The ties that bind: understanding the impact of sexual assault disclosure on survivors' relationships with friends, family, and partners

Research with women sexual assault survivors presenting for emergency care is safe: Results from a multi-site, prospective observational cohort study

A barrier to research with sexual assault survivors is the concern that research participation might be a negative experience for participants. We report the experiences with research of adult women sexual assault survivors participating in a large-scale, multi-site, prospective observational study that enrolled participants at the time of presentation for emergency care. Participants (n = 706, M = 28 years of age; 57% white, 15% Black) self-reported their experience with research 1 week, 6 weeks, 6 months, and 1 year post-assault. The vast majority rated the research experience as positive (95-97%), reported no drawbacks (84-89%), and felt that participating was worth it (93-95%). Positive experiences with research remained stable across the year, were generally consistent across demographic and clinical groups, and were reflected in qualitative comments. Given the tremendous morbidity experienced by sexual assault survivors and lack of progress in developing improved treatments for this population, ethically-conducted research with sexual assault survivors receiving emergency care should be encouraged.

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

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

Stereotypical Victims: Visibility of #MeToo Disclosures on Twitter

The #MeToo movement has brought greater visibility to the topic of sexual assault in public discourse. We analyzed a dataset of 1,070 Twitter #MeToo self-disclosures to examine the relationship between online visibility (retweets and favorites) and the content of victim-survivors' self-disclosures such as victim's gender, relationship to the perpetrator, and the emotions expressed in the tweet. The visibility of sexual assault self-disclosures was shaped by the extent to which they align with stereotypical misconceptions of victimization. These findings carry significant implications for understanding patterns of victimization, and for identifying whose voices are being amplified or not on Twitter.

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

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

Variation in rates of sexual assault crisis counsellor usage during forensic examination in California: an observational study

OBJECTIVES

A critical asset to post-assault care of survivors is support from sexual assault crisis counsellors (SACCs). We sought to elucidate variation in implementation between California counties in SACC accompaniment during Sexual Assault Forensic Examination (SAFE).

METHODS

SACC attendance data from 2019 was obtained from the California Governor's Office of Emergency Services (CalOES). To assess SACC attendance rates during SAFEs, we requested SAFE quantity data from sheriffs and public health departments, the State Forensic Bureau, and the California Department of Justice (DOJ), but all requests were unanswered or denied. We also sought SAFE data from District Attorneys (DAs) in each county, and received responses from Marin and Contra Costa Counties. To estimate numbers of SAFEs per county, we gathered crime statistics from the Federal Bureau of Investigation's (FBI's) Uniform Crime Reporting Program and OpenJustice, a transparency initiative by the California DOJ. For each data source, we compared SACC attendance to SAFE quantities and incidences of sexual assault statewide.

RESULTS

At the state level, data on SACC attendance per CalOES and DOJ archival data on sexual assault were used to approximate relative rates of SACC accompaniment at SAFEs; 83% (30 of 36) of counties had values <50%. The joint sexual assault crisis centre for Contra Costa and Marin Counties reported that 140 SACCs were dispatched in 2019, while DAs in Contra Costa and Marin reported completion of 87 SAFEs in 2019, for a calculated SACC accompaniment rate of 161%. Proxy data sourced from FBI and DOJ crime statistics displayed significant inconsistencies, and DOJ data was internally inconsistent.

CONCLUSIONS

SACC accompaniment at SAFEs appears to be low in most California counties, however, limited data accessibility and data discrepancies and inaccuracies (e.g., rates over 100%) prevented reliable determination of SACC accompaniment rates during SAFEs. Substantial improvements in data accuracy and transparency are needed to ensure survivors' adequate access to resources.

College students' perceptions of alcohol's role in disclosures of sexual assault and intimate partner violence

Objective: Much is known about how alcohol increases the risk of sexual assault or intimate partner violence victimization during college. This research qualitatively explores perceptions about how alcohol influences disclosures about these events to informal supports. Participants: Participants included college students who received a disclosure wherein they or the survivor were drinking during the disclosure (n = 81). Methods: Responses were coded with regard to who was drinking and whether the effect of drinking during the disclosure was perceived as positive, negative, mixed, or neutral/none. Results: Participants perceived alcohol to have both positive (e.g., increasing the likelihood of discussing difficult topics) and negative (e.g., cognitive impairment increased negative emotions) effects on disclosures. Conclusion: Prevention and intervention efforts should identify targeted strategies (e.g., remembering one or two easy and helpful phrases; revisiting the topic again while sober) to help survivors and disclosure recipients have constructive conversations in the presence of alcohol.

Reacting to Non-Prototypical Victims: Blame, Empathy, and Willingness to Label Sexual Assaults of Men and Sexual Minority Victims

Sexual assault is prevalent in the U.S. society, with an estimated 16% of women and 8% of men experiencing some form of sexual violence during their lifetime (Breiding, 2014). Sexual violence crosses all identity lines; however, legislation, cultural representation, and academic scholarship on sexual violence has historically been limited to assaults against women perpetrated by men. This dominant analysis of sexual assault focuses on the impact of sexism on sexual violence, neglecting the impact off other forms of oppression and attitudes related to sexuality and gender. This dominant representation leaves non-prototypical victims, such as men, people of other genders, and sexual minorities of all genders, less visible and less understood. This underrepresentation may lead to negative reactions toward these victims including blame, exoneration of the perpetrator, and reluctance to acknowledge assaults. In the current study, I explored the impact of both victim gender and sexual orientation on reactions to a hypothetical intimate partner sexual assault victim. Results indicated that perpetrators who assaulted a man were blamed less than those who assaulted a woman. Furthermore, study participants had more empathy for women who were assaulted than they did for men. There were no differences in participants' negative reactions to victims by sexual orientation. Results suggest that, while some advances have been made in public support for sexual assault victims, these advances may not extend yet to men as victims.

