Struggling to survive: sexual assault, poverty, and mental health outcomes of African American women

Exploration of Black/African American College Survivors of IPV During COVID-19 Utilizing Descriptive Analysis

The last few decades have ushered in an increase in scholarship focused on campus-based violence, specifically sexual violence, sexual assault, and unwanted sexual experiences. This rise in sexual violence scholarship has promoted the examination of current campus-based interventions, resources, and response systems. However, there exists a dearth of research exploring the experience of intimate partner violence for college students within college/university settings. In this descriptive analysis, we capture the prevalence of intimate partner violence for a nationwide sample of 1,035 college students across diverse college and university campuses within the United States. Researchers utilized a sociodemographic questionnaire and the Intimate Partner Violence Screening Questionnaire to capture and measure college students' experiences of intimate partner violence during the COVID-19 pandemic. To analyze the data, the Statistical Package for Social Sciences (SPSS 28) was used. Univariate analyses and cross-tabulation analyses were conducted to examine the data. Specifically, due to the majority of research focusing on cisgender, White heterosexual women respondents, we focus our analysis on the experiences of Black and/or African American survivors of intimate partner violence on college campuses, in hopes of capturing the prevalence of intimate and relationship violence for Black/African American college students across colleges and universities. Results of this study revealed the prevalence of all types of intimate partner violence and abuse such as emotional/psychological, physical, and sexual violence within Black/African American college students. Findings from this database study produce implications for college/university campuses to consider capacity to address enduring psychological concerns and outcomes tied to intimate partner violence within college/university campuses, while also considering culturally responsive prevention and intervention efforts.

An Interpretative Phenomenological Analysis of Black Women's Meaning and Experiences of Sexual Anxiety

Sexual anxiety can activate the stress response cycle during sex, compromising a woman's ability to experience sexual pleasure. Black women face additional cultural and contextual factors, such as hypersexualization, partner scarcity, and higher rates of sexual trauma that may increase the magnitude, frequency, and odds of experiencing sexual anxiety. However, limited research has explored this phenomenon among Black women. Thus, we sought to qualitatively explore how N = 25 premenopausal Black women living in the southern United States make meaning of experiences with sexual anxiety. We analyzed the interview data using an interpretive phenomenological approach. Three components of the phenomenon of sexual anxiety were gleaned: 1) causes of sexual anxiety, 2) characteristics of sexual anxiety, and 3) coping strategies. Each component included three to six elements of meaning making. For these Black women, causes of sexual anxiety included fears of sexual pain, partner unfamiliarity, previous traumas, mental health concerns, and intersecting socio-structural factors. Characteristics of sexual anxiety included mental, somatic, and emotional elements. Coping strategies included having a reassuring and supportive sex partner, supporting themselves with affirmations and mindfulness, attending therapy, and using substances. Through reflection about their perceived causes of, experienced characteristics of, and intentional coping with sexual anxiety, meanings were co-constructed through an intersectional frame. Implications for intersectionality-informed interventions and suggestions for mental health professionals and partners are discussed.

Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples

BACKGROUND

Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups.

OBJECTIVE

To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups.

DESIGN

Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age.

PARTICIPANTS

Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate).

MAIN MEASURES

SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool.

KEY RESULTS

Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation.

CONCLUSIONS

Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.

Prediction of adverse events risk in patients with comorbid post-traumatic stress disorder and alcohol use disorder using electronic medical records by deep learning models

BACKGROUND

Identifying co-occurring mental disorders and elevated risk is vital for optimization of healthcare processes. In this study, we will use DeepBiomarker2, an updated version of our deep learning model to predict the adverse events among patients with comorbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD), a high-risk population.

METHODS

We analyzed electronic medical records of 5565 patients from University of Pittsburgh Medical Center to predict adverse events (opioid use disorder, suicide related events, depression, and death) within 3 months at any encounter after the diagnosis of PTSD+AUD by using DeepBiomarker2. We integrated multimodal information including: lab tests, medications, co-morbidities, individual and neighborhood level social determinants of health (SDoH), psychotherapy and veteran data.

RESULTS

DeepBiomarker2 achieved an area under the receiver operator curve (AUROC) of 0.94 on the prediction of adverse events among those PTSD+AUD patients. Medications such as vilazodone, dronabinol, tenofovir, suvorexant, modafinil, and lamivudine showed potential for risk reduction. SDoH parameters such as cognitive behavioral therapy and trauma focused psychotherapy lowered risk while active veteran status, income segregation, limited access to parks and greenery, low Gini index, limited English-speaking capacity, and younger patients increased risk.

CONCLUSIONS

Our improved version of DeepBiomarker2 demonstrated its capability of predicting multiple adverse event risk with high accuracy and identifying potential risk and beneficial factors.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Prediction of Adverse Events Risk in Patients with Comorbid Post- Traumatic Stress Disorder and Alcohol Use Disorder Using Electronic Medical Records by Deep Learning Models

Background

Prediction of high-risk events in mental disorder patients is crucial. In our previous study, we developed a deep learning model: DeepBiomarker by using electronic medical records (EMR) to predict suicide related event (SRE) risk in post-traumatic stress disorder (PTSD) patients.

Methods

We applied DeepBiomarker2 through data integration of multimodal information: lab test, medication, co-morbidities, and social determinants of health. We analyzed EMRs of 5,565 patients from University of Pittsburgh Medical Center with a diagnosis of PTSD and alcohol use disorder (AUD) on risk of developing an adverse event (opioid use disorder, SREs, depression and death).

