Rape as an Economic Crime: The Impact of Sexual Violence on Survivors' Employment and Economic Well-Being

The Landscape of Sexual Harm in the Video Game, Streaming, and Esports Community

While sexual harm has been studied across a range of contexts, it has not yet been considered within the video game, streaming, and esports community. This study aimed to explore the landscape of sexual harm in this community, specifically, where it has been committed by esports professionals and video game live streamers. Fifty-five victim statements were extracted from online sources (such as Twitter/X and Reddit) and coded into variables relating to offender and victim demographics, offense characteristics, the offense process, and platform(s) used. Descriptive statistics were generated for each variable and Fisher's exact tests were conducted to examine the differences between adult-on-adult and adult-on-child cases. The findings reveal diverse offense outcomes across the sample, ranging from rape to sexual communication with a child. Some offense patterns can be seen in wider sexual offending literature, such as pre-offense alcohol consumption, offending against incapacitated victims (e.g., sleeping), and offending within an established romantic relationship. However, several offense process characteristics unique to the video gaming community were identified. These included offenders using their position of fame within the community to access victims and bypass the need for other coercive behaviors. Online offenses were more common with children and offenders demonstrated a preference for "live" methods, such as voice chat and video calling, rather than instant messaging or sharing images of themselves. This limits the digital evidence left behind and indicates the offenders' greater technological literacy. The study's findings shed light on the sexual harm that exists within this previously unexplored context and highlight areas where esports organizations, live-streaming platforms, and educational providers can do more to safeguard players, fans, and viewers in this community.

Impact of neighborhood disadvantage on posttrauma outcomes after sexual assault

In the United States, 8,000,000 people seek emergency care for traumatic injury annually. Motor vehicle collisions (MVCs) and sexual assault are two common sources of trauma, with evidence that reduced neighborhood-level socioeconomic characteristics increase posttraumatic pain and stress after an MVC. We evaluated whether neighborhood disadvantage was also associated with physical and mental posttrauma outcomes after sexual assault in a sample of adult women (N = 656) who presented for emergency care at facilities in the United States following sexual assault and were followed for 1 year. Neighborhood characteristics were assessed via the Area Deprivation Index, and self-reported pain, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms were collected at 6 weeks posttrauma. Adjusted log-binomial regression models examined the association between each clinical outcome and neighborhood disadvantage. Women in more disadvantaged neighborhoods were more likely to be non-White and have lower annual incomes. At 6 weeks posttrauma, the prevalence of clinically significant pain, anxiety, and depressive symptoms more than doubled from baseline (41.7% vs. 18.8%, 62.4% vs. 23.9%, and 55.2% vs. 22.7%, respectively); 40.7% of women also reported PTSD symptoms. Black, Hispanic, and lower-income participants were more likely to report pre- and postassault pain, anxiety, and depression. After adjusting for race, ethnicity, and income, no significant association existed between neighborhood disadvantage and any outcome, ps = .197 - .859. Although neighborhood disadvantage was not associated with posttrauma outcomes, these findings highlight the need for continued research in diverse populations at high risk of adverse physical and mental health symptoms following sexual assault.

A Qualitative Systematic Review of the Barriers and Facilitators of the Reintegration of Men Convicted of a Sexual Offense From Prison or Secure Care into the Community

This article is the first qualitative systematic review of studies examining the barriers and facilitators to male sex offenders reintegration from prison or secure care into the community. A search of 16 electronic databases produced 14,218 potential sources, which, after screening, resulted in 79 articles for inclusion. Papers were included if they used qualitative research methods about the barriers, facilitators, perceptions, experiences, and attitudes toward community reintegration from prison or secure care for men convicted of sexual offenses. Included papers were critically appraised and the findings were thematically synthesized. The findings identified that formal and cultural aspects of reintegration, such as probation services, stigmatization, and registration, were the three largest barriers that men faced upon their release, with stability aspects, such as positive relationships, religion, and support groups, being key facilitators to their successful reintegration. The implications for future research, and policy and practice, including prioritizing risk assessment and management, offering appropriate and timely treatment and rehabilitation, educating the community, better access to housing and employment, and services adopting a collaborative approach, are discussed.

Determinants of Referral Outcomes for Victim-Survivors Accessing Specialist Sexual Violence and Abuse Support Services

Sexual violence and abuse (SVA) is highly prevalent globally, has devastating and wide-ranging effects on victim-survivors, and demands the provision of accessible specialist support services. In the UK, Rape Crisis England & Wales (RCEW), a voluntary third sector organization, is the main provider of specialist SVA services. Understanding the profile of victim-survivors who are referred to RCEW and their referral outcomes is important for the effective allocation of services. Using administrative data collected by three Rape Crisis Centres in England between April 2016 and March 2020, this study used multinomial regression analysis to examine the determinants of victim-survivors' referral outcomes, controlling for a wide range of potentially confounding variables. The findings demonstrate that support needs, more so than the type of abuse experienced, predicted whether victim-survivors were engaged with services. Particularly, the presence of mental health, substance misuse and social, emotional, and behavioral needs were important for referral outcomes. The referral source also influenced referral outcomes, and there were some differences according to demographic characteristics and socioeconomic factors. The research was co-produced with stakeholders from RCEW, who informed interpretation of these findings. That victim-survivors' engagement with services was determined by their support needs, over and above demographic characteristics or the type of abuse they had experienced, demonstrates the needs-led approach to service provision adopted by RCEW, whereby resources are allocated effectively to those who need them most.

Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies

Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.

Understanding the lived experience of pregnancy and birth for survivors of rape and sexual assault

BACKGROUND

One in five women in the UK are survivors of rape and sexual assault, and four in five women will give birth. This implies that a substantial number of women experience rape and sexual assault before pregnancy. We highlight and explore the voices and lived experiences of survivors during pregnancy and birth, to better understand the relationship between sexual violence, biomedicine, and pregnancy and to inform maternity care practice.

METHODS

This qualitative research took an intersectional feminist approach. We conducted in-depth individual interviews in England with fourteen women who self-identified as survivors of rape or sexual assault, and who had experienced pregnancy and birth after the assault. We conducted open line-by-line coding of the interview transcripts, and identified key themes and sub-themes inductively.

RESULTS

Three themes help summarise the narratives: control, safety and trauma. Maintaining a sense of control was important to survivors but they often reported objectification by healthcare staff and lack of consent or choice about healthcare decisions. Participants' preferences for giving birth were often motivated by their desire to feel in control and avoid triggering traumatic memories of the sexual assault. Survivors felt safer when they trusted staff. Many participants said it was important for staff to know they were survivors but none were asked about this. Pregnancy and birth experiences were triggering when they mirrored the assault, for instance if the woman was prevented from moving. Many of our participants reported having unmet mental health care needs before, during or after pregnancy.

CONCLUSIONS

Survivors of sexual violence have specific maternity care needs. For our participants, these needs were often not met, leading to negative or traumatic experiences of pregnancy and birth. Systemic biases and poor birth experience jeopardise both psychological and physical safety. Funding for maternity and mental health services must be improved, so that they meet minimum staffing and care standards. Maternity services should urgently introduce trauma-informed models of care.

Sexual and Relationship Violence Among LGBTQ+ College Students: A Scoping Review

Although there has been increased attention to campus sexual and relationship violence (SRV) because of Title IX and the #MeToo movement, much of that attention has focused on victimization of cisgender heterosexual women. This scoping review uncovers information from empirical studies on what is known about LGBTQ+ (e.g., lesbian, gay, bisexual, transgender, queer, and nonbinary) students' experiences of campus SRV. Using rigorous scoping review methods (i.e., searches of 15 databases, searches of expert websites, hand searching, reference harvesting, and forward citation chaining), we identified 60 documents published since 2000 that contained findings from empirical studies related to LGBTQ+ students and SRV on U.S. college and university campuses. Through content analysis, we summarized findings around five key themes: (1) extent and types of victimization, (2) negative outcomes, (3) knowledge of and attitudes about SRV, (4) perspectives on SRV services and prevention education programs, and (5) recommendations from study authors based on their findings. Implications for research, practice, and policy based on these findings are discussed.

How Many Terms Does It Take to Define Sexual Assault? Inconsistencies in U.S. Higher Education Sexual Misconduct Policies

Campus sexual misconduct policies (SMPs) outline prohibited conduct. We sought to document the range of terms used to refer to forms of nonconsensual sexual contact in SMPs and to analyze the content of definitions provided for the term "sexual assault." We coded the 2016-2017 SMPs from a sample of 381 U.S. schools. We identified 125 unique terms and documented both a terminological and conceptual morass around sexual assault. Policy language may have implications for students' and administrators' evaluation of experiences and reports of sexual assault.

Participatory Design Application in Youth Sexual Violence and Abuse Prevention: A Mixed-Methods Systematic Review

Youth sexual violence and abuse (SVA) are leading public health and human rights issues around the world. Prevention is key to reducing SVA rates and minimising resultant harms. Despite advocacy for more collaborative approaches, knowledge of how to effectively engage young people and key stakeholders in the design, implementation, and evaluation of SVA prevention programs is limited. This mixed-methods systematic review aimed to synthesise available evidence on participatory design (PD) application in primary and secondary SVA prevention targeting young people. A systematic search was executed across seven electronic databases. Eligible studies were peer-reviewed, published in English, reported primary or secondary SVA prevention, described application of PD or a related approach, and targeted young people aged 12-25 years. Quality was assessed using the Mixed Methods Appraisal Tool. Overall, 20 articles reporting 15 studies were included. Most (55%; n = 11) employed a qualitative design. Descriptions, methods, and scope of PD application varied across included studies. A lack of empirical evaluations prevented conclusions regarding the utility of PD application in terms of measured outcomes. The methodology, agent of change, training, and engagement (MATE) taxonomy was subsequently developed to describe and classify PD application. As illustrated in the MATE taxonomy, PD methods promoting agency, encouraging input, and facilitating empowerment are likely to facilitate more meaningful engagement of participants. Integration of participant and expert views, community consultation, and appropriate socio-cultural adaption appear to be critical determinants of program acceptability and feasibility. Empirical evaluations are needed to assess the relative utility of PD methods in line with SVA prevention objectives.

"Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence

Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.

Separate units for incarcerated people who committed sexual offenses: luxury or necessity?

Introduction

The policy on treatment of people who commit sexual offenses (PSOs) varies greatly across countries, creating different treatment environments. This study was conducted in Flanders (i.e., the Dutch-speaking part of Belgium) where PSOs receive their treatment in the community. Before this transfer takes place, many PSOs spend time inside prison together with other offenders. This raises the question to what extent PSOs are safe in prison and whether this period would benefit from an integrated therapeutic program. This qualitative research study focuses on the possibility of separate housing for PSOs by examining the current experiences of incarcerated PSOs and contextualizing those with the professional experience of national and international experts in the field.

Methods

Between 1 April 2021 and 31 March 2022, 22 semi-structured interviews and six focus groups took place. Participants were comprised of 9 imprisoned PSOs, 7 international experts on prison-based PSO treatment, 6 prison officer supervisors, 2 prison management delegates, 21 healthcare workers (both inside and outside prison), 6 prison policy coordinators, and 10 psychosocial service staff members.

Results

Nearly all interviewed PSOs reported suffering at the hands of fellow inmates or prison staff because of the nature of their offenses, varying from exclusion and bullying to physical violence. These experiences were corroborated by the Flemish professionals. Consistent with scientific research, the international experts all reported working with incarcerated PSOs who reside in living units separate from other offenders and the therapeutic benefits to this approach. Despite this growing evidence, the Flemish professionals remained reluctant to implement separate living units for PSOs in prisons because of the perceived risk of increased cognitive distortions and further isolation of this already stigmatized group.

Conclusion

The Belgian prison system is not currently organized to create separate living units for PSOs, which has important ramifications for the safety and therapeutic opportunities of these vulnerable prisoners. International experts emphasize a clear benefit for introducing separate living units where a therapeutic environment can be created. Although this would have significant organizational and policy-oriented implications, it would be useful to explore whether these practices could be implemented in Belgian prisons as well.

Exposing the Secret: Listening to Bedouin Men Who Have Experienced Sexual Violence

There are few indigenous men's voices regarding sexual violence against them, particularly concerning Bedouin men's views. How do Bedouin men who have experienced SV describe, perceive, and interpret their experiences in their cultural context? Seventeen Bedouin men, residents of either recognized or unrecognized Bedouin settlements in the Negev, Israel. Phenomenological semi-structured interviews were recorded, transcribed verbatim, and then translated into English. Themes were generated using thematic analysis. Three main themes were found: descriptions of the incidents, reactions to the experiences, and the need for keeping incidents of SV secret due to the stigma involved as a result of patriarchal, political (i.e., tribal hierarchy), and private (i.e., family loyalty) norms, and the matrix of multiple and often conflicting roles and identities that Bedouin men must assume despite their experiences. The incidence of SV against men in the Bedouin community is alarming and must be acknowledged by the research community and public health practitioners as a serious health issue that requires more holistic research to better understand the men's experiences. More efforts are needed on the local, regional, and global levels to provide post-violence care for survivors and to prevent SV. In particular, there is a need to reduce the stigma associated with SV so that young men will be willing to speak up about their trauma without shame and receive help.

Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure

BACKGROUND

Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares.

METHODS

A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares.

RESULTS

PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares.

CONCLUSIONS

Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.

Victim-Survivors' Prioritization of Reasons for Non-Reporting Adult Sexual Assaults to Law Enforcement

Despite the potential benefits of reporting a sexual assault to the police, few sexual assault victim-survivors choose to do so. Prior research on reasons for non-reporting has lacked American Indian/Alaska Native representation as well as a quantitative prioritization of non-reporting reasons. This study sought to fill those gaps by using quantitative data from 95 participants in an online, self-administered survey of victim-survivors of adult sexual assaults in Alaska. Descriptive, univariate results revealed great variation in the reasons for non-reporting. Further, which reasons were more commonly endorsed changed when measuring victim-survivor prioritization of reasons (primary, secondary, and tertiary) rather than simple endorsement. Lastly, there were few subgroup differences when conducting bivariate analyses using racial/ethnic identity and the act of reporting other adult sexual assaults in Alaska. The results of this study add to existing literature on non-reporting with an emphasis on changing how we measure the reasons behind non-reporting. The results also signal to criminal justice policy makers and practitioners that proactive, comprehensive efforts must be made to regain the faith and trust of current and potential victim-survivors so that they see the criminal justice system as a viable avenue for securing justice in ways that are meaningful to them.