"I Could Never Tell My Parents": Barriers to Queer Women's College Sexual Assault Disclosure to Family Members

Queer women are at high risk of college sexual victimization, but they face barriers to formal support services. As a result, informal support is critical. This study uses data from 40 open-ended interviews to explore family members' reactions to queer women's disclosures and examine whether their family is a reliable source of informal support. Findings indicate that family reactions are often more harmful than helpful. In comparison to research focused on heterosexual survivors, we find family reactions to be more extreme and disparaging of queer survivors' sexual identities. In fact, family members' negative reactions may pose barriers to accessing formal services.

The Role of Social Reactions to Disclosures in the Relationship Between Sexual Assault Acknowledgment and Psychological Symptoms

Following a sexual assault, women experience a host of negative psychological consequences. While some survivors label their sexual assault experience as such (i.e., are acknowledged survivors), other survivors do not. The effect of acknowledgment of sexual assault on postassault outcomes has yielded mixed findings. It was hypothesized that social reactions may account for the relationship between acknowledgment status and psychological symptoms. Results indicated that acknowledged survivors reported more severe posttraumatic stress disorder symptoms, which were partially accounted for by turning against social reactions. Future studies should explore the mechanisms responsible for these relationships and analyze the individual social reactions.

Social network responses to victims of potentially traumatic events: A systematic review using qualitative evidence synthesis

Background

A substantial number of qualitative studies examined how adult victims of potentially traumatic events (PTEs) experienced support provided by family members, friends, colleagues, and other significant others in the informal network. Importantly, the large majority of qualitative studies focused on the perceived support of victims of specific events such as sexual offences, partner violence, homicide, accidents and disasters. Although it is likely that across specific PTEs there are similarities as well as differences in experienced support from the informal network, to date no systematic review synthesized the results of qualitative studies on support from the informal network following various types of PTEs. The aim of the present systematic review is to fill this gap in the scientific knowledge, which is also highly relevant for victim services, policymakers, and the informal network.

Methods

A literature search of qualitative studies was conducted using the electronic databases of PubMed, Web of Science, CINAHL, Psych INFO, Scopus, Criminal Justice Abstracts and Picarta. The quality of the identified studies was assessed with the Consolidated Criteria for Reporting Qualitative research (COREQ) checklist, followed by analysis of the results of the identified studies using Qualitative Evidence Synthesis.

Findings

Seventy-five papers were included in the synthesis, involving 2799 victims of PTEs such as accidents, disasters, homicide, intimate partner violence (IPV), and sexual offences. Saturation was only achieved for IPV. Overall, four major categories of perceived social support were identified, namely, support perceived as supportive, supportive but insufficient, unsupportive, and absent from informal support providers, which included friends, family, neighbors, (if applicable) offender’s family, religious group members, work/school colleagues, fellow victims, the local community, and the social network in general. Across the PTE groups, there were similarities in experiencing positive forms of support (particularly empathy and sharing experiences) as well as negative forms of support (abandonment, avoidance, lack of empathy, and not experiencing support despite victim’s request for help). There were also differences across PTE groups, in particular, victims of sexual and intimate partner violence mentioned a number of other supportive (mobilizing support, no unsupportive responses) and non-supportive (e.g., justification or normalization of violence and minimizing responses) responses.

Conclusions

The review showed that different actors within the social informal network can play an important role in providing support after victims experience violence, homicide, accidents, and disasters. However, the review revealed that the large majority of qualitative studies were aimed at victims of IPV, and only for this type of PTE was saturation achieved. This indicates that, although this synthesis identified several similarities and differences, it is still too early to draw more definitive conclusions on similarities and differences in experienced social support after various PTEs and that future qualitative studies focusing on other PTEs are much needed.

The Feasibility of a Novel Recruitment Protocol for Collecting Survivor Data via Disclosure Recipient Referrals

The current arricle describes a novel recruitment protocol for collecting data from sexual assault and intimate partner violence survivors referred to research studies by individuals to whom they had previously disclosed. Challenges in both recruiting participants and interpreting data are described. Only 35.8% of cases had usable data for both survivors and disclosure recipients, suggesting that this referral method had limited success in recruiting matched pairs. Suggestions for modifications to improve the protocol for future research are offered. Potential advantages and drawbacks of various methods for recruiting dyads are described in order to facilitate future research on survivors' disclosure processes, social reactions, and the influence of social reactions on survivor recovery.

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.

Chipped or Whole? Listening to Survivors' Experiences With Disclosure Following Sexual Violence

Sexual violence is a prevalent crime but vastly underreported and with serious long-term health consequences for survivors. Disclosure of sexual violence represents a social experience that may offer support towards healing or further traumatization depending on the response received. Although current research suggests that process of disclosure itself is important, as are social responses, there is a dearth of research examining the perceived impact of initial responses to disclosure on healing and relationships, particularly over time. The current study used data from nine focus groups with 45 survivors to explore the impact of initial disclosure reactions on recovery, from the survivors' perspectives. Constant comparative analysis identified several themes, including subtypes of positive and negative responses to disclosure and long-term impacts on healing and relationships. Survivors disclosed to informal and formal support persons and although many identified responses as positive or negative, some also experienced mixed responses. Survivors identified perceived long-term impacts on healing, interpersonal relationships, and social justice. Our findings suggest disclosures are a critical point for potential intervention after sexual violence. It is through the disclosure process that survivors can be supported and empowered to connect with others and move further along in their journey towards healing and recovery. Public awareness and promotion of positive responses could be designed to reach children and youth, so that the next generation is equipped with the tools to support each other in difficult times, particularly in the aftermath of sexual violence.