Results

DeepBiomarker2 predicted whether a PTSD + AUD patient will have a diagnosis of any adverse events (SREs, opioid use disorder, depression, death) within 3 months with area under the receiver operator curve (AUROC) of 0.94. We found piroxicam, vilazodone, dronabinol, tenofovir, suvorexant, empagliflozin, famciclovir, veramyst, amantadine, sulfasalazine, and lamivudine to have potential to reduce risk.

Conclusions

DeepBiomarker2 can predict multiple adverse event risk with high accuracy and identify potential risk and beneficial factors. Our results offer suggestions for personalized interventions in a variety of clinical and diverse populations.

Unmet need for mental health services utilization among under-resourced Black and Latinx adults

INTRODUCTION

Substantial unmet need for mental health services (MHS) exists in the United States, with pronounced disparities among people of color. Research highlights the need to identify facilitators and barriers to MHS utilization among Black and Latinx individuals to better promote overall health. We tested an expanded model of MHS use based on Andersen's (1995) conceptual framework of health care utilization. Associations were examined between sociodemographic variables, trauma and adversity burden, living with HIV, and unmet need for MHS in a community sample of underresourced Black and Latinx individuals. Barriers to MHS utilization are described.

METHODS

Five-hundred participants completed the UCLA Life Adversities Screener (LADS), sociodemographic measures, and items assessing need for and barriers to MHS.

RESULTS

228 (46%) participants reported a need for MHS; of these, 115 (51%) reported receiving MHS. A binomial logistic regression model estimated the relative contribution of the LADS on need for MHS. Severity of LADS, younger age, and living with HIV predicted unmet need for MHS. Barriers to MHS included financial and time constraints and health system-related issues. One-way analysis of variance (ANOVA) tests revealed differences in mental health symptoms by MHS need.

DISCUSSION

The unmet need for MHS in this sample of Black and Latinx individuals highlights the importance of addressing the systemic roots of trauma and adversity burden, and eliminating structural barriers to treatment to reduce existing health and mental health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual violence among young women in Nigeria: a cross-sectional study of prevalence, reporting and care-seeking behaviours

BACKGROUND

Only a few studies, mostly hospital-based, have examined sexual violence among young people women in Nigeria. We examined the prevalence, correlates, perpetrators, reporting of and health-seeking behaviour for sexual violence using data of 395 young women (aged 17-24) obtained from a Nigerian university.

METHODS

We selected participants using stratified sampling and defined sexual violence as sexual acts or attempts to obtain sexual acts by violence or coercion by any person irrespective of their relationship to the victim. Descriptive and inferential statistics were used to summarise the data obtained.

RESULTS

Our analysis shows that 39.5% of the respondents had experienced some form of sexual violence. Adequate family financial support was protective against sexual violence after adjusting for all background characteristics (AOR: 0.60 95% CI: 0.39-0.93). However, young women who use alcohol had higher odds of reporting sexual violence experience than those who never used alcohol. In most cases (78.5%), perpetrators were well known to the victims. Only 3.3% of sexual violence cases were reported to law enforcement agencies and just 13.1% of victims sought care from health providers.

CONCLUSION

Sexual violence occurs at a tragically high frequency, and victims rarely report incidents to law enforcement agencies or access the much-needed care. The findings suggest a need for interventions that address why victims of sexual violence rarely report to law enforcement or seek care.

Distinctive impacts of sexual trauma versus non-sexual trauma on PTSD profiles in highly trauma-exposed, Black women

BACKGROUND

Prior findings suggest that psychopathology following interpersonal trauma or assaultive violence may present differently from prototypical posttraumatic stress disorder (PTSD). However, whether this is true for sexual trauma (ST) in the context of other salient lifetime traumatic experiences is yet unknown. We predicted that ST exposure may result in higher avoidance and numbing symptoms and blunted fear responses, relative to non-sexual trauma (NST), particularly if ST occurred during childhood.

METHODS

Participants were n = 5163 Black women recruited in an urban public hospital. We investigated effects of ST on PTSD symptoms, fear-potentiated startle (FPS) response (n = 285), and amygdala reactivity and habituation to social threat cues with fMRI (n = 95).

RESULTS

ST was associated with greater PTSD symptoms (p = 2.64 × 10^-21), but this was observed across all symptom clusters. Women who experienced repeated ST in both childhood and adulthood showed greater PTSD (p = .0009) and numbing symptoms (p = .002). In the FPS paradigm, the ST group startled more on all blocks and stimulus types than the NST group (p = .004). Developmental timing of ST did not influence startle magnitude. ST was not associated with amygdala habituation or reactivity.

LIMITATIONS

Generalizability is limited to Black women with a high trauma burden. Associations are cross-sectional, limiting causal conclusions.

CONCLUSION

While survivors of ST may present with more severe PTSD symptoms, their profiles are not characteristically different from similar NST controls. Childhood sexual abuse exposure alone did not result in a unique symptom profile. ST represents a uniquely high-burden stressor with likelihood for more severe posttraumatic outcomes.

The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women

Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures.

Sexual assault survivors' engagement with advocacy services during the COVID-19 pandemic

Sexual assault advocates provide support to survivors as they navigate medical, legal, housing, and other complex systems. However, social distancing measures enacted in response to coronavirus disease 2019 (COVID-19) forced changes to traditional advocacy services. The current study aimed to understand how the COVID-19 pandemic transformed survivors' engagement with sexual assault advocacy services. Semi-structured interviews were conducted with 12 sexual assault advocates from a community-based advocacy organization in Detroit. Thematic analysis was employed to uncover emergent themes reflecting COVID-19's impact on survivors' engagement with advocacy services. Three themes were identified: (1) Disruption to advocacy services; (2) difficulty obtaining tangible resources; and (3) desire for COVID-related support, information, and resources. This study highlights the needs of sexual assault survivors during the COVID-19 pandemic and explores how public health emergencies have the potential to exacerbate the needs of this vulnerable population. Implications and future directions for service provision and research are considered.

Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape

INTRODUCTION

The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design.

METHODS

In a sample of 639 rape-exposed women who were assessed within 20 days of rape and over 6 months, baseline data were used to predict PTSD symptom severity scores up to 6 months post-rape.

RESULTS

The incidence of PTSD at 3 months was 48.5% and the cumulative incidence at 6 months post-rape was 54.8%. Baseline experience of rape stigma (guilt, shame, self-blame, social devaluation and discredit) and depression were significant predictors of PTSD symptom scores over time, in mixed linear regression models. Higher levels of depression and rape stigma were associated with higher PTSD scores. Assault-related factors were not associated with PTSD scores.

LIMITATIONS

We could not measure PTSD symptom trajectories in all rape survivors, some of who may be at greater risk for PTSD e.g. non-disclosing rape survivors, those who declined participation and those who were extremely distressed at the time of recruitment.

CONCLUSION

Addressing internalised and externalised stigma and resultant mental health effects on women who present to rape clinics may reduce the long-term adverse effects of rape on mental health outcomes, such as PTSD. Rape survivors who present with high levels of depression soon after a rape should be carefully monitored and appropriately treated in order to reduce PTSD severity.

Post-traumatic Growth in Women With Histories of Addiction and Victimization Residing in a Sober Living Home

Research consistently documents the deleterious sequelae of interpersonal trauma, including domestic and sexual violence (DSV). More recently, however, researchers and practitioners have focused on positive outcomes, such as post-traumatic growth (PTG), in survivors of DSV. Although research has begun to document the prevalence and correlates of PTG, no study to our knowledge has explored PTG in a sample of women with histories of addiction and victimization residing in a trauma-informed sober living home (SLH). The purpose of the current study was to examine this gap in the literature. Participants were 59 women (89.8% White; 86.4% heterosexual; mean age = 41.6) who completed a survey while residing in a SLH. Most women reported moderate to high levels of PTG. At the bivariate level PTG was related to less depression, post-traumatic stress disorder, and financial worries, and greater active coping, and sense of community. PTG was also related to the absence of past 6-month physical intimate partner violence. In regression analyses, PTG was related to less depression and greater sense of community. These data offer insights into modifiable factors such as fostering a sense of community while also promoting mental health treatment that could be the focus of interventions to increase PTG in women with histories of addiction and victimization residing in SLHs.

The Impact of Traumatic Events on Mental Health Among Older African American and Black Caribbean Adults

Objectives: This study examined the frequency and impact of traumatic events on the mental health of older African American and Black Caribbean adults. Methods: The current study used data from the National Survey of American Life of 1,135 African American and 426 Black Caribbean adults aged 50 and older. Analysis examined the impact of traumatic events on both positive (i.e., happiness and life satisfaction) and negative (i.e., depressive symptoms, psychological distress, and 12-month anti-depressant use) domains of mental health. Results: Findings indicate that approximately 80% of older African Americans and Black Caribbeans reported experiencing a traumatic event at some point in their lifetime. Among African Americans assaultive violence was associated with more depressive symptoms, lower levels of life satisfaction, and lower levels of happiness. This was not the case among Black Caribbeans. Conclusions: These findings provide preliminary insight in mental health outcomes for older African American and Black Caribbean adults.

Developmental Timing of Trauma in Women Predicts Unique Extracellular Vesicle Proteome Signatures

BACKGROUND

Exposure to traumatic events is a risk factor for negative physical and mental health outcomes. However, the underlying biological mechanisms that perpetuate these lasting effects are not known.

METHODS

We investigated the impact and timing of sexual trauma, a specific type of interpersonal violence, experienced during key developmental windows of childhood, adolescence, or adulthood on adult health outcomes and associated biomarkers, including circulating cell-free mitochondrial DNA levels and extracellular vesicles (EVs), in a predominantly Black cohort of women (N = 101).

RESULTS

Significant changes in both biomarkers examined, circulating cell-free mitochondrial DNA levels and EV proteome, were specific to developmental timing of sexual trauma. Specifically, we identified a large number of keratin-related proteins from EVs unique to the adolescent sexual trauma group. Remarkably, the majority of these keratin proteins belong to a 17q21 gene cluster, which suggests a potential local epigenetic regulatory mechanism altered by adolescent trauma to impact keratinocyte EV secretion or its protein cargo. These results, along with changes in fear-potentiated startle and skin conductance detected in these women, suggest that sexual violence experienced during the specific developmental window of adolescence may involve unique programming of the skin, the body's largest stress organ.

CONCLUSIONS

Together, these descriptive studies provide novel insight into distinct biological processes altered by trauma experienced during specific developmental windows. Future studies will be required to mechanistically link these biological processes to health outcomes.

Associations Between Emotion Dysregulation Dimensions and Parenting Behaviors in Trauma-Exposed African American Mothers

Parenting behavior is key to understanding transmission of intergenerational trauma-related risk. Emotion dysregulation (ED) and psychological symptoms are associated with negative parenting behaviors, although their unique roles remain unclear. The current study examined associations of ED dimensions, depression, PTSD, and substance use with parenting behaviors in African American mothers. Participants included 98 mother-child dyads recruited from an urban hospital setting. Trauma exposure, ED, depression, substance use, and parenting behaviors (overreactivity, laxness, demandingness, warmth, corporal punishment) were assessed using self-report measures. PTSD was assessed using a semi-structured interview. Correlational results showed significant positive associations between ED and dysfunctional parenting behavior (p < .001), overreactivity (p < .001), and laxness (p < .01) and negative associations with warmth (p < .01). These associations varied across the dimensions of ED examined. Regression analyses were run to examine the unique effects of ED (separate models for overall and specific dimensions) and psychological symptoms; overall ED and its dimensions accounted for significant variance in parental behaviors (R2 = .10-.24, p's < .01), while additional model steps including psychological symptoms were not significant except for the association between depression and lower warmth. In efforts to reduce the intergenerational effects of trauma, parenting interventions that include a direct focus on certain dimensions of ED may be critical.

