Gender Minority Stress and Resilience Measure: A Meta-Analysis of the Associations with Mental Health in Transgender and Gender Diverse Individuals.

Transgender and gender diverse (TGD) individuals are more likely to experience mental health difficulties than cisgender individuals due to unique stressors related to their stigmatized gender identity and/or expression. This meta-analysis examined the associations between gender minority stressors and resilience factors, as measured by the Gender Minority Stress and Resilience Measure (GMSR; Testa et al., 2015), and two types of mental health symptoms (i.e., depression and anxiety). A comprehensive literature search and study inclusion process following PRISMA guidelines identified 69 sources, representing 47 unique samples. Mean effect sizes revealed significant positive associations between all GMSR minority stress subscales and anxiety and depression symptoms (rs = .22 to .40) with larger correlations for proximal stressors compared to distal stressors. The GMSR resilience subscales were significantly negatively correlated with anxiety and depression symptoms (rs = -.07 to -.16). These findings highlight the robust relationship between gender minority stressors and mental health symptoms among TGD individuals and indicate a need for addressing these stressors both by reducing exposure to external stressors and by addressing the internalization of those stressors in clinical settings. The small effects for the resilience subscales suggest a need to examine additional resilience factors that may be more pertinent to mental health among TGD individuals.

Sexual assault characteristics and posttraumatic stress symptoms among collegiate women: The role of posttraumatic cognitions.

Although it is well-established that sexual assault is a risk factor for posttraumatic stress symptoms (PTSS) and other negative mental health outcomes, research is needed to help identify which individuals are most likely to experience ongoing distress following sexual assault. Negative cognitions following trauma may be influenced by sexual assault characteristics and have been shown to be associated with PTSS. The present study examined whether sexual assault characteristics were associated with PTSS by way of posttraumatic cognitions in a sample of 475 female college students who had experienced a sexual assault since the age of 14 years. Participants completed an online survey that included questions about sexual assault characteristics (i.e., whether the perpetrator used force, whether they experienced a freeze response), posttraumatic cognitions, and PTSS. Path analysis revealed that survivors who indicated they froze during the assault reported higher levels of PTSS, total effect = .28, p < .001, direct effect = .19, p < .001; posttraumatic cognitions regarding others, indirect effect = .02, p = .047, and other-safety, indirect effect = .05, p = .003, partially accounted for this association. Only the direct effect of perpetrator use of force on PTSS was statistically significant, total effect = .23, p = .090, direct effect = .16, p = .009; none of the indirect effects were statistically significant, ps = .063-.669. The results support that assault characteristics are associated with postassault outcomes and are consistent with the cognitive model of posttraumatic stress disorder.

The Role of Gender, Sexual Assault History, and Sexism in Endorsement of Rape Myths Among College Students.

The present study examined the roles of sexual victimization history, sexism toward women, and sexism toward men in the gender difference in rape myth acceptance. The data were obtained from 2,011 male and female college students who completed an online survey. The results suggested that gender had a significant indirect effect on rape myth acceptance via sexual assault history and several forms of sexist beliefs. The findings supported the importance of considering additional antecedents of rape myths in research, as well as in programming geared toward preventing sexual assault and improving support for survivors.

The Prevalence of Nonsuicidal Self-Injury in Military Personnel: A Systematic Review and Meta-Analysis.

Military service members and veterans (SMVs) are at risk for self-directed violence, including nonsuicidal self-injury (NSSI). While NSSI is an important construct worthy of independent study, it is understudied among SMVs and, when included in research, typically examined in the context of suicide risk. Consequently, lifetime prevalence rate estimates of NSSI among SMVs vary. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis estimated the average lifetime NSSI prevalence among SMVs and explored demographic and methodological factors that may account for observed variability. Based on a search of Ovid MEDLINE, Embase, PsycINFO, and Web of Science, 47 samples from 42 articles across five countries met inclusion criteria. Results revealed an average NSSI lifetime prevalence rate of 15.76% among SMVs. Significantly higher prevalence rates were observed among clinical (28.14%) versus community (11.28%) samples and studies using interviews to assess NSSI (23.56%) versus self-report (13.44%) or chart review (7.84%). Lifetime prevalence increased as publication year increased and decreased as sample size increased. In contrast to prior literature, prevalence rates were comparable between active-duty SMVs, and studies collecting data anonymously versus those that did not. Lifetime prevalence was not moderated by age, gender, race, country, primary research focus, quality of NSSI operationalization, or whether NSSI methods were assessed. Findings suggest NSSI is a pervasive problem among military personnel, particularly within clinical settings, highlighting the need for systematic assessment of this important but understudied clinical phenomenon among SMVs. Further research is necessary to elucidate additional risk factors for NSSI among SMVs, including trauma exposure.