A Pilot Evaluation of an Intervention to Improve Social Reactions to Sexual and Partner Violence Disclosures

The purpose of this study was to evaluate an intervention (Supporting Survivors and Self [SSS]) created to increase positive social reactions and decrease negative social reactions to sexual assault and partner violence disclosures among informal support disclosure recipients. Participants were 1,268 college students from a medium-sized New England university who completed an online baseline survey and were assigned to either the treatment or control condition. The SSS intervention trained potential informal supports on what to say and not to say to disclosure recipients. Six months after the SSS intervention, participants in both conditions completed the follow-up survey online. Although intentions to provide positive social reactions significantly increased among participants in the treatment group compared with the control group and there were marginally significant effects in the anticipated directions for alcohol-specific intended social reactions, no overall difference was observed across conditions in actual social reactions provided. Moderation analyses suggested that, in general, the SSS intervention was more effective on various outcomes for students who were younger, male, non-White, sexual minorities, and/or non-victims. Moderation analyses also suggested that the intervention varied in efficacy depending on the circumstances of the disclosure. Despite the mixed outcomes of the SSS intervention, these data suggest that the SSS intervention was effective in improving social reactions for some students and under some circumstances. Future research is needed to further refine the SSS intervention to bolster its effectiveness in reducing negative social reactions and increasing positive social reactions for all students.

A Mixed-Method Process Evaluation of an Intervention to Improve Social Reactions to Disclosures of Sexual Assault and Partner Abuse

Because of the high rates and deleterious consequences of sexual assault (SA) and partner abuse (PA) on college campuses, there is a proliferation of programming to both prevent and respond to these issues. Most research to date, however, presents outcome evaluation data on these programs and neglects to present process evaluation data which are critical for program refinement and dissemination. The purpose of this study was to present process evaluation data (i.e., acceptability and feasibility) specific to a program that endeavored to increase positive and decrease negative social reactions from disclosure recipients to individuals disclosing SA and PA. Participants were 303 students who completed the program and participated in postintervention surveys and a subset of students (n = 18) who completed exit interviews. Results documented that the program was both feasible and acceptable, as evidenced by high satisfaction ratings. Important suggestions were also provided for how to improve the program, such as reducing repetition and making scenarios more realistic. Finally, participants who reported higher program engagement and more program usage generally reported more intentions to provide positive social reactions, less intentions to provide negative social reactions, and less actual negative social reactions. This information is useful not only for adapting the current program discussed herein but also for program developers and preventionists wishing to create similar programming to effectively prevent and improve response to SA and PA.

The Association Between a History of Sexual Violence and Romantic Relationship Functioning: A Systematic Review

The consequences of sexual violence are substantial and include both intra- and interpersonal problems. Notably, sexual violence has been associated with difficulties in interpersonal relationships including intimate relationships. While there have been prior reviews considering various interpersonal and dyadic consequences associated with sexual violence, there has not been a comprehensive review considering the various aspects of adult dyadic functioning including intimacy, relationship conflict, and satisfaction satisfaction among both child and adult victims of sexual violence. The databases PsycINFO and PubMed were searched for terms related to sexual victimization (e.g., sexual assault, sexual victimization, sexual abuse, rape, revictimization), terms related to relationships (e.g., romantic relationship, intimate relationship), and terms related to relationship functioning (e.g., satisfaction, relationship quality, conflict, communication, intimacy, sexual functioning). Eligible studies for this review were required to (1) be an original study, (2) be written in English, (3) identify a sample or subsample consisting of women reporting a history of sexual violence in either childhood or adulthood, and (4) measure at least one of the following relationship areas: intimacy, relationship conflict, or relationship satisfaction in heterosexual adult romantic relationships. A total of 20 articles met inclusion criteria and were included in this review. Results demonstrated mixed findings on the association between sexual violence and relationship functioning, with some studies demonstrating an association between sexual violence and relationship functioning, and others failing to find such associations. These findings are discussed within the context of gaps in the extant literature and future research directions.

Communicating a History of Sexual Trauma: Partner Responses to Women's Disclosure

The study aimed to understand how women who experienced sexual trauma but are now in a healthy relationship perceive their partners' responses to their disclosure of sexual trauma. Forty-one women completed an in-depth semi-structured phone interview. Responses were analyzed using reflexive thematic analysis, identifying two overarching themes and six subthemes. The results provide a voice to the needs and preferences of women who experienced sexual trauma, but are navigating communication in a healthy relationship. Given that most women disclosed their experiences with partners, this sample provides valuable insight for clinicians, interventionists, and partners of survivors to navigate supportive interactions.

Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities

The disclosure of child sexual abuse (CSA) is a complex process that remains partially understood, despite its crucial role in survivors' recovery. Gender specific experiences of disclosure have been little investigated while this information is crucial to better tailor interventions for survivors. This qualitative study aims to 1) explore survivors' experiences in disclosing to close ones, and 2) contrast experiences of male and female survivors. Fifty-one CSA survivors (25 women and 26 men) aged 18 years or older were recruited via community services for survivors. Two main categories emerged from thematic content analysis: 1) experiences of disclosure hindering CSA recovery or 2) ones fostering CSA recovery. Men felt ignored when their close ones were focused on their own emotions of indifference, helplessness and guilt toward CSA. Men felt guilty when confronted with reactions of blame for their own inaction or disempowered when pressured to remain silent or to forgive. Women felt ignored when their close ones showed anger toward their perpetrator. Women felt guilty when they were held accountable for CSA events or disempowered when pressured to take legal actions. Women, but not men, reported feeling considered through caring and heart-to-heart discussions. Recommendations for awareness messages and practitioners are discussed.

"I've Never Told Anyone": A Qualitative Analysis of Interviews With College Women Who Experienced Sexual Assault and Remained Silent

The purpose of this study was to gain an understanding of the decision made by some college women who are raped to tell no one. In-depth interviews were conducted with 15 college women between the ages of 19-24 who had never shared their sexual assault with anyone prior to speaking to the researchers. This study provides a systematic investigation of the factors underlying women's decisions to remain silent. The knowledge and understanding gained from these in-depth interviews offer insight for individuals and institutions to support these students and for the development of future efforts encouraging women survivors to tell someone.

How Do Victims of Sexual Violence Benefit From Mutual Disclosure? An Exploratory Study of Women in South Korea

Sexual violence victims in the Republic of Korea (henceforth, South Korea) have mutual support groups that provide a variety of programs promoting mutual disclosure between them. These programs are based upon the premise that responses within those groups are more supportive than conventional responses; however, there is no empirical evidence of mutual disclosure. The aim of the current study is to answer two research questions: (a) How do responses and outcomes of mutual disclosure compare with those of traditional disclosure? and (b) What themes describe mutual disclosure as distinguishable from a traditional one? A sample of 25 Korean sexual violence victims reported their disclosure experiences by responding to a survey and/or an in person interview. This study found that responses and outcomes of mutual disclosure were overall positive based on their similar victimized experience. The finding emphasizes a balance between a victim's dual role as help-seeker and support provider for the benefits of mutual disclosure. Existing mutual support groups and relevant institutions should consider the aspects and effects of mutual disclosure to provide more opportunities for victims to speak out as well as to foster greater access to support.

A Dyadic Study of Impacts of Sexual Assault Disclosure on Survivors' Informal Support Relationships

After a sexual assault, victims often disclose their assault to an informal support provider (SP) to receive social support. Ample research exists on social reactions of informal SPs to disclosure and how those reactions affect the victim both positively and negatively, but little research exists on how the disclosure impacts a survivor's support relationships both in the short and in the long term. This qualitative interview study examined 45 ethnically diverse informal support dyads where women disclosed sexual assault to an informal SP (e.g., friend, family, significant other). Assault disclosure was examined to determine its impact on relationship quality of survivors and their SPs. Results revealed positive and negative effects on survivor-SP relationships of assault disclosure and social reactions. In almost all matched pairs (91%), the survivor, SP, or both remarked on how the relationship had changed following disclosure. Family member SPs spoke of survivors' risk-taking and poor relationship choices. Significant others spoke of the toll of supporting survivors who sometimes left their needs unmet and strained their relationships with survivors. Friend SPs often appraised how the survivor engaged in other types of relationships, but overall felt that their relationships had become stronger or closer as a result of the disclosure. Implications of this study include acknowledging that informal supporters, particularly significant others, can experience adverse effects after disclosure, and that help is needed not only for survivors but also for their informal support sources. Future research should continue to investigate both the short-term and longitudinal impacts of sexual assault disclosure on survivors' informal support relationships.

Social Reactions Received by Survivors of Intimate Partner Violence: A Qualitative Validation of Key Constructs From the Social Reactions Questionnaire

The majority of intimate partner violence survivors tell at least one person about the abuse, and the reactions of these support providers can have a profound impact on survivors' recovery. In recent years, the Social Reactions Questionnaire (SRQ) has become the predominant measure of social reactions toward intimate partner violence survivors, but the SRQ was developed based on the experiences of sexual assault survivors only. To determine how well intimate partner violence survivors' descriptions of social reactions from informal support providers align with constructs in the SRQ, we examined qualitative interview data about survivors' interactions with informal support providers obtained from a larger study with 113 female survivors of intimate partner violence. Excerpts were coded inductively, and a total of 12 types of social reactions emerged. Seven of these social reactions aligned with existing social reactions in the SRQ: (a) emotional support, (b) tangible aid, (c) blame, (d) took control, (e) treated differently, (f) egocentric reactions, and (g) distraction. An additional six reactions emerged as separate constructs, including (h) minimization, (i) told to leave, (j) advice, (k) interventions, and (l) indifference. These findings highlight the need for direct interventions with friends and family members to improve social reactions toward intimate partner violence survivors.

Testing the pathway from pre-migration sexual violence to suicide-related risk among North Korean refugee women living in South Korea: do social networks matter?

PURPOSE

To examine the pathways from pre-migration sexual violence to suicide-related risk via the lack of important social networks among North Korean refugee women living in South Korea.

METHODS

As part of a larger study, cross-sectional social network data from 273 North Korean refugee women aged 19 or older (M = 41 years; range = 19-69) were collected by self-reported surveys from April to May 2014 in South Korea. Snowball sampling was used for participant recruitment. We analyzed whether lack of network diversity and lack of kin ties mediated the association between pre-migration sexual violence and suicide-related risk in two multivariable mediation analyses.

