Beliefs About Consent and Sexual Assault Perpetration in a Longitudinal Study of College Men.

This study examined the mediating role of beliefs about both active and passive consent in the prospective associations between sexual assault (SA) risk factors and coercive, incapacitated, and forcible attempted/completed SA among college men. Participants were 471 college men who completed self-report surveys at the end of each of their 4 years of college. SA risk factors (risky behavior, rape-supportive beliefs and peer norms, personality traits, childhood adversity) were assessed at Wave 1, beliefs about consent were assessed at Wave 2, and perpetration was assessed at Waves 3 and 4. Multivariate regression models with bias-corrected bootstrapping assessed longitudinal mediation. SA risk factors were negatively associated with endorsement of active consent (verbal approval required) and positively associated with passive consent (assume "yes" until you hear a "no"), with strongest effects observed for coercive SA. Both types of beliefs about consent served as mediators between risk factors and perpetration. Findings suggest that prevention programs should include a focus on reducing SA risk factors, clarifying definitions of consent, and improving sexual communication.

Driving Aggression and Anxiety: Intersections, Assessment, and Interventions.

OBJECTIVE: Driving aggression and anxiety are significant contributors to risky driving and motor vehicle crashes (MVCs), which are leading causes of U.S. morbidity and mortality. Even though aggression and anxiety can be conceptualized as related features of the fight-or-flight response, literature on these topics has not been integrated. Driving aggression and anxiety are also transdiagnostic constructs that span multiple psychiatric disorders. Assessment and treatment of these complex problems must be understood to reduce the public health burden of MVCs. METHOD: A comprehensive literature search was conducted using PsycInfo and Google Scholar. RESULTS: Definitions and prevalence of constructs including driving anger, aggressive driving, posttraumatic stress disorder, driving phobia, and transdiagnostic factors are delineated. Psychosocial correlates and assessment instruments are reviewed. Theoretical models that explicate personological, affective, cognitive, and behavioral components are explored. Differential and shared processes underlying driving aggression and anxiety are examined. Interventions are described, with a focus on promising cognitive-behavioral methods. CONCLUSION: Driving aggression and anxiety likely share affective and cognitive characteristics such as emotional reactivity and distorted threat appraisals. Further research is needed to support theoretical models linking driving aggression and anxiety, and to validate assessment instruments that capture both constructs. Epidemiologic studies are needed to determine norms, prevalence, and clinical cutpoints. Integration of interventions for these interrelated problems could ultimately reduce risky driving and MVCs.

A longitudinal study of risk factors for repeated sexual coercion and assault in U.S. College men.

The purpose of the current study was to understand the prevalence, severity, and predictors of repeated sexual coercion and assault (SCA) in a non-criminal sample. Participants were 795 college men who were surveyed at the end of each of their 4 years in college. Participants completed self-report inventories once per year for 4 years. Measures assessed demographics, adverse childhood experiences, offense characteristics, antisocial personality characteristics, attitudes towards women and forced sex, perceived social norms, sexual behavior, and substance use. Results indicated that, among the 238 participants who reported at least once incident of SCA, 68 % engaged in repeated SCA, with repeat offenders engaging in aggressive acts of higher severity that began at an earlier age. A multinomial logistic regression model compared single and repeat offenders to non-perpetrators. Both single and repeat offenders endorsed more risky behaviors and sexually aggressive beliefs than non-perpetrators. Single offenders were higher on childhood adversity than non-perpetrators and repeat offenders were higher on antisocial personality traits than non-perpetrators. A second multivariate model compared single offenders to repeat offenders. Repeat offenders scored higher than single offenders on risky behaviors, sexually aggressive beliefs, and antisocial traits. Findings highlight the high prevalence of repeated SCA in young adults, the need for interventions that decrease rape supportive attitudes and risky substance use, and the importance of expanding models of sexual recidivism to include multiple risk factors.

Barriers and Facilitators of Mental Health Treatment-Seeking in U.S. Active Duty Soldiers With Sexual Assault Histories.

Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others.

Factors associated with use of verbally coercive, incapacitated, and forcible sexual assault tactics in a longitudinal study of college men.

Although verbally coerced and incapacitated sexual assaults are common, less is known about perpetrators of these incidents in comparison to perpetrators of forcible assaults. Furthermore, few studies have investigated factors that differentiate perpetrators who employ different forms of sexual assault tactics. The current study included 526 men who completed self-report inventories at the end of each of their four years in college. Measures assessed sexual assault tactics, demographics, incident characteristics, risky behavior, rape supportive beliefs and peer norms, antisocial traits, and childhood adversity. Perpetrators were grouped based on the most severe tactics reported over the course of 7 assessed time periods, with 13% in the verbal coercion group, 16% in the incapacitation group, and 5% in the forcible group. ANOVAs determined that the forcible group scored significantly higher than incapacitation and verbal coercion groups on risky behavior, rape supportive beliefs/norms, antisocial traits, and childhood adversity. The incapacitation group scored higher than the verbal coercion group on risky behavior. In a multinomial logistic regression analysis comparing tactic groups to non-perpetrators, all tactic groups scored significantly higher on risky behavior and rape supportive beliefs/norms, and the forcible group scored higher on antisocial traits and childhood adversity. Perpetrators in the forcible group had engaged in more repeat offenses, and perpetrators of both the incapacitated and forcible assaults were more likely to use alcohol before the incident. Findings highlight the need for interventions that are tailored to offense trajectories, alter rape supportive attitudes and peer norms, and decrease campus substance use. Aggr. Behav. 41:34-43 2015. © 2014 Wiley Periodicals, Inc.