Social Media Communication About Sexual Violence May Backfire: Online Experiment with Young Men

Sexual violence harms millions of individuals each year in the United States. Survivors of sexual violence endure long-term hardships such as significant financial setbacks, physical and mental health consequences, academic challenges, and stunted career achievement. Digital feminist activism (DFA) has created space online where women can disclose experiences of sexual violence. Research thus far has been limited to documenting the existence and value of DFA for those who participate and has not addressed whether DFA can influence a key demographic for prevention, young men. We conducted an experiment to examine the impact of DFA on college-aged men's reactance to messaging, rape myth acceptance, knowledge about severity, and susceptibility to perpetrate sexual violence. University men (n=230, 18-29 years old) were randomized to one of three conditions: (1) tweets from women challenging rape myths, (2) tweets from women providing information about sexual violence harms, or (3) no exposure control. Tweets challenging rape myths or providing information did not impact rape myth perceptions, knowledge, or susceptibility. Participants had greater reactance (unintended outcome) to tweets challenging rape myths, and subsequently higher rape myth acceptance and lower knowledge about the severity of sexual violence. Rape myth acceptance was associated with susceptibility to perpetrate sexual violence overall. Our finding that some forms of DFA have a negative, indirect influence among college-aged males highlights important unintended consequences and the need for more efficacious communication to prevent sexual violence perpetration.

Inventory of U.S. Public Data Sources to Measure the Socioeconomic Impact of Experiencing Interpersonal Violence

Introduction

There is limited recent information regarding the impact of interpersonal violence on an individual's non-health-related experiences and attainment, including criminal activity, education, employment, family status, housing, income, quality of life, or wealth. This study aimed to identify publicly available representative data sources to measure the socioeconomic impact of experiencing interpersonal violence in the U.S.

Methods

In 2022, the authors reviewed data sources indexed in Data.gov, the Inter-university Consortium for Political and Social Research data archive, and the U.S. Census Bureau's Federal Statistical Research Data Center network to identify sources that reported both nonfatal violence exposure and socioeconomic status-or data sources linking opportunities to achieve both measures-over time (i.e., longitudinal/repeated cross-sections) at the individual level. Relevant data sources were characterized in terms of data type (e.g., survey), violence measure type (e.g., intimate partner violence), socioeconomic measure type (e.g., income), data years, and geographic coverage.

Results

Sixteen data sources were identified. Adverse childhood experiences, intimate partner violence, and sexual violence were the most common types of violence faced. Income, education, and family status were the most common socioeconomic measures. Linked administrative data offered the broadest and the most in-depth analytical opportunities.

Conclusions

Currently, linked administrative data appears to offer the most comprehensive opportunities to examine the long-term impact of violence on individuals' livelihoods. This type of data infrastructure may provide cost-effective research opportunities to better understand the elements of the economic burden of violence and improve targeting of prevention strategies.

Student-Athlete Preferences for Sexual Violence Reporting: A Discrete Choice Experiment

BACKGROUND

Sexual violence (SV) is prevalent among US college athletes, but formal reports are rare. Little is known about adaptations to institution-level reporting policies and procedures that could facilitate reporting.

METHODS

We conducted a discrete choice experiment (DCE) survey with 1004 student-athletes at ten Division I NCAA member institutions to examine how attributes of the reporting system influence the decision to formally report SV to their institution. Changes in utility values were estimated using multinomial logistic regression and mixed multinomial logistic regression. Importance scores were compared to understand student-athlete preferences.

RESULTS

In order of relative importance, the two attributes most preferred by student-athletes were higher probabilities of students perpetrating SV being found in violation of code of conduct policies (relative importance score = 33), and the availability of substance use amnesty policies (relative importance score = 24). Student-athletes with prior SV experiences were more likely to opt out of formally reporting in the DCE paired choice, had lower estimated utility values for all attributes, and had less between-person heterogeneity. While anonymous reporting and survivor-initiated investigations were preferred by student-athletes on average, there was considerable valuation heterogeneity between student-athletes (sizeable deviations from mean estimated utilities). These two attributes also varied in relative importance; anonymous reporting had higher relative importance after interacting levels with prior SV experiences and competitive status, but lower relative importance after interacting levels with whether a student-athlete played on men's or women's sports teams.

CONCLUSIONS

Changes to reporting policies and procedures (e.g., transparency about SV reporting outcomes, implementing substance use amnesty policies) may be promising institution-level interventions to increase formal reporting of SV among student-athletes. More research is needed to understand preference heterogeneity between students and generalize these findings to broader student populations.

To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study

BACKGROUND

Findings from prospective studies question the assumption that mental health problems observed in traumatized adults mainly reflect the effects of potentially traumatic events.

AIMS

Aim of the present comparative prospective study is to clarify the extent to which victims of potentially traumatic events with mental health, social, financial, and/or legal problems, already suffered from such problems before these events.

METHOD

Data was extracted from three surveys of the prospective VICTIMS-study (T1 = 2018, T2 = 2019, T3 = 2020), conducted with the population-based longitudinal LISS-panel. Differences between victims (n = 340, victimized by violence, accidents, and serious threats in the 12 months before T3) and nonvictims (n = 3,872, not victimized by such events in this period), were examined using multivariate logistic regression analyses.

