Cognitive Impairment as A Vulnerability for Exploitation: A Scoping Review.

Exploitation is a form of abuse that occurs when one person unfairly manipulates another for profit or personal gain. Various individual and social characteristics have the potential to increase an individual's risk of being exploited. Cognitive impairment is one potential vulnerability factor that has received minimal research attention. This scoping review aimed to investigate cognitive impairment as a factor that may increase an individual's vulnerability to exploitation. Study inclusion criteria were: (a) empirical studies; (b) studies presenting extractable data related to cognitive impairment and exploitation; (c) studies exploring cognitive impairment as a vulnerability factor for exploitation; (d) studies published after 1998; and (e) studies available in English. A six-step search strategy was employed: (a) electronic searches of bibliographic databases; (b) screening reference lists of included studies; (c) forward citation tracking in Google Scholar; (d) expert recommendations; (e) website searches of relevant Non-Governmental Organizations (NGOs); and (f) a call for evidence. Twenty studies met the inclusion criteria. Three types of exploitation were reported: sexual (n = 10), financial (n = 8), and criminal (n = 2). Intellectual disability (n = 8) and mental health (n = 8) were the most frequently described forms of cognitive impairment. The results indicate that cognitive impairment is a factor that increases vulnerability to exploitation. However, the limited number and disparate nature of the studies means that it is impossible to disentangle all the complexities in the relationship between cognitive impairment and exploitation. Further research is needed to understand if cognitive impairment increases vulnerability to all types of exploitation or if it results in varying levels of susceptibility to different types of exploitation.

Rethinking Lifetime Abuse in Old Age.

Research on abuse is often piecemeal and focused on specific forms, populations, and social situations. As a result, these studies tend to ignore the web of abuse resulting from the interactive effects of various forms of abuse over the life course, together referred to as "lifetime abuse." An examination of abuse from the point of view of older adults is likely to provide a lifetime perspective based on linking child abuse to elder abuse over the life course and an assessment of its consequences. Despite the growing awareness and resulting body of knowledge regarding this phenomenon, proposed theoretical formulations about it remain limited. The present article aimed to conceptualize the multifaceted phenomenon of lifetime abuse and to gain a deeper perspective of the topic by understanding its dimensions, meanings, and experiences in older age, based on a critical review of empirical studies. A model is suggested, which can be useful for future exploration and understanding of lifetime abuse. Based on a critical review of previous studies, we suggest a theoretical framework of lifetime abuse from the perspective of older adults, identifying three key domains: (a) perception of time and life review in old age; (b) cumulative and interactive abusive life events; and (c) resilience versus vulnerability over the life course. We propose a heuristic model to explore and understand lifetime abuse. We believe our proposed model is open to reflection and elaboration and is intended to raise questions that could enhance the need for our understanding of lifetime abuse in old age.

Dissociative Subtype of Posttraumatic Stress Disorder and its Correlates Among Treatment-Seeking Refugees.

The dissociative subtype of posttraumatic stress disorder (PTSD-DS) denotes a severe type of PTSD associated with complex trauma exposure and psychiatric comorbidity. Refugees may be at heightened risk of developing PTSD-DS, but research is lacking. This cross-sectional study aimed to examine PTSD-DS and its demographic, trauma-related, and clinical correlates among a convenience sample of refugee patients over 18 years old who were diagnosed with PTSD according to DSM-5. PTSD-DS (Clinician-Administered PTSD Scale for DSM-5), trauma exposure (Life Events Checklist for DSM-5) and general psychopathology (Brief Symptom Inventory) were assessed at intake. T-tests, chi-square tests, and logistical regression analysis were conducted. The final sample consisted of 552 participants (177 (32.1%) women; 375 (67.9%) men; average age 40.0 years (SD = 11.2)) who originated from 63 countries. Of those, 158 (28.6%) met criteria for PTSD-DS. Participants with PTSD-DS scored significantly higher on PTSD symptom severity (t(550)=-5.270, p < .001), number of traumatic event types (t(456)=-3.499, p < .001), and exposure to sexual assault (χ(1) = 6.471, p = .01) than those without PTSD-DS. The odds of having PTSD-DS increased by 14.1% with exposure to each additional traumatic event type (OR = 1.141, CI 0.033-1.260). In conclusion, around 29% of adult treatment-seeking refugees with PTSD met the criteria for PTSD-DS. Those exposed to multiple traumatic event types including sexual assault, regardless of sex, were especially at risk. Having PTSD-DS was associated with more severe PTSD. Prioritizing trauma-focused treatment for those with PTSD-DS is recommended.