Understanding the association between material hardship and posttraumatic stress disorder: a test of the social selection and social causation hypotheses and an exploration of gender differences

PURPOSE

There is a well-established association between poverty and posttraumatic stress disorder (PTSD); however, little research has tested the temporality of the association.

METHODS

Using data from Waves IV (2008; N = 14,800) and V (2016-2018; N = 10,685) of the National Longitudinal Study of Adolescent to Adult Health, we examined temporal associations between material hardship (a specific operationalization of poverty) and PTSD, as well as assessed for potential gender differences in associations. We conducted logistic regression and generalized structural equation modeling to examine associations between material hardship and PTSD and assess for mediation and moderation by gender.

RESULTS

Prior PTSD diagnoses were associated with an increased likelihood of material hardship (OR = 1.64; 95% CI 1.21, 2.21). The indirect effect of gender on material hardship through PTSD diagnoses was significant. Prior material hardship was associated with an increased likelihood of PTSD diagnoses (OR = 1.81; 95% CI 1.35, 2.42). The indirect effect of gender on PTSD diagnoses through material hardship was significant. There was no evidence of moderation by gender for either association.

CONCLUSION

Results suggest reciprocal associations between material hardship and PTSD. Economic policies, as well as improved access to evidence-based PTSD treatments, may reduce the burden of both material hardships and PTSD.

Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women

The link between socioeconomic status and posttraumatic stress disorder (PTSD) symptoms is well established. Given that Black women are disproportionately burdened by both poverty and PTSD symptoms, research focusing on these constructs among this population is needed. The current study assessed the association between material hardship (i.e., difficulty meeting basic needs) and PTSD symptoms among 227 low-income Black women in the United States. We explored several potential explanations for the association between poverty and PTSD symptoms (e.g., individuals living in poverty may experience higher levels of trauma exposure; individuals living in poverty may have less access to relevant protective resources, like social support; poverty itself may represent a traumatic stressor). Using robust negative binomial regression, a positive association between material hardship and PTSD symptoms emerged, B = 0.10, p = .009, SMD = 0.08. When trauma exposure was added to the model, it was positively associated with PTSD symptoms, B = 0.18, p < .001, SMD = 0.16, and material hardship remained positively associated with PTSD symptoms, B = 0.10, p =.019, SMD = 0.08. When social support indicators were added to the model, they were not associated with PTSD symptoms; however, material hardship remained significantly associated, B = 0.10, p = .021, SMD = 0.08. In the model with material hardship and trauma exposure, a significant interaction between material hardship and trauma exposure on PTSD symptoms emerged, B = -0.04, p = .027. These results demonstrate the importance of including material hardship in trauma research, assessment, and treatment.

Talking to Others About Sexual Assault: A Narrative Analysis of Survivors' Journeys

Previous research suggested the benefits for sexual assault survivors to talk about their trauma and its mental health implications, but it remained unclear what steps sexual assault survivors need to take to be able to have these conversations. To address this gap in the literature, this study aims to explore the journeys of sexual assault survivors with the use of narrative interviews to retain the richness of the data. This study reports the findings of a narrative analysis of the accounts of six female sexual assault survivors aged between 20 and 38. The analysis provides an individual case profile for each participant, the core aspects and tone of each narrative, and a cross-case analysis. The cross-case analysis reveals an overarching theme of "the bumpy journey" within which the individual difficulties encountered are examined. The analysis also reveals the two main factors that motivated the participant to strive to make a difference for other sexual violence survivors and to improve their mental health through talking about their experiences. The implications for services providing continuous and long-term support to sexual assault survivors and clinical practices are discussed.

Prevalence and correlates of sexual violence among adolescent girls and young women: findings from a cross-sectional study in a South African university

BACKGROUND

Epidemiological data on the prevalence and factors associated with sexual violence is critical to understanding the magnitude of the problem and designing effective interventions. Drawing from cross-sectional data from a South African university, we examined the prevalence and correlates of sexual violence among adolescent girls and young women (AGYW).

METHODS

We analysed data of 451 AGYW selected using stratified sampling. Sexual violence was defined as any sexual acts, and attempt to obtain sexual acts without consent. We used adjusted and unadjusted logistic regression models to examine the factors associated with exposure to sexual violence while controlling for relevant covariates.

RESULTS

The lifetime and past-year prevalence of sexual violence was 37.9% and 25.3%, respectively. A higher prevalence of sexual violence was reported by heavy episodic drinkers of alcohol (lifetime 48.4% and past year 34.0%), those who received insufficient financial support (lifetime 58.0% and past year 35.8%) compared to non-users of alcohol (lifetime 27.2% and past year 17.2%),) and those who received adequate financial support (lifetime 20.8% and past year 13.1%). AGYW who reported heavy episodic use of alcohol had higher odds of reporting lifetime (AOR: 1.86; 95% CI: 1.07-3.25) and past year (AOR: 2.03; 95% CI: 1.10-3.75) experience of sexual violence compared to non-users. However, individuals who received adequate family financial support were 76% and 65% less likely to report lifetime and past year experience of sexual violence than those who received inadequate family financial support. Also, AGYW who rated themselves as very religious were 80% and 75% less likely to report lifetime and past year experience of sexual violence compared to those who were not religious.

