in-depth, semi-structured interviews in June-August 2020. Interviews were transcribed verbatim and analyzed using Dedoose. Data were coded and analyzed through thematic analysis.

RESULTS

Four major themes, contextualized by COVID-19 and racial injustice, emerged from the data analysis: (1) IPV-related trends; (2) impact on IPV survivors, services, and agency morale; (3) inter-agency collaborations; and (4) future opportunities for innovative service delivery. Gaps and opportunities for developing culturally congruent, trauma-informed services were identified.

CONCLUSION

Findings suggest that responsive and accessible IPV resources and associated advocacy services can make the difference between life and death for survivors.

The Predictors of Awareness of Sexual Abuse and Sexual Violence in the Media and the Influence on Actions of the Individuals

Introduction: The number of reportings on sexual abuse (SA), sexual violence (SV) cases covered in the media has risen a significant amount with most cases involving women and children. The aim of the study is to explore the questions: Are people aware of sexual abuse and sexual violence in the media? What are the predictors of awareness of sexual abuse and sexual violence? Does the awareness of sexual abuse and sexual violence in the media affect the actions of the individuals? Methods: A representative survey of the German-speaking resident population (2020) on physical and mental well-being was used. The participants (N = 2,503: females = 50.9%) were between the ages of 14 and 97 (M = 49.81). The German version of the Adverse Childhood Experiences Questionnaire, The General Habitual Well-Being Questionnaire and questions about own experiences of sexual harassment on the internet, experiences of domestic sexual abuse and different socio-economic variables were used. The outcome variables regarding the awareness of SA and SV in the media, different types of scandals (church, pedophile, USA), #MeToo-debate and the change in actions were used. Frequency analyses and binary regressions were conducted. Results: One thousand five hundred and fifty-five (62.6%) respondents answered yes to being aware of SA and SV in the media. The results show that females, aging, number of children in household, Protestant and Catholic religion, school graduation, own experience(s) of sexual harassment on the internet, own experience(s) of SA in childhood, and Adverse Childhood Experiences have a significant higher association to the awareness of SA and SV in the media. German nationality and Muslim religion have a significant lower association. The variables that most commonly affected the awareness of SA and SV, scandals, debate and the individual actions were age, own experiences of sexual harassment on the internet and the Protestant religion. Conclusion: Advertising more support centers, hotlines and linking this information to sexual abuse cases covered in the media should be considered. Media bystander interventions could be helpful to train people to react appropriately. Further investigation that considers the different types of media and its influence on the awareness of SA and SV is needed.