1
|
Nobels A, De Schrijver L, Van Landuyt M, Vandeviver C, Lemmens GMD, Beaulieu M, Keygnaert I. "In the End You Keep Silent": Help-Seeking Behavior Upon Sexual Victimization in Older Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2318-2343. [PMID: 38149594 DOI: 10.1177/08862605231220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Sexual violence is considered a prominent mental health problem. Exposure to sexual victimization during lifetime has been linked to mental health problems in old age. Research in adult victims has shown that they experience many barriers for disclosure and seeking professional help upon sexual victimization. However, information on help-seeking behavior in older victims of sexual violence is non-existent. With this study we aim for a better understanding of help-seeking behavior upon sexual violence in older adults. We used a mixed methods approach with an explanatory sequential design. Data were collected through structured face-to-face interviews with a random sample of 227 sexual violence victims of 70 years and older living in Belgium. Quantitative data were triangulated with qualitative data from 15 in-depth interviews with older victims. We found that up to 60% of older sexual violence victims never disclosed their experiences and 94% never sought professional help. Help-seeking is a complex process comprising several phases, which are affected by strong feelings of shame and self-blame, ageist premises and taboos about sexuality. In the end, most victims choose to cope on their own. Occasional disclosure only happens decades after the sexual violence took place. Older victims do not spontaneously disclose to healthcare workers but expect professionals to initiate the conversation. In conclusion, few older victims disclose or seek professional help upon sexual victimization. Healthcare professionals working with older adults need capacity building through training, screening tools, and care procedures to initiate conversation on sexual violence, and to detect signs, prevent, mitigate and respond to sexual victimization in older adults.
Collapse
Affiliation(s)
- Anne Nobels
- Department of Public Health and Primary Care, International Center for Reproductive Health, Ghent University, Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Lotte De Schrijver
- Department of Public Health and Primary Care, International Center for Reproductive Health, Ghent University, Ghent, Belgium
- Vlaamse Vereniging van Klinisch Psychologen, Brussels, Belgium
| | - Mira Van Landuyt
- Department of Public Health and Primary Care, International Center for Reproductive Health, Ghent University, Ghent, Belgium
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law, and Social Law, Ghent University, Ghent, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin-Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Marie Beaulieu
- School of Social Work, Research Chair on Mistreatment of Older Adults and Research Center on Aging, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Ines Keygnaert
- Department of Public Health and Primary Care, International Center for Reproductive Health, Ghent University, Ghent, Belgium
- Women's Clinic, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
2
|
Nobels A, Meersman C, Lemmens G, Keygnaert I. "Just something that happened?": Mental health impact of disclosure and framing of sexual violence in older victims. Int J Geriatr Psychiatry 2023; 38:e6036. [PMID: 38088814 DOI: 10.1002/gps.6036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Despite the important impact of sexual violence (SV) on mental health, few victims disclose their experiences. Although research in adult victims suggests that SV disclosure could protect against long-term mental health problems, studies in older adults are lacking. OBJECTIVES To establish the prevalence of depression, anxiety, posttraumatic stress disorder (PTSD), suicide attempts, and self-harm, their association with SV disclosure, and the moderating effect of sociodemographic characteristics and SV framing in the relation between SV disclosure and the different mental health outcomes in older SV victims. METHODS Data on sexual victimisation, mental health, SV framing, and disclosure were collected through structured face-to-face interviews with 171 randomly selected sexually victimised adults of 70 years and older living in Belgium. SV was measured using behaviourally specific questions based on a broad definition. Mental health outcomes were measured using validated scales. RESULTS Depression, anxiety and PTSD were reported by 34%, 33% and 9% of participants respectively, 5% had attempted suicide and 1% reported self-harm during lifetime. SV framing was associated with the kind of help victims consulted. SV disclosure was not linked with depression and anxiety, but was associated with an increase of PTSD symptoms in older victims with care dependency (p = 0.004) or a chronic illness and/or disability (p = 0.025). CONCLUSIONS SV disclosure in itself does not protect against adverse mental health outcomes in old age. Capacity building of professionals trough training and development of clinical guidelines and care procedures may increase appropriate response to SV disclosure by older victims.