RESULTS

The large majority of victims with current (at T3) anxiety and depression symptomatology (74%), general mental health problems (71%), partner/family (67%), financial (76%), and legal problems (58%), and lack of support (79%), already had these problems (at T1 and/or at T2). A similar pattern was observed among nonvictims. Of the victims with current probable PTSD (at T3), 87% already had any mental health problem. At T3, among both groups, the incidence of problems was substantially lower than their prevalence. The large majority of victims with post-event mental health, social, financial, and legal problems already suffered from these problems in the past.

CONCLUSIONS

When victims seek help for their problems, professional care providers should be aware that in most cases, as among nonvictims, these problems are chronic/re-current rather than new problems.

Association Between Intimate Partner Violence and Depressive Symptoms among Women Aged 15 to 45 Years in Peru: A Three-Year Analysis of the Demographic and Health Survey

We conducted a secondary data analysis based on the 2014, 2015, and 2016 Demographic and Health Surveys to determine the association between intimate partner violence (IPV) and depressive symptoms in Peruvian women aged 15-45 years. Depressive symptoms were assessed through the PHQ-9, while IPV was assessed through the CTS-2. A total of 24,099 subjects were included. The prevalence of depressive symptoms and IPV was 6.98% and 64.72%, respectively. Victims of IPV were 2.47 times more likely to have depressive symptoms compared to those who were never assaulted. In conclusion, there is a strong association between IPV and depressive symptoms.

Sexual Violence and Its Associated Psychosocial Effects in Ireland

Current data on the prevalence and psychosocial correlates of sexual violence in the Republic of Ireland is lacking, with the most recent sexual abuse and violence survey dating back to 2001. The current study sought to identify what proportion of Irish adults have experienced sexual violence, if there are sex differences in exposure to different forms of sexual violence, and to what extent different forms of sexual violence are associated with adverse psychosocial outcomes. To achieve these objectives, we carried out a nationally representative sample of Irish adults (N = 1,020) completed self-report measures of history of sexual violence and mental health. Results suggest that approximately one-in-three (34.4%) Irish adults experienced some form of sexual violence, including 14.8% who were sexually assaulted (raped) and 31.1% who were sexually harassed. Women were significantly more likely than men to have experienced all forms of sexual violence (ps < .001), with the exception of sexual assault by a parent or guardian. All forms of sexual violence were associated with an increased likelihood of serious mental health problems, with sexual assault by a parent/guardian associated with several other psychosocial outcomes in life, including education achievement, history of being taken into state care, salary, and employment status. Sexual violence is a common experience in the general population and women are disproportionately affected (1-in-2 women versus 1-in-5 men). Additional resources to increase mental health care among survivors of sexual violence is urgently needed. How our findings compare to Ireland's previous sexual abuse and violence survey and the implications of our findings for policy are discussed.

Unchaste Celibates: Clergy Sexual Misconduct against Adults—Expressions, Definitions, and Harms

There is an ignored, misunderstood, and complex reality within the broader clergy sexual abuse scandal within the Roman Catholic Church (RCC)—that of clergy sexual misconduct against adults (CSMAA). Estimates and calculations of numbers of victims/survivors over the last half-century reach into the early millions. Furthermore, evidence reveals that CSMAA does produce many serious personal, relational, and practical harms. This article presents and discusses the many expressions of such harms. However, even with the evidence of such harms CSMAA events are, for the most part, still generally perceived as consensual affairs. Such a perception is challenged when CSMAA is contextualised within a professional misconduct framework, and even more so, when survivors thereof participate in the research. Furthermore, CSMAA is clearly not just one type of event. Accordingly, this article also presents a continuum of expressions of CSMAA to assist with perceptual accuracy of this issue along with an unambiguous definition of CSMAA.

Factors Associated With Law Enforcement Reporting in Patients Presenting for Medical Forensic Examinations

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011-2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p = .001). Patients who were not students were more likely to report than students (OR = 3.24; p = .002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p = .007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p = .008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p = .056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting.

Sexual Assault and the Association With Health, Quality of Life, and Self-Efficacy in the General Norwegian Population

The lifetime prevalence of sexual assault was examined in a representative sample of the general Norwegian adult population (n = 1,792), in addition to the association between sexual assault and health, quality of life, and general self-efficacy. Respondents completed questionnaires assessing these factors. Overall, 6.7% (n = 120) of the respondents (10.9% of women and 1.9% of men) reported an experience of sexual assault. Respondents in the sexual assault group reported significantly worse mental and physical health as well as poorer quality of life and lower self-efficacy, compared with those without sexual assault experience. The most prevalent mental problems in the sexual assault group were depression (61.7%), sleep problems (58.3%), eating disorders (26.7%), and posttraumatic stress disorder symptoms at a clinical level (25.0%). The most prevalent physical problems were chronic pain (47.5%) and musculoskeletal disease (30.8%). The proportions of physical and mental health problems were not significantly different between male and female victims. Results indicated that having experienced sexual assault during one's life appears to be associated with lifetime occurrence of multiple health problems for both genders and reduces a person's perceived general self-efficacy and quality of life.