"This Time It Was Different:" Creating a Multidisciplinary, Trauma-Informed, Victim-Centered Approach to Sexual Assault Cold Case Investigations and Prosecutions.

Police and prosecutors recommend that sexual assault survivors have a medical forensic exam and the collection of a sexual assault kit (SAK; also known as a "rape kit") to preserve biological evidence (e.g., semen, blood, saliva, hair) if they want to pursue criminal prosecution. However, law enforcement personnel do not routinely submit SAKs to crime laboratories for forensic DNA testing. Instead, they often place untested kits in storage and close many of these reported cases after minimal investigation. Current estimates indicate there are 300,000 to 400,000 untested SAKs in law enforcement agencies throughout the United States. In response to this national problem, the U.S. Department of Justice created the Sexual Assault Kit Initiative (SAKI) Project to support kit testing, re-investigation, and prosecution of these "cold case" sexual assaults. The SAKI program also provides training and technical assistance to police, prosecutors, and victim advocates on how to use a multidisciplinary, trauma-informed, and victim-centered approach in cold case prosecutions. This study examined the extent to which one SAKI-funded site implemented these three guiding principles in their interactions with victims while prosecuting cold case sexual assaults. We conducted semistructured qualitative interviews with N = 32 sexual assault survivors from the first cohort of cold cases that were re-opened and prosecuted in this jurisdiction. Nearly all cases (n = 31) ended in a guilty plea or trial conviction, and the vast majority of survivors indicated that they had positive experiences with the SAKI team. Survivors noted that they were listened to, believed, supported, and well-prepared by a multidisciplinary team of practitioners who were personally invested in their cases and in their well-being. Implications for creating multidisciplinary, trauma-informed, and victim-centered approaches with other communities are discussed.

Factors Behind Contemporary Rape Myths in Europe: A Systematic Review.

Rape myths are social constructs, deeply rooted in European society. They play a role in maintaining false beliefs about sexual violence and are one of the main factors in sexual abuse behavior. In this review article, the authors focused on the factors influencing the perpetuation and spread of false beliefs regarding sexual violence, its victims, and perpetrators. The goal of the study is to achieve a more profound comprehension of the cultural and social dimensions linked to this occurrence. In conducting the systematic literature review, three databases have been used to search for pertinent articles: ProQuest, Scopus, and ERIH Plus. Only peer-reviewed scientific articles in English published between 2013 and 2023 were deemed eligible. Furthermore, inclusion criteria stipulated that articles must present empirical research of European origin, focusing on the keywords: "myths about rape," "myths about sexual violence," and "myths about rape." In total 2,507 articles were initially identified, with 79 ultimately meeting the inclusion criteria. The analysis revealed the presence of several factors influencing the function of rape myths. These were categorized into sociodemographic, individual, and systemic. The general populace of European society commonly holds beliefs in rape myths. Moreover, numerous studies point to large legal and systemic inequalities that lead to social inequalities and, consequently, to the perpetuation of rape culture through victimization and victim blaming. This review demonstrates the need for future research on sex education as a factor in preventing rape myths.

Vulnerability of individuals on mental health medications to drug facilitated sexual assaults.

Drink spiking in social settings is one of the most pervasive forms of drug-facilitated sexual assault (DFSA). There are no current data in Australia on the rates of drink spiking or their associated assaults. There is also little known about the prevalence of different substances involved and how the current substance use trends compare to sexual assault trends. To explore this, a recalculation of sexual assault trends to estimate substance related sexual assault was performed. Data about recent trends of mental health prescriptions and sexual assault were obtained from the Australian Institute of Health and Welfare (AIHW). The analysis of these datasets highlighted that females are the highest consumers of antidepressants and benzodiazepines. Results also indicated a statistically significant positive correlation between females and a higher incidence of sexual assault (r = 0.996, p < .001). This paper demonstrates that females are at most risk of drug-drug interactions (e.g., diazepam and ketamine) with their medications due to the higher rate of prescriptions amongst this population, and therefore more vulnerable to both opportunistic and proactive DFSA. While these findings are preliminary and not causal, they highlight trends in need of further study.