The Impact of Victim Blaming and Locus of Control on Mental Health Outcomes Among Female Sexual Assault Survivors.

To elucidate individual differences in sexual assault survivor outcomes, we examined locus of control as a moderator of the relationship between victim blaming and both posttraumatic stress disorder (PTSD) symptoms and unhealthy alcohol use. The sample consisted of 82 female sexual assault survivors who had disclosed their victimization to at least one person. The results of this survey demonstrated that locus of control did not moderate the relationship between victim blaming and PTSD, or the relationship between victim blaming and unhealthy alcohol use. The findings further supported the direct relationship between victim blaming and a range of negative mental health outcomes among survivors.

Attitudes Toward Men and Rejection of Rape Myths: The Impact on Survivor Rape Acknowledgment.

Because unacknowledged rape survivors (i.e., those who do not conceptualize their victimization as rape) are less likely to report the crime to police or seek formal services, a better understanding of factors that contribute to rape acknowledgment is a key step to improving access to care and assault reporting on college campuses. To contribute to this line of research, this study examined the indirect effect of sexist attitudes toward men on rape acknowledgment via rejection of rape myths among female rape survivors. The analyzed sample included 250 college female rape survivors (M age = 22.49 years, SD = 7.27) who completed measures of sexual assault history, sexist beliefs toward men, and rejection of rape myths. Among these women, 49.6% were classified as acknowledged rape survivors and 50.4% of the sample was classified as unacknowledged rape survivors. Indirect effects of sexist beliefs on rape acknowledgment via rape myth rejection were supported for four types of sexist beliefs, including resentment of paternalism, compensatory gender differentiation, maternalism, and complementary gender differentiation. Specifically, the findings supported that people with greater levels of these particular types of sexist beliefs toward men rejected rape myths less, and lower rejection of rape myths was associated with increased likelihood of unacknowledged rape. The indirect effects were not supported for the heterosexual hostility or heterosexual intimacy subscales of sexist beliefs. By identifying antecedents of rape acknowledgment, the findings from this study can be used to inform programming geared toward encouraging survivors to seek services, which ultimately improves survivor outcomes.

The Effect of Social Anxiety on the Risk of Sexual Victimization via Assertiveness in an Ethnically Diverse Sample.

Preliminary evidence suggests social anxiety may increase the risk of sexual victimization via decreased sexual assertiveness. A sample of 2,043 undergraduate students completed an online survey. Analyses of moderated indirect effects examined whether gender or ethnicity moderated the indirect effect of social anxiety on sexual victimization via sexual assertiveness. No moderation effects were found, but the indirect effect of social anxiety on sexual victimization via sexual assertiveness was significant for all five types of sexual victimization. Clinically, the findings suggest that sexual assault risk reduction programs may be improved by including assertive resistance strategies and behavioral rehearsals.

Psychological outcomes following sexual assault: Differences by sexual assault setting.