Lifetime Prevalence of Sexual Violence and Its Associated Factors among High School Female Students in Jarso District, Oromia Region, Eastern Ethiopia

Background

Sexual violence is a serious public health problem affecting millions of young girls and women across the world. Recently, the issue of sexual violence against schoolgirls has garnered global and national attention with implications for health and education outcomes. Sexual violence is driven by a multitude of risk factors that occur at different levels. Understanding the magnitude, risk factors, and conceptuality of sexual violence is crucial for setting priorities and elimination efforts at different levels. Therefore, the objective of this study was to determine the lifetime prevalence of sexual violence and associated factors among high school female students in Jarso district, Oromia region, eastern Ethiopia.

Methods

A school-based cross-sectional study was conducted in public high schools of Jarso district, eastern Ethiopia, from 1^st March to 5^th April 2019. A multistage sampling technique was used to select 559 eligible study participants. Data were collected by a structured self-administered questionnaire. The outcome measure of interest was lifetime sexual violence. Bivariate and multivariable logistic regression analyses were done. Statistically significant association of variables had been declared based on the adjusted odds ratio (AOR) with its 95% CI and p value < 0.05.

Results

The overall magnitude of sexual violence among female students was 28.6% (95% CI: 25%-32.2%) in the study area. Forty (7.2%) participants have experienced coercive sex against their consent. Participant's level of education ((AOR = 1.5, 95% CI (1.03–2.30)), being unmarried ((AOR = 2.80, 95% CI (1.40–5.81)), consumption of alcohol ((AOR = 3.41, 95% CI (1.11–10.40)), using substances (hashish and/or shisha) ((AOR = 2.6, 95% CI (1.02–6.50)), and ever initiated sexual intercourse ((AOR = 5.9, 95% CI (3.3–10.7)) were positively and statistically associated with sexual violence at p value < 0.05.

Conclusion

The overall magnitude of sexual violence was relatively high (28.6%). Thus, any intervention aimed to address sexual violence should consider the identified associated risk factors in the study area.

The use of professional help and predictors of unmet needs for dealing with mental health to legal problems among victims of violence, accidents, theft and threat, and nonvictims in the general population

AIMS

Victims of violence, accidents, theft, and serious threat (hereafter abbreviated as victims) are more than nonvictims at risk for problems in different domains, varying from mental health to legal problems. However, the extent to which victims with these problems compared to nonvictims with similar problems receive problem-related professional or formal help is unclear. It is unknown if predictors of unmet needs differ between victims and nonvictims. Aim of the present study is to fill this gap of knowledge.

METHODS

Data was extracted from surveys of the VICTIMS-study (2018, 2019 and 2020), conducted with the Dutch population-based longitudinal LISS panel. Each survey assessed 1.) experiences with physical violence, accidents, theft, and serious threat and other traumatic or stressful events in the past 12 months and 2.) various problems and use of professional help, e.g. do receive help, do not need help, could use help but do not use it, cannot find or afford help for these problems. Multivariate logistic regression analyses were performed to assess differences in problems, in the use of problem-related professional help, and in predictors of unmet needs between victims (N = 1,756) and nonvictims (N = 5,000).

RESULTS

Victims more often had assessed problems than nonvictims. Victims compared to nonvictims with similar problems had 1.5 to 2 times more often unmet needs: they could not find or afford professional help for their mental, physical, partner/family, financial and legal problems. In addition, victims less often received help for legal and administrative problems. Most predictors of unmet needs, e.g. could use help but do not use it, cannot find or afford help, were not significant and hardly differed between both groups.

CONCLUSIONS

The findings that victims compared to nonvictims more often have various problems and more often cannot find or afford problem-related professional help, suggest that there is room for improvement for victims services.

The Role of Physical and Sexual Assaults on the Ability to Complete Work Responsibilities

Sexual and physical assaults have many serious and persistent negative impacts on individual health. There is now a considerable literature base identifying and discussing these health outcomes. Less is known about the mediating mechanisms that link these types of assault with later outcomes. This study examines the role of sexual and physical assaults in self-perceptions of individual health on missing or cutting back on work responsibilities. In particular, perceptions of both mental and physical health are investigated to further refine understanding of the different impacts of assault on survivor health and behavior. Using a sample of 3,791 adults aged 30 to 84 from the Midlife in the United States (MIDUS) study, results of the analyses indicate that sexual and physical assaults do not have a direct effect on missing/cutting back on work responsibilities but do have an indirect effect through perceptions of health. The results can inform academic research, as important impacts of assault may be masked if mediating mechanisms are not investigated. In terms of policy, adults who have difficulty carrying out work responsibilities should be assessed for their overall health and survivors of violence should be offered health-related services following a victimization experience.

Exploring Help Seeking Patterns for Emerging Adult Victims Using the National Intimate Partner and Sexual Violence Survey

Emerging adulthood is a critical developmental period and a particularly important one for studying responses to interpersonal victimization as they can shape future coping patterns. This study focuses on non-college-attending emerging adults to explore their use of help seeking and satisfaction with resources. Comparisons are made with their college-attending counterparts. The findings highlight (a) the importance of friends across gender and education levels as a common resource and one perceived as helpful and (b) the large proportion of victims of interpersonal violence who do not seek any help. These results are discussed in connection with future research and policy implications.