CONCLUSION

Our study shows that sexual violence affects a large proportion of girls, requiring intervention that not only focuses on increasing social support for survivors, facilitating reporting, and ensuring perpetrators are convicted, but also target alcohol use reduction and poverty alleviation.

Residential Greenness Positively Associated with the Cortisol to DHEA Ratio among Urban-Dwelling African American Women at Risk for HIV

As ecosystems that support human health, societies, and civilization change in the era of the Anthropocene, individuals with disproportionate balance of salivary hormones may be at greatest risk of morbidity and mortality. Vulnerable communities, in particular, are overburdened by inequities in features of built environments linked to health disparities. This study examined the cross-sectional association of greenness in the built environment with the ratio of cortisol to dehydroepiandrosterone (DHEA) in an urban-dwelling high-risk community sample of African American women (n = 84, age 18-44 years). Saliva samples, collected across 2 consecutive days, were assayed for cortisol and DHEA. Controlling for sexual violence, perceived stress, education, and income, as well as crime, traffic density, and vacant properties, we observed a significant positive cross-sectional association between greenness and the cortisol to DHEA ratio, (β = 7·5, 95% CI: 0.89, 14.19). The findings highlight environmental influence on stress response at waking when there is the greatest individual variation. Implications for advancing our understanding of the waking ratio of cortisol to DHEA as a potential marker of physiological resilience are discussed.

Racial Disparities in Sexual Assault Characteristics and Mental Health Care After Sexual Assault Medical Forensic Exams

Background: Sexual assault (SA) is common, but Black individuals might be at higher risk of SA and negative health sequalae. Racial differences in SA characteristics and health care utilization after SA are largely unknown. Materials and Methods: We reviewed medical records of 690 individuals (23.9% Black; 93.6% women) who received a SA medical forensic exam (SAMFE) at a southeastern U.S. hospital. We examined bivariate racial differences in SA characteristics and used zero-inflated Poisson regressions to estimate racial differences in mental health outpatient visits at the SAMFE hospital. Results: Among survivors of SA, Black survivors were more likely than White survivors to have been victimized by an intimate partner (odds ratio [OR] = 1.77, confidence interval [95% CI] = 1.02-3.07) and they had more post-SA outpatient mental health visits at the SAMFE hospital (incidence rate ratio [IRR] = 2.05, 95% CI = 1.70-2.47). Black survivors were less likely to report alcohol or drug use before the SA (OR = 0.42, 95% CI = 0.28-0.62). In multivariable models, Black survivors trended toward more mental health visits than White survivors (IRR = 1.63, 95% CI = 0.82-2.44), but intimate partner violence (IPV) significantly moderated that association (IRR = 0.01, 95%CI = ≤0.001-0.03). Black survivors assaulted by an intimate partner were less likely to access mental health care than White IPV survivors. Conclusions: The hospital setting of a SAMFE could be a unique opportunity to serve Black survivors and reduce racial disparities in mental health sequelae, but additional support will be needed for Black survivors experiencing IPV. An intersectional, reproductive justice framework has the potential to address these challenges.

The Relationship between Women's Resources and Health-Related Quality of Life in a Sample of Female Victims of Intimate Partner Violence

While it is known that resource inadequacy increases the risk of exposure to intimate partner violence (IPV) and that women's health is significantly impacted by IPV, scant research has documented diminished resources as a primary determinant of women's health. Fifty female victims of moderate to severe IPV completed assessments of their physical, sexual and psychological experiences of IPV, resource profile, symptoms of posttraumatic stress disorder (PTSD) and depression and mental and physical health-related quality of life (HRQoL). Women's resources, controlling for age, income, psychological abuse and sexual coercion, were unique predictors of symptoms of PTSD, symptoms of depression; and mental HRQoL. The public health implications of the adequacy of women's resources are discussed in the context of IPV prevention and intervention. Future studies should evaluate the efficacy of economic empowerment programs regarding the impact on IPV survivors' mental and physical health and safety.

The Holistic Grief Effects of Bereaved Black Female College Students

This study examined the holistic grief effects of Black female college students. A total of 105 participants from two universities, who identified as Black or African American females, completed a questionnaire regarding death losses and grief effects they experienced. Descriptive statistics and ANOVAs examined between-group differences based on loss experiences. Linear regressions predicted the grief effects Black female college students experience based on time since loss and cause of death. Participants displayed holistic grief effects in all six dimensions of cognitive, emotional, behavioral, physical, interpersonal, and spiritual/world assumptions, with emotional and cognitive effects as the most experienced grief effects. The cause of death had a statistically significant effect on grief effects with suicide and murder, displaying higher mean effects. Although statistically significant relationships were not found between grief effects and time of loss, most mean effects peaked at 7-12 months post-loss. Implications and recommendations for future research are provided.

African American Sexual Assault Survivors and Mental Health Help-Seeking: A Mixed Methods Study

Little research has focused on African American women's sexual assault victimization and mental health seeking. A mixed methods study was conducted to explore African American women's sexual assault in relationship to mental health seeking and experiences with mental health providers in a large community sample. Quantitative survey and qualitative interview data indicated unique correlates of immediate and longer term seeking of help from various mental health sources. Barriers and facilitators of African American women's mental health seeking were identified and qualitative themes were uncovered relevant to this group of survivors. Implications for research and clinical practice with this population are provided.

