Prevalence of trauma exposure and PTSD symptoms among the Icelandic population: gender and regional differences.

AIM: The primary aim of this cross-sectional study was to provide descriptive data about the lifetime prevalence of trauma exposure with a particular focus on sexual violence and natural disasters and to assess the prevalence of symptoms of post-traumatic stress disorder (PTSD) in the Icelandic population. In addition, the aim was to investigate whether PTSD symptoms, trauma types and prevalence differed by gender and geographical location. METHOD: A representative sample of the population between the ages of 18 and 80 years was randomly selected from the Icelandic National Registrar. The study included a total of 1766 participants consisting of 930 (52.7%) women and 836 (47.3%) men, with an overall mean age of 49.9 years (standard deviation 16.1). Participants were contacted by phone and asked questions from the Lifetime Events Checklist (LEC-5) to assess lifetime exposure to traumatic events. Individuals who had experienced traumatic events completed the PTSD Checklist for DSM-5 (PCL-5) to assess PTSD symptoms. RESULTS: Exposure to trauma is common among the Icelandic population, with 84.3% of the participants experiencing at least one kind of trauma. Of those exposed to trauma, 10.5% fulfilled criteria indicating a higher risk of PTSD. The prevalence of sexual violence and other unwanted sexual experiences was relatively high (16.2% and 24.4%, respectively) compared with other national studies. Women were almost four times more likely than men to have been exposed to sexual violence (24.9% vs 6.4%), and were more likely to have been exposed to other unwanted sexual experience (35.1% vs 12.4%, respectively). Exposure to natural disasters is frequent but with great geographical variation. CONCLUSIONS: This study highlights the high prevalence of trauma in Iceland, revealing significant gender disparities in sexual violence and geographical variations in natural disaster exposure.

Facilitators of Sexual Assault Disclosure: A Dyadic Study of Female Survivors and Their Informal Supports.

Two-thirds of survivors typically disclose their experience to others at some point following sexual assault, but little in-depth research has addressed factors facilitating disclosure. In the current study, a diverse sample of 45 female sexual assault survivors (75% racial/ethnic minorities) and their 45 informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following assault. Disclosure facilitation was expressed by 40 survivors and 31 SPs, of which 28 were matched S/SP dyadic pairs. Narrative data on the overarching thematic category of sexual assault disclosure facilitation was analyzed using descriptive thematic analysis methods. Several themes emerged from the analysis of quotes specific to the facilitation of disclosure, including: individual (e.g., survivor psychological, behavioral, and disclosure recipient factors), interpersonal (e.g., SP-solicited disclosures, helping others, mutual disclosures), and societal (e.g., lack of barriers, formal supports, media). Implications are drawn for future research on facilitators of sexual assault disclosure. Clinical practice implications are provided for professionals supporting survivors and their informal support networks.

Exploring Correlates of Social Reactions to Disclosure Among Latina Sexual Assault Survivors.

Social reactions to sexual assault (SA) disclosure are well-documented in the literature, but less is known about disclosure and reactions received by Latina survivors. The current study analyzed correlates of positive and negative social reactions to sexual assault disclosure in a community sample of Latina survivors (n = 239). Compared to White survivors, Latina survivors were more likely to report turning against and acknowledgement without support reactions. Among Latina survivors, contrary to hypotheses, both "stereotypical" (e.g. more violent assaults) and "non-stereotypical" (e.g. pre-assault substance use) assault characteristics were associated with acknowledgement without support negative social reactions. Furthermore, total number of sources Latina survivors disclosed to were associated with turning against social reactions. Implications for future research on disclosure/social reactions and Latina survivors are discussed.

What relates to length of stay in a sober living home among women with histories of victimization and addiction? A longitudinal analysis.

Despite preliminary research suggesting that length of stay in sober living homes (SLHs) is related to sustained sobriety, little research has examined factors that relate to length of stay in SLHs. The purpose of the proposed exploratory study was to prospectively examine baseline characteristics of women with histories of addiction and victimization as correlates of length of stay in a trauma-informed, gender-responsive SLH. Participants (N = 45) were surveyed three times over a 1-year period. Women were invited to participate within a week of their arrival to the SLH. Nearly two-thirds (62.2%, n = 28) of women stayed under 3 months, and 37.8% (n = 17) of women stayed over 3 months. Whereas older age and greater financial worries were associated with staying over 3 months at the SLH, other variables (e.g., demographics, mental health, recent victimization, recent substance use) were unrelated. Findings indicate that efforts may be needed to ensure that younger women as well as women with less financial worries, who may be less likely to stay for longer periods of times at SLHs, have adequate support for sobriety.