Women's Behavioral Coping Responses During Sexual Assault: Association With Posttraumatic Stress Disorder Symptoms and the Moderating Role of Alexithymia.

We examined the associations between women's behavioral coping responses during sexual assault and posttraumatic stress disorder (PTSD) symptoms, and the moderating role of alexithymia in college women (N = 152). Immobilized responses (b = 0.52, p < .001), childhood SA (b = 0.18, p = .01), and alexithymia (b = 0.34, p < .001) significantly predicted PTSD. The interaction between immobilized responses and alexithymia was significant (b = 0.39, p = .002), indicating a stronger association for those higher in alexithymia. Immobilized responses are associated with PTSD, particularly for those with difficulty identifying and labeling emotions.

Prevalence and risk of psychiatric disorders as a function of variant rape histories: results from a national survey of women.

PURPOSE: Rape is an established risk factor for mental health disorders, such as posttraumatic stress disorder (PTSD), major depressive episodes (MDE), and substance use disorders. The majority of studies have not differentiated substance-involved rape or examined comorbid diagnoses among victims. Therefore, the aim of the present study was to estimate the prevalence of common trauma-related psychiatric disorders (and their comorbidity) in a national sample of women, with an emphasis on distinguishing between rape tactics. A secondary objective was to estimate the risk for psychiatric disorders among victims of variant rape tactics, in comparison to non-victims. METHODS: A nationally representative population-based sample of 3,001 non-institutionalized, civilian, English or Spanish speaking women (aged 18-86 years) participated in a structured telephone interview assessing rape history and DSM-IV criteria for PTSD, MDE, alcohol abuse (AA), and drug abuse (DA). Descriptive statistics and multivariate logistic regression analyses were employed. RESULTS: Women with rape histories involving both substance facilitation and forcible tactics reported the highest current prevalence of PTSD (36%), MDE (36%), and AA (20%). Multivariate models demonstrated that this victim group was also at highest risk for psychiatric disorders, after controlling for demographics and childhood and multiple victimization history. Women with substance-facilitated rapes reported higher prevalence of substance abuse in comparison to women with forcible rape histories. Comorbidity between PTSD and other psychiatric disorders was higher among rape victims in comparison to non-rape victims. CONCLUSIONS: Researchers and clinicians should assess substance-facilitated rape tactics and attend to comorbidity among rape victims. Empirically supported treatments are needed to address the complex presentations observed among women with variant rape histories.

Examining posttraumatic stress symptoms in a national sample of homicide survivors: prevalence and comparison to other violence victims.

The present study examined posttraumatic stress disorder (PTSD) symptoms among friends and family members of homicide victims (homicide survivors). Out of a national sample of 1,753 young adults who completed follow-up interviews after participating in the National Survey of Adolescents, 268 homicide survivors and 653 victims of other interpersonal violence were selected for the study. Participants completed structured telephone interviews that covered the loss of a family member or close friend to homicide, violence exposure, and PTSD symptomatology. Findings indicated that 39% of homicide survivors met criteria for all 3 symptom clusters and 30% of homicide survivors met criteria for 2 PTSD clusters (functional impairment was not assessed). Multivariate logistic regression analyses demonstrated that homicide survivors were more likely than victims of other violence to meet criteria for all 3 PTSD symptom clusters (OR = 1.91, p < .05) and 2 symptom clusters (OR = 1.77, p < .05) when demographic characteristics and number of violent events were included in the model. These findings highlight the high prevalence of subthreshold PTSD symptoms among homicide survivors. Results suggest that homicide survivors are at elevated risk for PTSD symptoms in comparison to victims of other interpersonal violence.

The role of rape tactics in risk for posttraumatic stress disorder and major depression: results from a national sample of college women.