Sexual assault is associated with increased psychological distress. It is possible that military sexual assault (MSA) is associated with heightened psychological distress compared to adult sexual assault that occurs pre- or postmilitary service due to the nature of the military setting. Veterans and service members (N = 3,114; 19.6% women) who participated in the Post-Deployment Mental Health Study completed self-report measures of sexual assault history, symptoms of posttraumatic stress disorder (PTSD), symptoms of depression, hazardous alcohol use, drug use, and suicidal ideation. Women who reported a history of MSA endorsed higher levels of all types of psychological distress than women who did not experience adult sexual assault. Women who reported a history of MSA also endorsed higher levels of PTSD and depression symptoms than women who experienced pre- or postmilitary adult sexual assault. Men who reported a history of adult sexual assault, regardless of setting, reported higher levels of PTSD and depression symptoms than individuals who did not experience adult sexual assault. MSA was associated with higher psychological distress than pre- or postmilitary adult sexual assault among women. Among men, distress associated with MSA was comparable to sexual assault outside the military. Women may face unique challenges when they experience sexual assault in the military, and men may face additional stigma (compared to women) when they experience sexual assault, regardless of setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What's in a Label? The Impact of Media and Sexual Assault Characteristics on Survivor Rape Acknowledgment.

Media coverage of sexual assault has increased since 2017 due to high-profile cases and social media campaigns designed to increase awareness of sexual assault. The purpose of this study was to examine whether media coverage of the Harvey Weinstein allegations and the onset of the 2017 viral #MeToo movement impacted the likelihood of college women acknowledging their own victimization as rape. Participants were 207 female rape survivors who completed an online survey that included assessments of survivor acknowledgment and characteristics of the sexual assault. Some participants completed the study prior to the Harvey Weinstein allegations and onset of the #MeToo movement, and some participants completed the study after these events. The likelihood of survivors labeling their experience as rape did not differ based on when participants completed the study, odds ratios (ORs) = 0.61-3.92, ps = .127-.604. Use of both nonforceful verbal resistance, OR = 2.63, p = .001, and assertive resistance, OR = 3.05, p < .001, were positively associated with the likelihood of survivor acknowledgment. The effects of both perpetrators' use of force and experiencing immobility on survivor acknowledgment were moderated by the timing of study completion, ORs = 4.22 and 0.11, respectively, ps = .023-.040. These findings suggest that media coverage may impact how certain sexual assault characteristics influence how survivors label their victimization experiences.

Self- and Other-Directed Violence as Outcomes of Deployment-Based Military Sexual Assault in Iraq/Afghanistan-era Veteran Men and Women.

Although military sexual assault (MSA) has been well-established as a risk factor for psychopathology (e.g., PTSD, depression), little research has examined the association between MSA and self- and other-directed violence. Furthermore, there has been a growing empirical focus on potential gender differences in the effects of MSA, but few of these studies have examined gender differences in self- and other-directed violence. In a sample of 1571 Iraq/Afghanistan-era veterans (21.0% women), we examined the effect of MSA on difficulty controlling violent behavior and attempting suicide among veteran men and women, above and beyond the influence of childhood sexual abuse, combat trauma, PTSD, and major depressive disorder. Results of a logistic regression revealed that MSA increased risk of attempting suicide and difficulty controlling violence among women but not men. Thus, the results suggest that MSA may be a risk factor for both types of violence in women. Furthermore, because PTSD was associated with both types of violence in both men and women, MSA may also confer risk of violence via PTSD.

The Prevalence of Sexual Revictimization: A Meta-Analytic Review.

The literature consistently demonstrates evidence that child sexual abuse survivors are at greater risk of victimization later in life than the general population. This phenomenon is called sexual revictimization. Although this finding is robust, there is a large amount of variability in the prevalence rates of revictimization demonstrated in the literature. The purpose of the present meta-analysis was to calculate an average prevalence rate of revictimization across the literature and to examine moderators that may potentially account for the observed variability. Based on a review of PsycINFO and PILOTS, 1,412 articles were identified and reviewed for inclusion. This process resulted in the inclusion of 80 studies, which contained 12,252 survivors of child sexual abuse. The mean prevalence of sexual revictimization across studies was 47.9% (95% confidence intervals [43.6%, 52.3%]), suggesting that almost half of child sexual abuse survivors are sexually victimized in the future. The present study failed to find support for any of the examined moderators. Potential explanations of and implications for the results are offered, including suggestions for therapists.

The Prevalence of Military Sexual Trauma: A Meta-Analysis.