RESULTS

The prevalence of past-year suicide-related risk was 34.4% in our study sample, and 31.1% of the participants reported at least one type of pre-migration sexual violence. Pre-migration sexual violence was associated with increased suicide-related risk. Lack of network diversity (b = 0.03, 95% CI 0.01-0.07) and lack of kin ties (b = 0.03, 95% CI 0.01-0.08) partially mediated this association.

CONCLUSION

Assessment of pre-migration sexual violence victimization needs to begin at an early stage of resettlement. Study findings highlight the urgent need to create suicide prevention programs that incorporate social network interventions, especially for North Korean refugee women who have experienced sexual violence during migration.

Who Helps the Helpers? Social Support for Rape Crisis Advocates

Secondary exposure to trauma may have negative effects on rape victim advocates' well-being. Self-care can help to mitigate these negative effects on advocates' well-being, and prior research suggests that social support is an especially important aspect of advocates' self-care. However, there is a lack of research on how rape crisis advocates access and receive social support in relationship to their advocacy work. Therefore, semistructured qualitative interviews were conducted with 15 rape crisis advocates who volunteered for a rape crisis center in Chicago to understand how they accessed social support from informal and formal support providers, and when they did receive support, what was helpful versus unhelpful. Data were analyzed using thematic content analysis. Results revealed that many advocates were able to seek out and receive positive instrumental and emotional social support that nurtured them and their work. However, advocates also experienced a variety of barriers to obtaining positive support from informal support providers, including fear of burdening providers and a reluctance or lack of preparedness of their support providers to speak about the issue. Advocates emphasized the need for rape crisis centers to provide resources for their informal social support systems in order to encourage helpful responses. In addition, advocates praised the rape crisis center for its built-in formal support structures, but also encouraged the organization to seek broader representation of persons from minority backgrounds among their advocates and mentors. Implications and future directions for research and rape crisis centers are also discussed. The present study highlights the importance of social support systems for advocates and potential barriers that may be addressed to reduce service provider burnout and vicarious trauma.

Alcohol's Role in Social Reactions to Sexual Assault Disclosures: A Qualitative Study of Informal Support Dyads

Studies of informal support dyads are lacking to understand the disclosure of sexual assaults and social reactions informal supporters make to survivors. This study of 19 informal support dyads using interview data examined how three relationship types-significant others (i.e., romantic partners), family, and friends-differ in social reactions to sexual assaults in the context of drinking or alcohol problems. It was expected that alcohol's role in responses to such disclosures would differ depending on relationship type as well as role alcohol played in the assault and/or in the survivor's life or those in her social network, including the perpetrator. Results show that alcohol has mixed effects and that alcohol-related assaults as well as contexts where survivors, perpetrators, and/or their support networks have alcohol problems need further study to understand how such disclosures and social reactions occur and the impact they have on survivors, their relationships, and recovery.

Navigating Sex and Sexuality After Sexual Assault: A Qualitative Study of Survivors and Informal Support Providers

Qualitative interview data from 45 matched pairs of survivors disclosing sexual assaults and their primary informal support providers (e.g., friend, family member, significant other) were used to explore survivor and support provider perspectives on changes in sexuality postassault and how those close to them have been affected as a result. Changes in sexuality included loss of interest in sex, increase or change in sexual partners, engaging in sex work, and increased sexual behavior. Support providers generally regarded promiscuity as a risky sexual behavior. If the support provider was the survivor's sexual partner, he or she discussed exercising caution when navigating sexual intimacy with the survivor. Not all sexual encounters with romantic partners were positive; some survivors discussed being triggered (i.e., with post-traumatic stress disorder [PTSD] flashbacks) or experiencing the dissolution of their relationships due to the sexual impacts of their assault. Counseling implications are discussed in the context of improving survivors' sexual experiences in general and in romantic relationships postassault. Implications can also be applied to prevention, scholarship on sex work, and sexuality research.

Social reactions to disclosure of interpersonal violence and psychopathology: A systematic review and meta-analysis

Public attention has been increasingly paid to how friends, family members, and others can best support survivors of sexual assault and other forms of violence. The broader social support literature posits that perceiving social support positively is more important to mental health than the degree to which social support is actually received, and that negative interactions with social supporters are more harmful than positive interactions are helpful (potentially because negative reactions violate survivors' expectations of their social supporters). This may be especially true after a crisis, such as interpersonal violence. Thus, this systematic review and meta-analysis summarizes the literature on social reactions to interpersonal violence. Meta-regression analyses were performed on 1871 correlations from 51 studies reflecting the degree to which receiving specific reactions more frequently, or perceiving reactions more positively, was associated with psychopathology. Results indicated that negative social reactions to disclosure-especially reactions involving controlling, distracting, and treating survivors differently-were associated with worse psychopathology, whereas positive social reactions did not appear to be protective. Perceiving reactions more positively was associated with less severe psychopathology, but (although causation cannot be concluded) positive perceptions' potential benefit appeared to be smaller than the potential risk conveyed by negative reactions. These findings indicate that interventions which reduce the degree to which survivors receive negative social reactions are needed.