A Prospective Study of Exposure to Gender-Based Violence and Risk of Sexually Transmitted Infection Acquisition in the Women's Interagency HIV Study, 1995-2018

Background: Our objectives were to estimate the association of gender-based violence (GBV) experience with the risk of sexually transmitted infection (STI) acquisition in HIV-seropositive and HIV-seronegative women, to compare the STI risks associated with recent and lifetime GBV exposures, and to quantify whether these associations differ by HIV status. Methods: We conducted a multicenter, prospective cohort study in the Women's Interagency HIV Study, 1994-2018. Poisson models were fitted using generalized estimating equations to estimate the association of past 6-month GBV experience (physical, sexual, or intimate partner psychological violence) with subsequent self-reported STI diagnosis (gonorrhea, syphilis, chlamydia, pelvic inflammatory disease, or trichomoniasis). Results: Data from 2868 women who reported recent sexual activity comprised 12,069 person-years. Higher STI risk was observed among HIV-seropositive women (incidence rate [IR] 5.5 per 100 person-years) compared with HIV-seronegative women (IR 4.3 per 100 person-years). Recent GBV experience was associated with a 1.28-fold (95% confidence interval [CI] 0.99, 1.65) risk after adjustment for HIV status and relevant demographic, socioeconomic, and sexual risk variables. Other important risk factors for STI acquisition included unstable housing (adjusted incidence rate ratio [AIRR] 1.81, 95% CI 1.32-2.46), unemployment (AIRR 1.42, 95% CI 1.14-1.76), transactional sex (AIRR 2.06, 95% CI 1.52-2.80), and drug use (AIRR 1.44, 95% CI 1.19-1.75). Recent physical violence contributed the highest risk of STI acquisition among HIV-seronegative women (AIRR 2.27, 95% CI 1.18-4.35), whereas lifetime GBV experience contributed the highest risk among HIV-seropositive women (AIRR 1.59, 95% CI 1.20-2.10). Conclusions: GBV prevention remains an important public health goal with direct relevance to women's sexual health.

Barriers in seeking support: Perspectives of service providers who are survivors of sexual violence

Research with survivors of sexual violence suggests that most do not seek supportive services from community organizations. The purpose of this study is to understand the unique barriers that service providers, who are also survivors of sexual violence, may experience and how it informs their work with survivors. We conducted semi-structured interviews with 19 female, trans, and nonbinary survivors of sexual violence who are also employed as domestic violence or sexual assault advocates, community organizers, therapists, health care providers, educators, or substance abuse counselors, and had worked with survivors of sexual violence in their current positions. We coded the data using a multistep strategy derived from grounded theory. Participants indicated sensitivity to community-level barriers including where services are offered, perceived cost of services, and taking time off of work. Internalized blame, shame, minimization of their experiences, and trauma were also mentioned as significant barriers for themselves and impacted their work with survivors. Our findings suggest a need for trauma-informed intervention in community practice and policy.

An Exploration of Sexual Assault Survivors' Discourse Online on Help-Seeking

Although sexual assault is associated with significant negative psychological health outcomes, few survivors seek support from formal providers. This study explored the barriers to accessing and benefitting from services for sexual assault, as disclosed in narrative posts on social media, using qualitative methodology. Of the 1,179 narratives posted to the subreddit'r/rapecounseling' that were reviewed, 81 data extracts from 52 women were included in this study based on predefined inclusion/exclusion criteria. Six themes were identified that prevented survivors from accessing or benefitting from help. Internal barriers included feeling overwhelmed and avoidance-based coping. External barriers included availability of services, suitability of services, and therapist-caused harms. Stigma was the only barrier that was experienced both internally and externally. These findings suggest a need for more supportive mental health services.

Supporting survivors of sexual violence: protocol for a mixed-methods, co-research study of the role, funding and commissioning of specialist services provided by the voluntary sector in England

INTRODUCTION

The voluntary sector provides a range of specialist services to survivors of sexual violence, many of which have evolved from grass roots organisations responding to unmet local needs. However, the evidence base is poor in terms of what services are provided to which groups of survivors, how voluntary sector specialist (VSS) services are organised and delivered and how they are commissioned. This will be the first national study on the role of the voluntary sector in supporting survivors in England.

METHODS AND ANALYSIS

This study uses an explanatory sequential naturalistic mixed-methods design with two stages. For stage 1, two national surveys of providers' and commissioners' views on designing and delivering VSS services will facilitate detailed mapping of service provision and commissioning in order to create a taxonomy of VSS services. Variations in the national picture will then be explored in stage 2 through four in-depth, qualitative case studies using the critical incident technique to explain the observed variations and understand the key contextual factors which influence service provision. Drawing on theory about the distinctive service contribution of the voluntary sector, survivors will be involved as co-researchers and will play a central role in data collection and interpretation.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the University of Birmingham research ethics committee for stage 1 of the project. In line with the sequential and co-produced study design, further applications for ethical review will be made in due course. Dissemination activities will include case study and end-of-project workshops; good practice guides; a policy briefing; project report; bitesize findings; webinars; academic articles and conference presentations. The project will generate evidence about what survivors want from and value about services and new understanding about how VSS services should be commissioned and provided to support survivors to thrive in the long term.