Due to methodological heterogeneity, the exact prevalence of military sexual trauma (MST) is unknown. To elucidate our understanding of the pervasiveness of this important social issue, a meta-analysis was conducted. A computerized database search in PsycINFO, PubMed, and PILOTS revealed 584 unique citations for review. Of these identified studies, 69 met the inclusion criteria for the meta-analysis. The results revealed that 15.7% of military personnel and veterans report MST (3.9% of men, 38.4% of women) when the measure includes both harassment and assault. Additionally, 13.9% report MST (1.9% of men, 23.6% of women) when the measure assesses only assault and 31.2% report MST (8.9% of men, 52.5% of women) when the measure assesses only harassment. Regardless of the type of victimization incident (i.e., harassment or assault), women evidenced significantly larger prevalence rates compared to men. Self-report measure and interviews were associated with higher prevalence rates than the review of veterans affair (VA) medical records when measuring both harassment and assault and only harassment. No significant differences were observed among prevalence rates based on VA, non-VA, or both VA and non-VA recruitment. Ultimately, the findings suggest that MST is a pervasive problem, among both men and women in the military, highlighting the importance of this line of research.

The Indirect Effect of Child Maltreatment Severity on Adult PTSD Symptoms through Anxiety Sensitivity.

Although the rate of posttraumatic stress disorder (PTSD) among survivors of child maltreatment is high, individuals differ in symptom severity and many do not experience clinically significant levels of psychopathology. The present study tested the indirect effects of child maltreatment severity on adult PTSD, suicidal ideations, and alcohol dependence via anxiety sensitivity. A sample of 336 participants (mean age of 22.81 years, SD = 8.93; 70.2% female) completed an online survey of child abuse and neglect, anxiety sensitivity, PTSD symptom severity, suicidal ideation severity, and alcohol dependence severity. The results revealed significant indirect effects of child maltreatment on PTSD symptom severity through cognitive and social concerns, but not physical concerns. No direct or indirect effects were demonstrated for suicidal ideations or alcohol dependence severity. These findings elucidate mechanisms in the robust relationship between child maltreatment and adult PTSD symptoms and can potentially inform future research on mechanisms of change in psychotherapy.

Rape myth acceptance and rape acknowledgment: The mediating role of sexual refusal assertiveness.

Unacknowledged rape, defined as when an individual experiences an event that meets a legal or empirical definition of rape but the individual does not label it as such, is prevalent. Research examining predictors of rape acknowledgment is needed. Sexual assertiveness may be an important variable to consider, as an individual's typical behavior during sexual situations may influence rape acknowledgment. To assess the indirect effect of rape myth acceptance on rape acknowledgment through sexual refusal assertiveness, an online survey of 181 female rape survivors was conducted. The indirect effects of two types of rape myths (He didn't mean to and Rape is a deviant event) were significant and positive. Specifically, acceptance of these two rape myths was negatively related to sexual refusal assertiveness, which was negatively associated with likelihood of rape acknowledgment. The results of this study indicate that sexual refusal assertiveness is associated with lower likelihood of rape acknowledgment among rape survivors. As a result, it appears that, under certain circumstances, women high in rape myth acceptance may be more likely to acknowledge rape when it results in decreased sexual refusal assertiveness.

The impact of rape acknowledgment on survivor outcomes: The moderating effects of rape myth acceptance.

OBJECTIVE: Little is known about how rape acknowledgment relates to posttrauma functioning; recent research suggests the effect may depend on additional factors. In the current study, the moderating effect of rape myth acceptance (RMA) on the relationships between rape acknowledgment and mental health outcomes was examined. METHOD: A sample of 181 female rape survivors recruited from a university completed an online survey assessing RMA, rape acknowledgment, depression symptoms, and alcohol use. RESULTS: Generally, the results supported that RMA moderated the influence of rape acknowledgment on depression symptoms and average quantity per drinking episode, but not frequency of alcohol use. The findings demonstrated that when individuals endorsed high levels of RMA, acknowledged rape survivors reported worse outcomes than unacknowledged rape survivors. Among individuals low on RMA, unacknowledged rape survivors reported worse outcomes than acknowledged rape survivors. CONCLUSION: It is recommended that clinicians recognize the role of survivor beliefs, such as RMA, in the relationship between labeling sexual assault experiences and mental health consequences.