Reliability and Findings From an Instrument Examining Sexual Assault Disclosure Content and Context: The Sexual Assault Inventory of Disclosure

Compared to the depth of research examining the impact of sexual assault disclosure and related responses from others, little is known about the content shared during disclosures. Categorizing survivors as disclosers or nondisclosers disregards the nuanced and complex nature of disclosure. To address this gap, the current studies examined the reliability and preliminary results of the Sexual Assault Inventory of Disclosure (SAID), an inventory of content shared during disclosures and the context in which it was shared. The SAID proved reliable and preliminary findings suggest that perceptions of disclosures as positive or negative are predicted by differences in content and context, above and beyond disclosure recipients' response. The current study also explored gender differences in disclosure. Additional findings, implications, and suggestions for future studies using the SAID are discussed.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Title IX Mandated Reporting: The Views of University Employees and Students

Per Title IX of the Higher Education Amendments of 1972, many university employees are mandated reporters of sexual assault. University employees (N = 174) and students (N = 783) completed an online survey assessing knowledge and opinions of this reporting requirement. University employees and students generally reported being quite knowledgeable of reporting requirements. Most university employees indicated they would report an incident disclosed by a student, but students were fairly ambivalent about whether they would disclose to faculty members. Nearly one in five students (17.2%) indicated that Title IX reporting requirements decreased their disclosure likelihood. These findings suggest that mandated reporting policies, as well as how they are presented to students and faculty, should be examined in order to increase compliance and facilitate disclosure.

Social Reactions to Sexual Assault Disclosure: A Qualitative Study of Informal Support Dyads

This interview study examined 45 informal support dyads where sexual assault was disclosed. Analysis showed social reactions and appraisals of reactions varied by relationship type (family, friend, significant other). Themes identified were role reversal or "parentification" of supporters, reactions of anger and aggression toward perpetrators, supporters using their own trauma experiences to respond to survivors, and reactions of betrayal. Results revealed the potential for identifying relational patterns and dynamics occurring in social reactions through dyadic analysis not otherwise captured by a survivor-only perspective. This approach helps understand and address distinct relationship contexts to improve supporters' reactions to sexual assault disclosure.

"Everybody's Really Close-Knit": Disconnections Between Helping Victims of Intimate Partner Violence and More General Helping in Rural Communities

Social support is key to well-being for victims of intimate partner violence (IPV), and bystanders have an important role to play in preventing IPV by taking action when there is risk for violence. The current study used qualitative interviews to explore young adults' perspectives on helping in situations of IPV, and more general helping, in the rural communities in which they resided. Participants were 74 individuals between the ages of 18 and 24 years from 16 rural counties across the eastern United States. Participants generally described their communities as close-knit and helpful, especially around daily hassles (e.g., broken down car) and unusual circumstances (e.g., house fire). Although participants generated ways in which community members help IPV victims, these mostly focused on providing support or taking action in the aftermath of IPV as opposed to more preventive actions. Lack of financial resources were uniquely cited as a barrier to more general helping, whereas concerns about privacy and lack of deservingness of help were barriers to both general helping and helping in IPV situations, although these were more pronounced in IPV situations than general helping situations. Taken together, these results suggest that although people generally see their communities as helpful and close-knit, these perceptions and scripts did not necessarily translate to helping in situations of IPV. Bystander intervention programs are needed that provide more specific helping scripts for IPV.

Naming the Unspeakable Harm of Street Harassment: A Survey-Based Examination of Disclosure Practices

Street harassment may be considered an “unspeakable” harm on account of the routine silencing and trivialization of victims’ experiences. Disclosing street harassment is vital in making its harms visible and in working to transform social and cultural attitudes. Despite a recent resurgence of interest in street harassment via online activist groups, there is scant research on disclosure practices. Drawing on findings from an online, mixed-methods survey with 292 participants who have experienced street harassment, I examine disclosure practices using an intersectional lens. I argue that disclosure is an epistemological process, through which a limited and partial understanding of street harassment is produced.

Postassault Substance Use and Coping: A Qualitative Study of Sexual Assault Survivors and Informal Support Providers

This qualitative interview study examined 45 informal support dyads where a sexual assault was disclosed. Data from matched pairs of survivors and their primary informal support provider (e.g., friend, family, significant other), were used to explore the survivor-support provider (SP) perspectives of coping with assault-related distress via substance use and the effects of survivor substance use on the survivor-SP relationship. Results revealed that survivors' use of drinking and/or drugs to cope had both positive and negative effects on survivor-SP relationships. Findings also showed that SPs play various roles in providing support to survivors who cope via substance use, including engaging in substance use with the survivor and efforts to help get help in their recovery from the assault and substance abuse. Suggestions are made for how safe spaces can be provided where survivors and supporters can get information and treatment, whether formal or informal, that addresses sexual assault, PTSD and substance abuse issues in an integrated way.

Understanding Support Providers' Views of "Helpful" Responses to Sexual Assault Disclosures: The Impacts of Self-Blame and Physical Resistance

Prior research on the factors associated with various disclosure responses has often been conducted on sexual assault victims and formal support providers, while informal helpers, who are the most common recipients of disclosures, have received far less attention. This experimental study examined potential informal helpers' views of disclosure reactions and their influence on the self-reported likelihoods of engaging in those responses. Undergraduate students at a large Canadian university ( N = 239) received vignettes describing a hypothetical sexual assault disclosure that varied on victim's self-blame and physical resistance, and then rated common disclosure reactions. The results revealed that participants' perceptions of various responses were at odds with victims' experiences, with many negative responses, such as victim blame and egocentrism, viewed as equally or more helpful than positive responses, such as emotional support. Moreover, when the victim blamed herself and did not physically resist, positive responses were seen as less helpful whereas negative responses were seen as more helpful, with some notable gender differences. Regression analyses indicated that the perceived helpfulness of each response was the strongest predictor of the likelihood of providing that response. Practical implications of these findings are discussed.