Resource Loss Moderates the Association Between Child Abuse and Current PTSD Symptoms Among Women in Primary-Care Settings

This study examined if abuse during childhood, rape in adulthood, and loss of resources predict a woman's probability of reporting symptoms of posttraumatic stress disorder (PTSD), and whether resource loss moderates the association between reporting childhood abuse and PTSD symptoms. The sample included 767 women and was collected in publicly funded primary-care settings. Women who reported having been abused during childhood also reported more resource loss, more acute PTSD symptoms, and having suffered more adult rape than those who reported no childhood abuse. Hierarchical logistic regression yielded a two-variable additive model in which child abuse and adult rape predict the probability of reporting or not any PTSD symptoms, explaining 59.7% of the variance. Women abused as children were 1 to 2 times more likely to report PTSD symptoms, with sexual abuse during childhood contributing most strongly to this result. Similarly, women reporting adult rape were almost twice as likely to report symptoms of PTSD as those not reporting it. Resource loss was unexpectedly not among the predictors but a moderation analysis showed that such loss moderated the association between child abuse and current PTSD symptoms, with resource loss increasing the number and severity of PTSD symptoms in women who also reported childhood abuse. The findings highlight the importance of early assessment and intervention in providing mental health care to abused, neglected, and impoverished women to help them prevent and reverse resource loss and revictimization.

Occupational Well-Being in Sexual Assault Victims and Survivors

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

Starting the Conversation: Are Campus Sexual Assault Policies Related to the Prevalence of Campus Sexual Assault?

One goal of university campus sexual assault (CSA) policies is to help prevent CSA. Federal guidance in the 2014 White House Task Force to Protect Students From Sexual Assault Checklist for Campus Sexual Misconduct Policies suggests 10 elements for inclusion in CSA policies (e.g., Policy Introduction, Grievance/Adjudication), and outlines policy topics to be included within each element (Policy Introduction includes two topics: statement of prohibition against sex discrimination including sexual misconduct and statement of commitment to address sexual misconduct). However, no research has examined whether CSA policies impact CSA prevalence. To begin addressing this gap, we studied 24 universities participating in the 2015 Association of American Universities Campus Climate Survey on Sexual Assault and Sexual Misconduct. We linked 2014-2015 data from these universities' CSA policies and their CSA prevalence findings from the 2015 Association of American Universities (AAU) survey. To test whether the comprehensiveness of schools' CSA policies was related to schools' CSA prevalence, we examined the degree to which the CSA policies included recommended policy content from the aforementioned Checklist. Policies were characterized as more comprehensive if they included greater numbers of Checklist topics. We then correlated the number of topics within the policies with school-level CSA prevalence. We also explored whether there was lower CSA prevalence among schools with policies containing particular topics. Results suggested that greater comprehensiveness of schools' entire CSA policies was negatively correlated with CSA prevalence; however, these findings did not approach statistical significance. The number of negative correlations observed between schools' CSA policy elements and CSA prevalence among undergraduate women was greater than expected by chance alone, suggesting a possible connection between comprehensive CSA policies and CSA prevalence. Schools with policies that included a topic on their sexual assault response team had the lowest CSA prevalence for both women and men, and schools that included topics describing grievance/adjudication procedures had lower CSA prevalence. This study provides a novel examination of CSA and could inform needed research related to the impact of CSA policies on CSA.

Long-term impacts of college sexual assaults on women survivors' educational and career attainments

OBJECTIVE

To examine the well-documented mental and physical health problems suffered by undergraduate women sexually assaulted while on campus with an exploration of how the trauma impacts a survivor's lifetime education trajectory and career attainment.

PARTICIPANTS

In November and December 2015, researchers recruited US participants using an online crowdsourcing tool and a Listserv for sexual violence prevention and response professionals.

METHODS

Of 316 women who completed initial screening, 89 qualified to complete a Qualtrics survey. Eighty-one participants completed the online survey, and 32 participated in phone interviews.

RESULTS

Ninety-one percent of the participants reported health problems related to the assault that they attributed to difficulties they faced in their attainment of their education and career goals.

CONCLUSIONS

The findings suggest the importance of simultaneously examining the effects of human capital losses and mental and physical health problems attributed to the costly public health problem of campus sexual assault.

Risk Avoidance Strategies after Sexual Assault: A Dyadic Study of Survivors and Informal Support Providers

Interview data from 45 matched pairs of survivors disclosing sexual assaults and their primary informal support provider (friend, family, significant other) were used to explore survivor-support provider perspectives on self-protective behaviors survivors and those close to them take to protect themselves from future assaults. Strategies for reducing risk taken by survivors included behavioral changes, security measures, self-defense strategies, avoiding alcohol/drugs, and protecting others. Support providers play critical roles by encouraging survivors to pursue risk avoidance strategies, and employing these strategies themselves. Counseling and prevention implications are drawn in the context of risks facing survivors trying to avoid further sexual victimization.

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.