Exploring the association between anticipated and actual responses to disclosures of intimate partner violence and sexual assault.

Victims of intimate partner violence (IPV) and sexual assault (SA) commonly disclose their experiences to friends or family members, or within other personal relationships. Disclosure recipients' responses to these disclosures are associated with victims' mental health. Previous research has separately measured both actual responses to IPV/SA and anticipated responses to IPV/SA (e.g., response to a hypothetical scenario) from the perspective of disclosure recipients. Yet, little research has described the association between disclosure recipients' anticipated and actual responses. The aim of the current paper was to use a prospective design to examine the association between disclosure recipients' anticipated and actual responses to IPV/SA, including positive and negative social reactions, perceptions of victim responsibility, empathy, and confusion and ineffectiveness about how to respond. Participants (N = 126 college students aged 18-23; 70.6% women) answered questions about their anticipated responses to a hypothetical IPV/SA disclosure scenario, and then six months later answered the same questions about their actual responses to an actual disclosure of IPV/SA. Although most anticipated and actual responses were significantly associated, associations were moderate in size. Some associations were stronger for participants with a closer relationship to the victim, for participants who had their own victimization history, for women, and for men. Individuals can predict their responses to some degree, but are not totally accurate in doing so.

Correlates of African American sexual assault survivors' medical care seeking.

African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women's sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010-2011) to understand better African American women's sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.

Women's Experiences of Impairment and Incapacitation During Alcohol/Drug-Related Sexual Assaults: Toward a Survivor-Informed Approach to Measurement.

Researchers have categorized level of impact of drinking during alcohol/substance facilitated sexual assaults as unimpaired (perceived no effect of drinking), impaired (conscious, but impacted by substance use), or incapacitated (unconscious due to substance use). However, researchers have not always agreed on what constitutes these categories, and no qualitative research has been done to date to explore those discrepancies. Such work is needed in order to listen to survivors' voices, using their perspectives and experiences to develop trauma-informed practices specific to survivors of alcohol-involved assaults. The current study sought to shed light on impaired/incapacitated sexual assault experiences presenting 141 qualitative written responses of women who were drinking and/or using substances at the time of their assault. Results showed that while some responses aligned with previous researcher-defined quantitative impaired/incapacitated categories, most responses coded could be considered both impaired and incapacitated, or neither of these categories. Implications for further research, particularly qualitative work, are discussed specifically challenging previous research on impaired/incapacitated sexual assault experiences.

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

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

Proximal relationships between social support and PTSD symptom severity: A daily diary study of sexual assault survivors.

BACKGROUND: In cross-sectional studies, social support and posttraumatic stress disorder (PTSD) symptoms appear related, in that higher severity of PTSD is associated with lower social support and vice versa. Theoretical models of the causal direction of this relationship differ. Most longitudinal studies suggest that PTSD symptoms erode social support over time, although some suggest that higher social support is prospectively associated with decrease in PTSD symptom severity. It is unclear, though, how social support and PTSD affect each other in the short term. The purpose of this study was to test day-to-day relationships between PTSD and social support to elucidate how PTSD and social support influence each other. METHODS: Using 1173 daily observations from 75 college women who met screening criteria for lifetime sexual assault and past-month PTSD, this study tested same-day and next-day relationships between PTSD and social support using mixed models. RESULTS: Within-person analyses indicated that, when PTSD was higher than usual on a given day, social support was higher the next day. Between-person analyses suggested that people with generally higher social support tended to have lower PTSD symptoms on a given day, but average PTSD symptom severity was not associated with day-to-day fluctuations in social support. CONCLUSIONS: Rather than eroding in response to daily symptoms, social support might be sought out following increases in PTSD, and when received consistently, might reduce symptoms of PTSD in the short term. Interventions that increase college women's access to social support after sexual assault may thus be helpful in addressing PTSD.

A Qualitative Study of Sexual Assault Disclosure Impact and Help-Seeking on Support Providers.

Friends, family, and significant others who receive disclosures of sexual assault from survivors are also susceptible to the effects of trauma. Most studies on the impact of sexual assault disclosure focus on the experiences of friends of survivors but not significant others or family members, and do not examine support providers' (SPs) help-seeking behaviors. This study of 45 matched pairs of sexual assault survivors and SPs explored the impact of receiving a disclosure and dealing with the emotional weight of these disclosures. SPs were impacted emotionally and in post-disclosure behaviors. SPs reported feeling sadness, were triggered, felt angry, and felt inspired by survivors' disclosures. Active cognitive and behavioral reactions included care-taking of survivors and engaging in prevention. SPs discussed different ways they sought help to deal with the disclosure and why they did or did not seek help post-disclosure. We provide recommendations for SPs and service providers using this data from a diverse, community sample.