Intimate Partner Violence Predicts Child Marriage and Pregnancy Among Adolescents in Malawi.

A sizeable literature has shown that child marriage is associated with an increased risk for intimate partner violence (IPV). However, this research has been cross-sectional, and the temporality of the association has not been investigated. Specifically, no study has yet examined whether IPV is a predictor of child marriage and adolescent pregnancy. This study uses prospective longitudinal data on a cohort of adolescent girls from the Malawi Longitudinal Study of Families and Health to evaluate whether IPV victimization predicts child marriage or adolescent pregnancy. Using survival models, we find that adolescent girls who experienced physical IPV (measured at survey baseline, in 2017-2018) are more likely to enter child marriages (measured at survey follow-up, in 2021) (hazard ratio [HR] = 2.7 [1.44, 5.08]). Experiencing sexual IPV is also significantly associated with adolescent pregnancy (HR = 1.97 [1.16, 3.33]). These findings indicate the need for greater intervention to ensure healthy adolescent relationships, as well as further research to understand how abusive relationships shape early transitions to adulthood.

Overcoming Rape: A Mixed-Methods Approach to Understanding Psychological and Physical Health Functioning of Male Survivors.

When examining sexual assault, men are often hidden from the literature. The current study employed a mixed-methods, convergent parallel design to examine the experiences of 22 male survivors of sexual assault (mean age = 44.19, SD = 13.28, range 18-65; 91% European American; 50% heterosexual). Survivors were administered an online survey using quantitative and qualitative questions to assess rape myths, gender roles, self-esteem, self-efficacy, resiliency, coping, overall mental and physical health, and diagnostic criteria for alcohol abuse, post traumatic stress disorder (PTSD), and sexual dysfunction. Three key themes emerged from the integration of quantitative and qualitative data: (a) Help is Elusive, (b) Internal Struggles and External Strengths, and (c) Living with Clinical Diagnoses. This study adds to an important area of the literature that increases understanding of men's experiences with sexual violence and honors the voices of these survivors.

Communicating sexual health to the incarcerated population: information dissemination in a US sample of inmate handbooks.

Incarcerated individuals frequently enter prison with a history of high-risk lifestyle behaviours likely to contribute to the transmission of infectious disease. Prisons offer a unique setting in which to advance health equity to an underserved population by disseminating information and education. Sexual health education has the potential to mitigate negative health consequences in the incarcerated population and improve sexual health practices upon community re-entry, benefiting both incarcerated individuals and communities. Limited empirical research examines sexual health information and education in US correctional facilities. Handbooks, given to all people upon incarceration, have the potential to provide vital information and education to promote safe sexual practice and prevent disease transmission. This work, guided by 22 critical sexual health education recommendations from the US Centers for Disease Control and Prevention, examines the presence (or absence) of recommended sexual health information and guidance in prison handbooks. Handbooks (n = 74) from 49 of 50 US states were qualitatively analysed with results revealing limited information, education or guidance about sexual health/safe sexual practice during incarceration or afterwards. Utilising handbooks for comprehensive sexual education could be a critical step towards reaching members of an already at-risk underserved population.

Identifying as a Survivor Versus a Victim After Sexual Violence Predicts Divergent Posttrauma Pathways.

The present study investigated social identification with "survivors" versus "victims" following sexual violence and the degree to which this predicted posttraumatic growth versus posttraumatic stress. Participants (N = 290) were adult women who had experienced sexual violence. As predicted, cumulative sexual trauma was positively associated with symptoms of both posttraumatic stress and posttraumatic growth. Further, people who had experienced more cumulative sexual trauma were more likely to identify with victims, which in turn predicted posttraumatic stress. Similarly, people who had experienced more cumulative sexual trauma were also more likely to identify with survivors, and this in turn predicted posttraumatic growth.