Collapse
Affiliation(s)
- Anne Nobels
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Gilbert Lemmens
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Women's Clinic, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
3
|
Caswell RJ, Hodson J, Bradbury-Jones C, Ross JDC. Where do those experiencing sexual violence seek help and is routine enquiry acceptable within a sexual healthcare setting? Findings from a population-based survey. BMJ Open 2023; 13:e073204. [PMID: 37673457 PMCID: PMC10496700 DOI: 10.1136/bmjopen-2023-073204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES Most sexual violence (SV) remains undisclosed to healthcare professionals. The aims of this study were to identify where support would be sought after SV and whether routine enquiry about SV was acceptable in a sexual healthcare setting. DESIGN An online population-based survey collected data on a history of SV and preferences on support after SV, in addition to sociodemographic data. Respondents' views on being routinely asked about SV were sought. SETTING AND PARTICIPANTS This online survey was based in England, UK. There were 2007 respondents. RESULTS The police were the most frequent first choice for support after experiencing SV (n=520; 25.9%); however, this was less common in individuals in younger age groups (p<0.001) and in those with a history of SV (17.2% vs 29.9%, p<0.001). For the 27.1% (532 of 1960) of respondents who reported a history of SV, the first choice of place for support was Rape Crisis or similar third-sector organisation. The majority of respondents supported routine enquiry about SV during Sexual and Reproductive Health Service (SRHS) consultations (84.4%), although acceptability was significantly lower in older age groups. CONCLUSIONS AND STUDY IMPLICATIONS A greater awareness of the influence of sociodemographic factors, including ethnicity, age, gender, disability and a history of SV, when planning and delivering services for those who have experienced SV is needed. A history of SV is common in the general population, and a 'one-size-fits-all' approach to encourage disclosure and access to support is unlikely to be optimal. Routine enquiry about SV is highly acceptable in an SRHS setting and likely to improve disclosure when appropriately implemented.
Collapse
Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
| | - James Hodson
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
4
|
Minority Identity, Othering-Based Stress, and Sexual Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074221. [PMID: 35409901 PMCID: PMC8998422 DOI: 10.3390/ijerph19074221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Background: Some (minority) groups (MGs) are more vulnerable to sexual violence (SV) exposure than others. Othering-based stress (OBS) may mediate the relationship between minority identification and SV. This study aims to assess the prevalence of SV in different MGs to explore the relationship between minority identification and SV, to investigate whether belonging to multiple MGs moderates this relationship, and to explore OBS SV moderation for different MGs. Method: Through an online survey administered to a nationally representative sample in Belgium, data was collected from 4632 persons, of whom 21.01% self-identified as belonging to a MG (SI-Minority). SV prevalence was measured using behaviorally specific questions based on the WHO definition of SV. SI-Minority participants received an additional scale on OBS. Results: SI-Minority participants reported more SV victimization compared to the non-minorities. However, this increased risk was not moderated by minority identification but linked to the socio-demographic SV risk markers common to minority individuals. Multiple-minority participants were found more at risk of SV compared to single-minority respondents. Lesbian, gay, bisexual, pan-/omnisexual, asexual, and other non-heterosexual (LGB+) participants were found more at risk than heterosexual participants. OBS was found to be significantly correlated to SV in sexual and gender minorities and in cultural minorities. Conclusions: This study contributes to our understanding of the relationship between minority identification, OBS, and SV. Studying both specific and common SV vulnerabilities and outcomes within specific societal subgroups and the general population may inform policy makers when allocating resources to those interventions with the largest societal impact.
Collapse
|
5
|
Cismaru-Inescu A, Hahaut B, Adam S, Nobels A, Beaulieu M, Vandeviver C, Keygnaert I, Nisen L. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study. J Sex Med 2022; 19:569-580. [PMID: 35236640 DOI: 10.1016/j.jsxm.2022.01.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/26/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the World Health Organization calling for sexuality to be recognized as an aspect of well-being, no studies have explored sexual activity and physical tenderness in older adults aged ≥ 75 years in Belgium or those aged ≥ 85 years worldwide. AIM To assess the prevalence and predictors of sexual activity and physical tenderness in a sample of older adults. METHODS Using data from a Belgian cross-sectional study on sexual violence (UN-MENAMAIS), information on sexual activity, physical tenderness, and associated characteristics was collected during structured face-to-face interviews with older adults living in the community, assisted living facilities, or nursing homes. Cluster random probability sampling with a random route-finding approach was used to select the participants. OUTCOMES Current sexual activity and physical tenderness in the previous 12 months, sociodemographic characteristics, chronological age, subjective age, number of sexual partners, sexual satisfaction, attitudes toward sexuality in later life, quality of life, and lifetime sexual victimisation. RESULTS Among the 511 participants included, 50.3% were in a relationship, mainly living with their partner; 31.3% indicated they were sexually active; and 47.3% of sexually inactive participants reported having experienced forms of physical tenderness in the previous 12 months. Sexual activity was associated with the presence of a partner, satisfaction with sexual life, permissive attitudes regarding sexuality in later life, a younger age, and a lack of disability. Physical tenderness was associated with the presence of a partner, community residency, and permissive attitudes regarding sexuality in later life. CLINICAL IMPLICATIONS Raising awareness among the general population, healthcare professionals, and older adults about sexuality in later life could contribute to ending this taboo and should therefore be a priority for society. STRENGTHS AND LIMITATIONS Our study fills a gap in the literature regarding sexual activity and physical tenderness in older adults aged ≥ 70 years, including respondents aged up to 99 years. Additionally, we explored different forms of sexual expression beyond intercourse, and face-to-face interviews contributed to the quality of the collected data. The main limitation of this study was the sample size, although the findings were similar to recent statistical indicators in Belgium. CONCLUSION One in 3 older adults aged ≥ 70 years living in Belgium are sexually active. These findings provide an opportunity to inform the general public and older adults about later life sexuality and to educate healthcare professionals about aging sexuality to increase discussions and avoid assumptions of asexuality in later life. Cismaru-Inescu A, Hahaut B, Adam S et al. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study. J Sex Med 2022;19:569-580.