Testing the Family Stress Model among Black Women Receiving Temporary Assistance for Needy Families (TANF)

Black female primary caregivers who receive Temporary Assistance for Needy Families (TANF) are burdened not only by economic pressure but also by a disproportionate prevalence of psychological disorders. This is particularly pernicious given that poverty and maternal mental health impact child outcomes and may decrease the economic mobility of families. Consequently, it is imperative to understand the mechanisms that explain the association between economic pressure and child outcomes. The current study addressed this gap by testing an application of the Family Stress Model (FSM), which describes how economic pressure results in parental psychological distress, particularly depression, and in turn impacts parenting quality and child outcomes. Additionally, social support was assessed as a potential culturally-salient protective factor within the model. Four hundred sixteen Black female primary caregivers who receive TANF were administered a series of measures assessing mental health and family wellbeing. Structural equation modeling was utilized to test a single model that incorporated all hypotheses. Maternal depression and quality of parenting serially mediated the relationship between economic pressure and school performance. The relationship between economic pressure and adverse child outcomes, however, was mediated only by maternal depression. Social support did not significantly moderate the relationship between economic pressure and maternal depression; however, it did demonstrate a significant direct effect on maternal depression. The current study corroborates the application of FSM to another population. Further, it demonstrates the importance of interventions that target maternal mental health, parenting, social support, and family economic mobility as well as system-level policy interventions to address poverty.

Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence

BACKGROUND

Black women disproportionately suffer from violence and its subsequent mental health outcomes. Increasing levels of perceived stress are associated with greater symptoms of depression and post-traumatic stress disorder (PTSD). Social support and resilience can potentially mediate the negative consequences of perceived stress on women's mental health. This study assesses the association between perceived stress and mental health outcomes among Black women. In addition, this study examines social support and resilience as mediators of association between perceived stress and mental health.

METHODS

Black women residing in Baltimore, MD (n = 310) were recruited from STD clinics into a retrospective cohort study (2013-2018) on sexual assault and HIV risk. Social support and resilience served as coping variables and were assessed as mediators in the associations between perceived stress and mental health. Analyses were stratified by exposure to sexual violence in adulthood.

RESULTS

Almost half of our sample (46%) experienced severe depression and about one-third (27%) experienced severe PTSD. Resilience partially mediated the association between perceived stress and severe depressive symptoms among exposed women. Social support partially mediated the association between perceived stress and severe PTSD symptoms among exposed women.

LIMITATIONS

Since this is a cross-sectional analysis, we are unable to determine the temporal relationship between outcome and exposure variables. The CES-D-10 and NSESSS are scales that measure the severity of depressive and PTSD symptoms, respectively, and are not clinical diagnoses.

CONCLUSION

There is a critical need to develop interventions focused on reducing the burden of stress on mental health.

When Orgasms Do Not Equal Pleasure: Accounts of "Bad" Orgasm Experiences During Consensual Sexual Encounters

Orgasms during consensual sex are often assumed to be wholly positive experiences. This assumption overshadows the possibility that orgasm experiences during consensual sex could be "bad" (i.e., negative and/or non-positive). In the present study, we employed an online survey to explore the possibility that orgasm experiences could be "bad" during consensual sex by asking participants of diverse gender and sexual identities (N = 726, M age = 28.42 years, SD = 7.85) about a subset of potential bad orgasm experiences. Specifically, we asked participants whether they have ever had an orgasm during coerced sex, compliant sex, and/or when they felt pressured to have an orgasm (i.e., orgasm pressure). We also asked participants who had such an experience to describe it, resulting in qualitative descriptions from 289 participants. Using mixed quantitative and qualitative analyses, we found compelling evidence that orgasm experiences can be "bad" during consensual sex. Specifically, many participants described their experiences in negative and/or non-positive ways despite orgasm occurrence, reported that their orgasms were less pleasurable compared to other experiences, and suggested that their orgasm experiences had negative impacts on their relationships, sexuality, and/or psychological health. Participants also suggested that social location shaped their bad orgasm experiences, citing gender and sexual identity, gender identity conflict, race/ethnicity, and religion as important to their perceptions of and responses to their experiences. Results directly challenge the assumption that orgasms during consensual sex are always and/or unilaterally positive experiences.

Deconstructing Meta-Narratives: Utilizing Narrative Therapy to Promote Resilience following Sexual Violence among Women Survivors of Color

Sexual violence against women is an ongoing social problem that carries serious social and health implications. Although a large body of empirical literature has documented the detrimental effects of sexual violence on women's mental health, the great majority of this work is devoid of considering the unique cultural experiences of women of color (WOC). WOC report disparate rates of sexual violence, coupled with racially biased treatment from providers and law enforcement following an assault, that make them especially vulnerable to mental health challenges. In this theoretical paper, we explain how Narrative Therapy is uniquely suitable for promoting resilience following sexual violence in WOC. Using a case vignette, we demonstrate how Narrative Therapy was used to foster voice and empower a WOC to frame their narrative into a storyline of survival and resilience.

Women’s Experiences of Nature as a Pathway to Recovery From Sexual Assault

Given the serious challenges faced by female survivors of sexual assault, an understanding of how they heal after such an experience is vital. Yet little is known about how being in nature may be helpful in this regard. The purpose of this qualitative study was to develop an in-depth understanding of how nature helps women heal from sexual assault. A narrative analysis of semi-structured interview data provided by four female sexual assault survivors generated four main themes. These themes point to how nature served as a source of emotion regulation and spiritual connection, as well as how it facilitated greater acceptance and reduced dissociation. Themes also indicated reduced negative thinking and rumination, and increased attention to the here and now. Findings are contextualized within the existing literature on sexual assault, and implications for counselling and psychotherapeutic practice with survivors are provided.