A Short Measure of Social Reactions to Sexual Assault: The Social Reactions Questionnaire-Shortened.

Social reactions to disclosures of sexual assault have significant effects on women's postassault recovery. However, being the most widely used measure of these reactions, the 48-item Social Reactions Questionnaire (SRQ; Ullman, 2000) is too long for some research and evaluation efforts. Thus, we developed a 16-item short version, the Social Reactions Questionnaire-Shortened (SRQ-S). Three preexisting college and community samples of women survivors (N = 1,012; 1,084; and 344) were used to determine which SRQ items were most related to psychological symptoms and could form reliable subscales. The brief version was then administered in a college and community sample of 447 women survivors. Confirmatory factor analyses (CFAs) and supporting psychometrics showed the SRQ-S reliably measures three general scales of the SRQ (Turning Against, Unsupportive Acknowledgment, Positive Reactions) as well as eight 2-item subscales (e.g., Blame). The SRQ-S provides researchers and interventionists with a brief alternative measure to the original SRQ.

Social Support, Coping, and Posttraumatic Stress Symptoms in Female Sexual Assault Survivors: A Longitudinal Analysis.

Social support and coping affect each other after stressful life events, including sexual assault (Taylor & Stanton, 2007). The present study examined the associations among assault-specific support, maladaptive coping, and posttraumatic stress symptoms (PTSS) over 3 years in a sample of female sexual assault survivors from a large metropolitan area (N = 1,863). A 3-wave cross-lagged panel model revealed significant weak-to-moderate reciprocal associations between maladaptive coping and PTSS (ßs = .09 to .21), significant weak reciprocal associations between turning against social reactions and PTSS (ßs = .07 to .10), and inconsistent weak reciprocal associations between maladaptive coping and unsupportive acknowledgment reactions (ßs = .06 to .14). We conclude with implications regarding treatment and intervention for survivors and their support networks.

Correlates of Problem Drinking and Drug Use in Black Sexual Assault Victims.

Few studies have examined factors related to problem drinking and drug use in Black sexual assault victims. Given that sexual assault and histories of trauma are associated with substance abuse in victims, research is needed to determine what factors may be related to these outcomes for Black survivors. Furthermore, child sexual abuse (CSA) is a risk factor for substance abuse, but no studies have examined correlates of substance abuse outcomes separately according to CSA history. This study examines a large diverse sample of Black sexual assault victims (N = 495) to determine the associations of demographics, trauma history, assault characteristics, and postassault psychosocial factors with problem drinking and drug use using multivariate regressions. Traumatic life events, using substances to cope and self-blame, were associated with greater problem drinking and drug use. Implications for practitioners and policymakers are discussed.

Sexual Assault in Bisexual and Heterosexual Women Survivors.

Social support is related to sexual minority status and negative psychological impact among sexual assault survivors. We compared bisexual and heterosexual survivors on how different types of social support are connected to symptoms of posttraumatic stress disorder (PTSD) and depression. A community sample of bisexual and heterosexual (N = 905) women sexual assault survivors completed three annual surveys. Heterosexual women reported greater perceived social support and fewer negative reactions to disclosure of sexual assault than bisexual women, but there were no differences in frequency of social contact. Perceived social support and frequency of social contact were related to fewer psychological symptoms of PTSD and depression for all women. Heterosexual women had fewer psychological symptoms than bisexual women. Finally, perceived social support mediated the relationship of sexual orientation with depressive symptoms but not with PTSD symptoms. These findings suggest that social support and sexual orientation may explain women's post-assault adjustment.

Mediators of sexual revictimization risk in adult sexual assault victims.

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse, emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior and sexual refusal assertiveness mediational pathways by which child sexual abuse severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to child sexual abuse severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the child sexual abuse severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women.

Coping, emotion regulation, and self-blame as mediators of sexual abuse and psychological symptoms in adult sexual assault.

This study examined whether coping, emotion regulation, and self-blame mediate relationships of trauma histories with post-traumatic stress disorder and depression in adult sexual assault victims (N = 1863). A path analysis showed that theorized mediators partially mediated associations between trauma history variables and psychological symptoms. Specifically, child sexual abuse severity was related to greater post-traumatic stress disorder and depression indirectly through maladaptive coping and decreased emotion regulation but not self-blame. Other traumas had direct relationships with symptoms and partially mediated effects through maladaptive coping and emotion regulation. Child sexual abuse was unrelated to self-blame, but other traumas were related to greater self-blame. Results differed according to whether women had counseling post-assault. Implications are drawn for future research and clinical treatment of adult sexual assault victims.