"You Blame Me, Therefore I Blame Me": The Importance of First Disclosure Partner Responses on Trauma-Related Cognitions and Distress

Trauma recovery processes may be understood within a socioecological model. Individual factors (such as sex of the survivor) and microsystem factors (including trauma characteristics) have been studied extensively. However, there is a paucity of research examining the effects of macrosystem factors on the impact of trauma-especially examining how the response of the first person to whom the survivor disclosed affects trauma-related cognitions and distress. Sixty-three college student participants reported a history of disclosing at least one traumatic event in an online, anonymous survey. Participants also provided information on the first person they told about the trauma, the social reactions of that person, general social reactions to trauma disclosure, the participants' trauma-related cognitions and psychological distress (PTSD, other mental health issues), details about the traumatic event, and basic demographic information. Paired sample t tests showed that participants experienced the responses of the first person they told about their trauma as more favorable than the responses of the all of the people to whom they told about the event. Women and survivors of non-interpersonal trauma reported more supportive responses than men and survivors of interpersonal trauma. Hierarchical linear regressions showed that interpersonal trauma and victim blame on the part of the first person the survivor told were associated with more negative trauma-related cognitions. Interpersonal trauma, emotional support, and victim blame were associated with a greater degree of trauma-related distress. The results suggest that participants perceived the response of the first person they told as more beneficial than the response of the rest of their exosystem. However, the reactions of the first person the survivor told differed based on the sex of the survivor and the type of trauma they experienced. Consistent with previous research, interpersonal trauma and victim blame by the first person the survivor told about the trauma were associated with more trauma-related distress and negative cognitions. Trauma-related distress was also associated with greater emotional support by the disclosure partner. The results support the use of the socioeological model to better understand the complex nature of trauma recovery and have implications for prevention.

An Ecological Model of Well-being After Sexual Assault: The Voices of Victims and Survivors

In this article, the authors describe factors that enhance or detract from well-being after adult sexual assault from the perspective of sexual assault victims and survivors. The authors present a holistic view of the complex ways in which women respond to and cope with the impact of adult sexual assault while trying to create a sense of well-being. The forces that facilitate or detract from well-being are organized into an ecological model. The data originate from a grounded theory study in 2015, with 22 adult female adult sexual assault victims/survivors.

Seeing Roses in the Thorn Bush: Sexual Assault Survivors' Perceptions of Social Reactions

OBJECTIVE

After sexual assault, survivors often reach to others for support and receive a range of reactions. Although these reactions have been characterized by researchers as positive (e.g., emotional support) or negative (e.g., victim blaming), survivors vary in their perceptions in ways that do not always match this framework. The goal of this research was to examine the degree to which designations of reactions as "positive" or "negative" fits across types of reactions and explain instances of mismatch between these designations and survivors' perceptions.

METHOD

We conducted a qualitative analysis of interviews with 26 survivors of sexual assault to identify themes in their perceptions of social reactions.

RESULTS

Although social reactions were generally perceived in a manner that matched researcher categorizations, there was significant variation. Perceptions could be characterized in terms of whether the reaction felt comfortable/soothing, consistent with survivors' needs/hopes/expectations, and helpful in the long term. The closeness of survivors' relationships with responders, the degree to which they were impacted by the assault, and the presence of other social reactions explained variation from researcher designations of reaction types.

CONCLUSION

This study clarifies the considerations that survivors make when evaluating social reactions and what accounts for discrepant perceptions of these reactions; in particular, they highlight that there is no "one size fits all" reaction to survivors of sexual assault and the context in which reactions occur may affect how they are seen.

Correlates of Disclosure Cessation After Sexual Assault

Contacts with responders after sexual assault may influence further disclosure, but this possibility has not been explored empirically. Thus, this study investigates associations between survivors' contacts with responders and their decisions to discontinue disclosure. Fifty-four college students with a history of unwanted sexual experiences described 94 ordered contacts with responders. Results indicate that survivors' perceptions of responsiveness were not associated with continued disclosure, but survivors were more likely to continue disclosing when they perceived more rape myth acceptance from responders and when the assault was more recent. These findings highlight survivors' tenacity in meeting their needs, even after problematic responses.

Barriers to Healthcare Provision for Victims of Sexual Assault: A Grounded Theory Study

Background:

Victims of sexual assault need comprehensive healthcare services to deal with the consequences of their experience. However, there are still many girls/women that delay seeking healthcare after they experience sexual assault.

Objectives:

To explore the process of health care and clinical services for victims of sexual assault in the health care centers of Iran.

Patients and Methods:

This was a qualitative study based on the grounded theory method. The sample consisted of 23 health care providers and 10 victims of sexual violence. Unstructured interviews and observations were used for data collection. Constant comparative analysis was used according to the Strauss and Corbin method.

Results:

The analysis of all data led to the extraction of four categories: “performing routines”, “victims’ expectations”, “conflict between expectations of victims and existing healthcare services”, and the core category of “neglect of healthcare providers to address the needs and expectations of victims”. Providers were offering health care to the victims of sexual violence regardless of their needs. Due to this neglect, victims sought illegal solutions to overcome the consequences that led to social stigma.

Conclusions:

The findings indicate the lack of mutual understanding between health care providers and victims of sexual violence in relation to the expectations and priorities of victims.