Collapse
Affiliation(s)
- Adina Cismaru-Inescu
- CARE-ESPRIst, Studies and Evaluations, University of Liège, Liège, Belgium; Psychology of Aging Unit, University of Liège, Liège, Belgium.
| | - Bastien Hahaut
- CARE-ESPRIst, Studies and Evaluations, University of Liège, Liège, Belgium
| | - Stéphane Adam
- Psychology of Aging Unit, University of Liège, Liège, Belgium
| | - Anne Nobels
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Beaulieu
- School of Social Work and Research Centre on Aging, University of Sherbrooke, Sherbrooke, Canada
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, Ghent, Belgium; Research Foundation Flanders (FWO), Belgium
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Laurent Nisen
- CARE-ESPRIst, Studies and Evaluations, University of Liège, Liège, Belgium
| |
Collapse
|
6
|
Nobels A, Lemmens G, Thibau L, Beaulieu M, Vandeviver C, Keygnaert I. "Time Does Not Heal All Wounds": Sexual Victimisation Is Associated with Depression, Anxiety, and PTSD in Old Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052803. [PMID: 35270496 PMCID: PMC8910002 DOI: 10.3390/ijerph19052803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022]
Abstract
Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalising disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to address SV in later life. Studies researching the mental health impact of lifetime SV, i.e., SV during childhood, adulthood, and old age, are lacking. Between July 2019 and March 2020, 513 older adults living in Belgium participated in structured face-to-face-interviews. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety, and posttraumatic stress syndrome (PTSD) were measured using validated scales. Participants were asked about suicide attempts and self-harm during their lifetime and in the past 12 months. SV was measured using behaviourally specific questions based on a broad SV definition. We found rates for depression, anxiety, and PTSD of 27%, 26%, and 6% respectively, while 2% had attempted suicide, and 1% reported self-harm in the past 12 months. Over 44% experienced lifetime SV and 8% in the past 12 months. Lifetime SV was linked to depression (p = 0.001), anxiety (p = 0.001), and PTSD in participants with a chronic illness/disability (p = 0.002) or no/lower education (p < 0.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12 months. In conclusion, lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are important.
Collapse
Affiliation(s)
- Anne Nobels
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
- Department of Psychiatry, Ghent University Hospital, 9000 Ghent, Belgium;
- Correspondence: (A.N.); (I.K.)
| | - Gilbert Lemmens
- Department of Psychiatry, Ghent University Hospital, 9000 Ghent, Belgium;
- Department of Head and Skin–Psychiatry and Medical Psychology, Ghent University, 9000 Ghent, Belgium
| | - Lisa Thibau
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
| | - Marie Beaulieu
- School of Social Work, Research Chair on Mistreatment of Older Adults and Research Centre on Aging, University of Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, 9000 Ghent, Belgium;
| | - Ines Keygnaert
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
- Correspondence: (A.N.); (I.K.)
| |
Collapse
|
7
|
Nobels A, Cismaru-Inescu A, Nisen L, Hahaut B, Beaulieu M, Lemmens G, Adam S, Schapansky E, Vandeviver C, Keygnaert I. Correction to: Sexual violence in older adults: a Belgian prevalence study. BMC Geriatr 2022; 22:77. [PMID: 35078411 PMCID: PMC8790833 DOI: 10.1186/s12877-021-02623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|