A Qualitative Study Of Sexual Assault Survivors' Post-Assault Legal System Experiences

Following sexual assault, survivors may turn to the civil or criminal justice systems in pursuit of some form of legal justice. Informal support providers (SPs) often play a large role in survivors' post-assault experiences and recovery, including providing support during survivors' decision to pursue legal justice and in navigating the system. Yet, this has not been thoroughly examined in research, particularly through a dyadic lens. Using qualitative dyadic data from 45 survivor-SP matched pairs (i.e., friend, family, or significant other), the current study addresses this gap by looking broadly at survivors' post-assault experiences with the criminal and civil legal systems. Of the 45 pairs in the sample, the current study presents findings from a subsample of 28 survivors and 13 SPs regarding post-assault legal system experiences. Our findings suggest that survivors and SPs consider the perceived strength of their case, perceptions of police, and the possibility of institutional bias when deciding to report the assault to the police. Interviews revealed that reasons for legal system involvement extend beyond pursuance of perpetrator prosecution, such as filing for custody of their children after leaving a domestic violence situation or seeking financial compensation. Many survivors who had interactions with the police and legal system experienced secondary victimization, while a few survivors had positive experiences, despite their expectations. We recommend improved access to survivor advocates and suggest directions for future research stemming from findings.

Cumulative effects of the Gulf oil spill and other disasters on mental health among reproductive-aged women: The Gulf Resilience on Women's Health study

OBJECTIVE

To test whether effects of multiple (up to 5) disasters on mental health responses were cumulative (additive effects), or whether an earlier disaster produced sensitization (higher) or habituation (lower) responses to a later one.

METHOD

The Gulf Resilience on Women's Health study interviewed 1,366 southern Louisiana women regarding their exposure to Hurricanes Katrina, Rita, Gustav, and Ike and the Gulf oil spill (measured several ways), and administered validated measures of symptoms of depression and posttraumatic stress disorder (PTSD). Multiple linear and logistic regression with disaster exposures entered singly, combined, and as an interaction were used to model mental health.

RESULTS

Both exposure to the oil spill and hurricane disaster were associated with likely depression and PTSD, consistent with a cumulative model, but we did not find statistical interactions that would suggest sensitization or habituation. When results were examined with continuous symptom measures of depression and PTSD, they were similar, with the exception that exposure to the oil spill and experiencing illness or injury because of the hurricane disaster showed a significant interaction (p < .05) in a manner consistent with a sensitization effect when predicting PTSD symptoms. The results of this study point mainly to a cumulative risk for the mental health effects of multiple disasters, although some indication of sensitization occurred among those with particularly severe experiences. There was no evidence for habituation.

CONCLUSIONS

These findings may guide efforts to assist those in regions experiencing multiple disasters that occur in close sequence. (PsycINFO Database Record

The Association Between Past Sexual Abuse and Depression in Older Adults From Colombia

To explore the association between past sexual abuse and depression in elders living in Bogotá, Colombia, we used data from the SABE (Salud, Bienestar y Envejecimiento [Health, Well-being, and Aging]) Bogotá Study. Participants were 2000 community-dwelling adults aged 60 years and older in 2012. Sexual abuse was assessed by self-report. Depression was measured by the Geriatric Depression Scale. The weighted prevalence estimate was 2.6% for past sexual abuse and 23.4% for depression. Multivariate data analyses showed significantly higher odds of depression for past sexual abuse (odds ratio [OR] = 3.91, 95% confidence interval [CI]: 2.13-7.16). Other characteristics associated with depression were history of being displaced by violence (OR = 1.77, 95% CI: 1.30-2.40), low socioeconomic status, low education, poor self-rated health status, and poor self-rated memory. Thus, past sexual abuse and history of being displaced by violence were strongly associated with depression among Colombian elderly individuals.

Relationship Between Sexual Abuse in Childhood and the Occurrence of Mental Illness in Adulthood: A Matched Case-Control Study in Nigeria

This study aimed to examine the relationship between exposure to childhood sexual abuse (CSA) and the occurrence of mental illness in adulthood in Nigeria. An age- and gender-matched case-control study was conducted in the University of Port Harcourt Teaching Hospital, Nigeria, from January to March 2014. Cases were defined as individuals aged 18 to 60 years diagnosed with mental illness while controls were aged 18 to 60 years who did not have mental illness. The study had 304 subjects comprised of 152 case-control pairs. This case-control study showed a statistically significant association between exposure to CSA and occurrence of mental illness in adulthood (pair-matched odds ratio = 3.25, 95% CI = [1.70, 6.21]). The association between CSA and mental illness was still significant (adjusted odds ratio = 3.11, 95% CI = [1.67, 5.82]) after controlling for family functionality. A robust CSA prevention and treatment strategy that considers the victim and the perpetrator in Nigeria is hereby advocated. This could be achieved by the collaborative efforts of the government of Nigeria and non-governmental organizations.

Sexual Orientation, Race, and Trauma as Predictors of Sexual Assault Recovery

Sexual minorities and racial minorities experience greater negative impact following sexual assault. We examined recovery from sexual assault among women who identified as heterosexual and bisexual across racial groups. A community sample of women (N = 905) completed three yearly surveys about sexual victimization, recovery outcomes, race group, and sexual minority status. Bisexual women and Black women reported greater recovery problems. However, Black women improved more quickly on depression symptoms than non-Black women. Finally, repeated adult victimization uniquely undermined survivors' recovery, even when controlling for child sexual abuse. Sexual minority and race status variables and their intersections with revictimization play roles in recovery and should be considered in treatment protocols for sexual assault survivors.