The unique associations between rape acknowledgment and the DSM-5 PTSD symptom clusters.

It is well documented in the sexual assault literature that more than half of rape survivors do not label their experience as rape. This is called unacknowledged rape. Although this phenomenon is common and undoubtedly has huge implications for psychotherapy, the impact of acknowledgment status on psychological adjustment is unclear. The present study aimed to delineate the unique impact of rape acknowledgment on psychopathology by examining PTSD symptoms at the cluster level. To examine this, 178 female college students who reported rape completed an online survey, including an assessment of PTSD symptoms in the past month. The results suggested that, after accounting for several covariates, acknowledged rape survivors reported significantly greater levels of intrusion and avoidance symptoms compared to unacknowledged rape survivors. The findings suggest that examining PTSD symptoms at the cluster level may provide more insight into the process of recovery following rape and therefore may better inform treatment decisions.

ADHD and nonsuicidal self-injury in male veterans with and without PTSD.

The objective of the present research was to examine the association between ADHD symptoms and nonsuicidal self-injury (NSSI) in male Iraq/Afghanistan-era veterans with and without PTSD. Approximately 25% of veterans screened positive for clinically-significant levels of ADHD. Male veterans with PTSD were significantly more likely to report ADHD symptoms than male veterans without PTSD. In addition, as expected, ADHD was strongly associated with NSSI, even after accounting for the effects of demographic variables, PTSD, depression, and alcohol use disorder. Future work aimed at replicating and extending these findings in longitudinal studies of veterans is needed.

Examining the Psychological Effect of Rape Acknowledgment: The Interaction of Acknowledgment Status and Ambivalent Sexism.

OBJECTIVE: Although the majority of rape survivors do not label their experiences as rape (i.e., unacknowledged rape), the literature is mixed in terms of how this affects survivors' psychological functioning. To elucidate the discrepancies, the present study examined the interaction between rape acknowledgement and ambivalent sexism in relation to depression and posttraumatic stress disorder (PTSD) symptoms. METHOD: The analyzed sample included 128 female rape survivors who were drawn from a larger college sample of 1,595 participants. The participants completed measures of sexual assault experiences, ambivalent sexism, and depression and PTSD symptoms. RESULTS: The results supported a significant interaction between acknowledgement status and benevolent sexism in relation to both depression and PTSD symptoms. Conversely, the present study failed to find support for an interaction between acknowledgment status and hostile sexism. CONCLUSION: The clinical implications suggest that rather than seeing acknowledging rape as essential to the recovery process, clinicians should assess for and take into account other factors that may contribute to psychological functioning. Additionally, the findings support that more complex models of trauma recovery should be investigated with the goal of working toward a more comprehensive understanding of the longitudinal process of rape acknowledgment.

Meta-Analysis of the Prevalence of Unacknowledged Rape.

Many sexual violence survivors do not label their experiences as rape but instead use more benign labels, such as "bad sex" or "miscommunication." A meta-analysis was conducted to estimate the mean prevalence of unacknowledged rape and to inform our understanding of methodological factors that influence the detection of this phenomenon. Studies were identified using PsycINFO, PubMED, and PILOTS and were required to report the percentage of unacknowledged rape that had occurred since the age of 14 among female survivors. Moderator variables included mean participant age, recruitment source, rape definition, and unacknowledged rape definition. Twenty-eight studies (30 independent samples) containing 5,917 female rape survivors met the inclusion criteria. Based on a random effects model, the overall weighted mean percentage of unacknowledged rape was 60.4% (95% confidence interval [55.0%, 65.6%]). There was a large amount of heterogeneity, Q(29) = 445.11, p < .001, and inconsistency (I(2) = 93.5%) among included studies. The prevalence was significantly higher among college student participants compared to noncollege participants. The findings supported that over half of all female rape survivors do not acknowledge that they have been raped. The results suggest that screening tools should use behaviorally descriptive items about sexual contact, rather than using terms such as "rape."