Sexual Assault Disclosure Recipients' Experiences: Emotional Distress and Changes in the Relationship With the Victim

Sexual assault victims are more likely to disclose their experience to friends and family than formal support sources (e.g., police, counselors). As such, disclosure receipt is a relatively common occurrence, but little is known about the recipients' disclosure experience. This study examined predictors of recipient emotional distress and positive and negative changes in the victim-recipient relationship postdisclosure among 69 female undergraduates at 3 universities. Predictors of distress included greater self-rated closeness to the victim and greater confusion about how to help. Positive changes were predicted by greater closeness and less responsibility attributed to the victim, and negative changes were predicted by less closeness, greater assigned responsibility, and greater perceived ineffectiveness of one's help. Implications for improving the disclosure experience via psychoeducational interventions are presented.

Disclosing Sexual Assault Within Social Networks: A Mixed-Method Investigation

Most survivors of sexual assault disclose their experiences within their social networks, and these disclosure decisions can have important implications for their entry into formal systems and well-being, but no research has directly examined these networks as a strategy to understand disclosure decisions. Using a mixed-method approach that combined survey data, social network analysis, and interview data, we investigate whom, among potential informal responders in the social networks of college students who have experienced sexual assault, survivors contact regarding their assault, and how survivors narrate the role of networks in their decisions about whom to contact. Quantitative results suggest that characteristics of survivors, their social networks, and members of these networks are associated with disclosure decisions. Using data from social network analysis, we identified that survivors tended to disclose to a smaller proportion of their network when many network members had relationships with each other or when the network had more subgroups. Our qualitative analysis helps to contextualize these findings.

Impact of dissociation on treatment of depressive and anxiety spectrum disorders with and without personality disorders

OBJECTIVE

The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders.

METHODS

The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety-depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program - Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale.

RESULTS

A total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86%) patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the questionnaires). The patients' mean ratings on all measurements were significantly reduced during the treatment. Also, 67.5% reached at least minimal improvement (42.4% showed moderate and more improvement, 35.3% of the patients reached remission). The patients without comorbid personality disorder improved more significantly in the reduction of depressive symptoms than those with comorbid personality disorder. However, there were no significant differences in change in anxiety levels and severity of the mental issues between the patients with and without personality disorders. Higher degree of dissociation at the beginning of the treatment predicted minor improvement, and also, higher therapeutic change was connected to greater reduction of the dissociation level.

CONCLUSION

Dissociation is an important factor that influences the treatment effectiveness in anxiety/depression patients with or without personality disorders resistant to previous treatment. Targeting dissociation in the treatment of these disorders may be beneficial.

Pathways to Help

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors’ disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged—and assisted—the survivors in seeking help. Throughout this process, the survivors’ disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors’ wishes; the adults made the victims seek help, which was also against the survivors’ preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims’ continued engagement with these systems.

Informal social reactions to college women's disclosure of intimate partner violence: associations with psychological and relational variables

This researchers assessed informal (e.g., friends, family) social reactions to college women's (N = 139) disclosure of intimate partner violence (IPV) within their current romantic relationships and associated psychological (i.e., posttraumatic stress symptoms [PTSS] and global psychological distress symptoms) and relational (i.e., intentions to leave the abusive relationship) variables. Women completed confidential surveys, which assessed current partner abuse, psychological and relational variables, and three types of social reactions from informal supports to disclosure of IPV: positive (e.g., believing, validating the victim), negative (e.g., disbelieving, blaming the victim), and leaving (i.e., being told to end the relationship) reactions. At the bivariate level, negative social reactions to women's disclosure were related to increases in global psychological distress, PTSS, and leaving intentions; positive social reactions to disclosure related only to increases in PTSS; and being told to leave the relationship related to increases in PTSS and leaving intentions. In the regression analyses, after controlling for abuse severity, negative social reactions were significantly related to global psychological distress and PTSS, and being told to leave significantly related to leaving intentions and PTSS. Mechanisms for these relationships and implications are discussed.

Altered connectivity within the salience network during direct eye gaze in PTSD

BACKGROUND

Posttraumatic stress (PTSD) disorder has been associated with heightened threat sensitivity. Evidence suggests that direct eye gaze leads to sustained activation of the superior colliculus/periaqueductal grey within individuals with PTSD. The present analysis investigated functional connectivity within the salience network (SN) in the same sample as presented in a prior publication during direct versus averted gaze in adults with PTSD related to childhood maltreatment as compared to healthy individuals.

METHODS

Functional connectivity within the SN was examined using functional magnetic resonance imaging while participants viewed avatars positioned in direct versus averted gaze relative to the participant in 16 individuals with PTSD related to childhood maltreatment and 16 healthy control subjects. Connectivity within the SN was assessed via Independent Component Analysis (ICA). Associations with symptom severity were explored with multiple regression analyses on individual subject components.

RESULTS

Temporal multiple regression analyses revealed higher connectivity within the SN during direct versus averted gaze which was more pronounced in individuals with PTSD as compared to healthy controls. Compared to controls, individuals with PTSD showed increased integration of the left amygdala and the right insula within the SN. PTSD symptom severity was positively associated with connectivity of the right mid-cingulate cortex within the SN in PTSD subjects only.

CONCLUSIONS

Participants with PTSD showed enhanced coupling of the amygdala and the insula within the SN as compared to healthy control subjects during gaze processing. Our results provide evidence for an increased sensitivity of the salience network to direct versus averted gaze in individuals with PTSD related to childhood maltreatment.