Conducting Virtual Interviews With Sexual Assault Survivors and Their Informal Supports During COVID-19 and Beyond.

The current paper describes the author's experience conducting virtual interviews with sexual assault survivors and their informal supports (e.g., family, friend, partner) during the COVID-19 pandemic, drawing on past and present interviewing experiences with this population, and the recent literature on best practices for virtual interviewing and survivor/trauma-informed research methods. The experience of pivoting from past projects using face-to-face interview methods to doing virtual interviews with this population is presented and critically analyzed. Potential advantages and drawbacks of various methods and adaptations for doing virtual interviews in a dyadic sample of survivors and their informal supports are described to facilitate future research using virtual methods with sexual assault survivors and their informal supporters. Issues related to access (e.g., e.g., age, gender, race, ability, poverty) to interview participation are also noted as in need of more consideration. Finally, the impact on interviewers of doing this work in virtual versus face-to-face contexts is discussed.

Aspects of Selective Sexual Assault Disclosure: Qualitative Interviews With Survivors and Their Informal Supports.

Two-thirds of survivors typically disclose their experience to informal supports (e.g., friends, family, partners) at some point following sexual assault, but little in-depth research has addressed specific aspects of disclosure. In the current study, a diverse sample of 45 sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following the assault. Narrative data on the overarching thematic category of selective disclosure were analyzed using thematic analysis methods. Several subthemes emerged specific to (a) the circumstances of disclosure (prompted or coerced), (b) withholding details (framing disclosures to avoid rape myths and blame, strategic use of language, protecting others by not disclosing or limiting details), and (c) sharing details (selecting who was told, selecting trusted others for disclosure, selective details told to specific people, sharing with strangers easier). Implications are drawn for future research on aspects of selective disclosure of sexual assault and clinical practice implications for supporting survivors and their informal support networks.

Social Reactions to Disclosures of Multiple-Perpetrator Sexual Assault: Do Number of Offenders Matter?

Sexual assault (SA) victimization is a prevalent issue both in the U.S. and globally. Although SA victimization is usually perpetrated by a single-perpetrator, multiple-perpetrator sexual assaults (MPSAs) also occur. Unfortunately, there is less literature concerning MPSAs, including the well-being of survivors' post-assault. One factor that has been shown to be important in the well-being of SA survivors' post-assault are the social reactions survivors receive from others following disclosure. The current study sought to compare social reactions received by MPSA survivors to the social reactions received by single-perpetrator sexual assault (SPSA) survivors in a community sample of adult female SA survivors (N = 1,863). We examined "turning against" (TA) reactions, a type of negative social reaction in which the supporter expresses more overtly distressing reactions that focus blame on the victim. We also examined unsupportive acknowledgment reactions (UA) the second type of negative reaction in which survivors receive acknowledgment that the assault occurred but are not supported. Additionally, we examined differences in positive reactions that survivors received from their support systems. One-way Analysis of Variance showed statistically significant differences in social reactions to disclosure according to number of offenders in the SA, with MPSA survivors receiving more TA and UA negative reactions than SPSA survivors. There were no differences in positive reactions by number of offenders. Multiple regression analyses also revealed that several demographics, assault characteristics, and post-assault factors (total Post-Traumatic Stress Disorder (PTSD) symptoms, coping, attributions of self-blame) were related to the social reactions received by MPSA survivors post-assault. Implications and recommendations for support providers are discussed.

Are All Substance-Involved Sexual Assaults Alike? A Comparison of Victim Alcohol Use, Drug Use, and Combined Substance Use in Sexual Assaults.

Sexual assaults involving victim substance use at the time of the assault are common, but little is known about how different types of substances used at the time of the assault impact post-assault outcomes. The current study sought to compare victim alcohol use, drug use, and combined substance use in sexual assaults among a community sample of 693 victims. It was hypothesized that victims in the combined substance use assault type would report overall worse post-assault outcomes, more contextual and interpersonal traumas, and higher assault severity. Our results partially confirmed these hypotheses, but victims in the drug-involved assault type group overall reported higher assault severity and worse post-assault outcomes. These findings are probably partially attributed to the demographic characteristics of victims in the drug-only group (e.g. Black victims) who are more likely to experience a higher severity of violence. Implications for future research and policy regarding drug decriminalization are discussed.