The Contribution of Cognitive Strategies to the Resilience of Women Survivors of Childhood Sexual Abuse and Non-Abused Women

This study examines the contribution of four strategies—self-forgiveness, realistic control, unrealistic control, and hope—to the resilience of 100 women survivors of childhood sexual abuse (CSA), as compared with 84 non-sexually abused women. The findings show that CSA survivors exhibited lower resilience, lower self-forgiveness, lower hope, and higher levels of posttraumatic symptoms (PTS). They also indicate that resilience was explained by the participants’ financial status, PTS severity, and two cognitive strategies—self-forgiveness and hope. Finally, PTS and hope mediated the relation between CSA and resilience.

"Come on Baby. You Know I Love You": African American Women's Experiences of Communication with Male Partners and Disclosure in the Context of Unwanted Sex

We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women.

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. Inperson interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.

Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S

Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods.

Healing pathways: longitudinal effects of religious coping and social support on PTSD symptoms in African American sexual assault survivors

African American women are at a slightly increased risk for sexual assault (A. Abbey, A. Jacques-Tiaura, & M. Parkhill, 2010). However, because of stigma, experiences of racism, and historical oppression, African American women are less likely to seek help from formal agencies compared to White women (Lewis et al., 2005; S. E. Ullman & H. H. Filipas, 2001) and/or women of other ethnic backgrounds (C. Ahrens, S. Abeling, S. Ahmad, & J. Himman, 2010). Therefore, the provision of culturally appropriate services, such as the inclusion of religion and spiritual coping, may be necessary when working with African American women survivors of sexual assault. Controlling for age and education, the current study explores the impact of religious coping and social support over 1 year for 252 African American adult female sexual assault survivors recruited from the Chicago metropolitan area. Results from hierarchical linear regression analyses reveal that high endorsement of religious coping and social support at Time 1 does not predict a reduction in posttraumatic stress disorder (PTSD) symptoms at Time 2. However, high social support at Time 2 does predict lower PTSD at Time 2. Also, it is significant to note that survivors with high PTSD at Time 1 and Time 2 endorse greater use of social support and religious coping. Clinical and research implications are explored.

A review of the health effects of sexual assault on African American women and adolescents

OBJECTIVE

To review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault.

DATA SOURCES

Searches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape.

STUDY SELECTION

Criteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty-one publications met inclusion criteria.

DATA EXTRACTION

Articles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents.

DATA SYNTHESIS

Sexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes.

CONCLUSION

Sexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents' responses to assault.

The roles of spirituality in the relationship between traumatic life events, mental health, and drug use among African American women from one southern state

This study examines the role of spirituality as a moderator of the relationship between traumatic life experiences, mental health, and drug use in a sample of African American women. It was hypothesized that there would be an inverse relationship overall between spirituality and mental health and drug use among this sample of African American women. Secondly, was expected that spirituality would moderate the relationship between traumatic life events and mental health and drug use. African American women (n = 206) were recruited from the community and from probation officers in three urban areas of a southern state, and face-to-face interviews were completed. Findings indicated that there was a main effect for spirituality (as measured by existential well-being on the Spiritual Well-Being Scale) and traumatic life events, mental health, and alcohol use. In addition, spirituality was a significant moderator of the relationship between traumatic life events and cocaine use. Discussion and implications for African American women are included.

Gender Disparities in the Mental Health of Urban Survivors of Trauma

Women who experience traumatic events are at higher risk for mental health problems compared to men; however, gaps remain in our understanding of this disparity. A sample of 170 urban adults completed self-report measures. Women were significantly more likely to experience sexual assault and domestic violence compared to men, and they were significantly less likely to experience a robbery or mugging, being threatened with a weapon, or witnessing a death or assault compared to men. Also, women were more likely than men to meet criteria for probable post-traumatic stress disorder (PTSD) and depression after controlling for covariates and trauma level. Our findings suggest a possible differential vulnerability to the development of PTSD and depressive symptoms in women.

Gender disadvantage and common mental disorders in women

Research in the area of gender and mental health indicates that women are disproportionately affected by common mental disorders (CMDs) as well as co-morbid mental disorders. However, the concept of gender disadvantage, its correlates, and mental health outcomes has received relatively less research attention. In addition, there are no known systematic reviews in the area of gender disadvantage and common mental disorders in recent years. In this review we have therefore attempted to deconstruct the concept of gender disadvantage, identify important correlates of gender disadvantage and illustrate their influence on common mental disorders. Since gender is a social construct and is greatly influenced by one's culture and ethnicity, we have made an attempt to integrate international literature on the subject and highlight cultural and ethnic relevance of topics as they emerge. Finally, we have provided take home messages from existing literature, identified gaps in literature, and formulated directions for future research in this area.

"It's not just a job. This is where we live. This is our backyard": the experiences of expert legal and advocate providers with sexually assaulted women in rural areas

Sexual assault research has focused almost exclusively on urban areas, and research examining the experiences of expert service providers is nearly nonexistent. The purpose of this study was to add to the understanding of providers' experiences in working with sexually assaulted women in rural communities. Secondary victimization theory suggests that the nature of postassault expert interventions may have an adverse impact on victims. The focus of this hermeneutic phenomenological study was to explore the lived experiences of providers regarding their interactions with sexual assault survivors living in rural communities. Data were gathered from prosecutors, law enforcement, crisis center advocates, social workers, and victim-witness associates. Data analysis led to the identification of five significant themes: (a) rural-specific confidentiality issues, (b) resource needs in a rural setting, (c) the connection between victim blaming and low levels of reporting, (d) negative provider views of the community, and (e) smaller communities provided better victim care. Psychiatric nurses and mental health care systems have many opportunities to intervene with abused women in inpatient, outpatient, and other community settings. In primary and acute care setting, nurses should assess patients for a history of violence using multiple screening questions and should also educate victims and their families about available resources.