BACKGROUND: College women are at high risk for substance-involved rape. However, most studies have focused on forcible rape and have not differentiated these tactics from tactics that involve drug or alcohol intoxication. The purpose of this study was to determine the effects of lifetime exposure to forcible rape (FR), incapacitated rape (IR), and drug-alcohol facilitated rape (DAFR) tactics on risk for PTSD and depression. A secondary purpose was to examine the role of different incident characteristics, including relationship to the perpetrator, fear, injury, force, memory, and acknowledgement. METHODS: A national sample of 2,000 college women completed structured telephone interviews assessing demographics, psychiatric diagnoses, and rape experiences. RESULTS: Multivariate logistic regression analyses including demographic variables, multiple rape history, and rape tactics indicated that all three tactics were associated with increased risk for PTSD and depression. Correlational analyses revealed that rape tactics differed in relation to incident characteristics. Multivariate logistic regression analyses showed that only physical injury was positively associated with depression and no characteristics were related to PTSD. CONCLUSIONS: The strong association between IR/DAFR and psychiatric diagnoses suggests that the definition of rape experiences be expanded to include substance-involved tactics. Differing incident characteristics imply that IR/DAFR experiences are associated with different pathways to psychiatric symptoms in comparison to FR experiences.

Attributions of responsibility in a child sexual abuse (CSA) vignette among respondents with CSA histories: the role of abuse similarity to a hypothetical victim.

Previous research suggests that similarity to a victim may influence attributions of responsibility in hypothetical child sexual abuse scenarios. One aspect of similarity receiving mixed support in the literature is respondent child sexual abuse history. Using a sample of 1,345 college women, the present study examined child sexual abuse history, similarity to victim, and attributions of responsibility to a hypothetical victim, family member, and perpetrator in a child sexual abuse vignette. Results revealed no group differences in responsibility ratings among respondents with and without child sexual abuse histories. However, among the 133 respondents with child sexual abuse histories, results indicated that similarity to victim moderated the relationship between vignette characteristics, respondent history, and responsibility attributions. Results suggest that similarity to a victim may influence ratings in a self-preserving manner.

Evaluation of a Brief Suicide Prevention Training Program for College Campuses.

Suicide is the second leading cause of death in college students. While research indicates a positive impact of gatekeeper training programs on knowledge and attitudes, few have examined change in suicide prevention behaviors. The purpose of this study was to evaluate the effects of a brief suicide prevention training for college campuses on knowledge, self-efficacy to intervene, and gatekeeper behaviors. A longitudinal design was employed to examine changes from pretest to post-test and 3-month follow-up. Participants included 517 students, staff, and faculty who attended a 90-minute training and completed self-report surveys. The training included both didactic and experiential components. Repeated measures ANOVAs indicated that knowledge, self-efficacy to discuss suicide and to refer to resources, and gatekeeper behavior increased from pretest to post-test and follow-up. Students exhibited a greater increase in gatekeeper behaviors, in comparison to non-students. Large changes were observed on publicizing suicide prevention information and having informal conversations about suicide with students, and 76% had engaged in gatekeeper behavior at follow-up. Findings offer support for the potential efficacy of a brief prevention program, with promising effects on several suicide prevention behaviors. Declines on knowledge and self-efficacy from post-test to follow-up highlight the importance of booster sessions and complementary programming.

Prevalence and mental health correlates of witnessed parental and community violence in a national sample of adolescents.

BACKGROUND: Although research suggests that witnessed violence is linked to adverse mental health outcomes among adolescents, little is known about its prevalence or its significance in predicting psychiatric symptoms beyond the contribution of co-occurring risk factors. The purpose of this study was to identify the national prevalence of witnessed parental and community violence and to examine these life stressors as independent risk factors for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among adolescents. A secondary aim was to determine which characteristics of witnessed violence were associated with mental health outcomes. METHOD: Participants were 3,614 adolescents recruited from a 2005 US national household probability sample who completed structured telephone interviews assessing witnessed violence and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for PTSD and MDE. RESULTS: National prevalence of witnessed parental violence and witnessed community violence was estimated to be 9% and 38%, respectively. Both forms of witnessed violence predicted PTSD and MDE beyond variance accounted for by age, gender, race/ethnicity, income, and other traumatic event history. Perceptions of threat, repeated violence exposure, location of the violence, and relationship to the victim were associated with psychiatric diagnoses. CONCLUSIONS: Findings suggest that witnessed violence represents a significant public health burden with implications for psychological assessment and prevention efforts.

Witnessed community and parental violence in relation to substance use and delinquency in a national sample of adolescents.

This study examined whether witnessed community and parental violence represented risk factors for substance use and delinquency among adolescents, beyond the contribution of direct violence and other risk factors. We also examined the role of violence characteristics. Participants were a national sample of 3,614 adolescents. Structured telephone interviews assessed demographics, trauma history, witnessed violence, delinquency, and substance use. While accounting for trauma history and other risk factors, witnessed community and parental violence were associated with delinquency. Community violence was associated with substance use. Chronic violence, knowing the perpetrator, and violence outside of school were correlated with substance use and delinquency among adolescents who witnessed community violence. These findings highlight the importance of targeting witnessed violence in prevention and intervention efforts.

Losing a loved one to homicide: prevalence and mental health correlates in a national sample of young adults.

The present study examined the prevalence, demographic distribution, and mental health correlates of losing a loved one to homicide. A national sample of 1,753 young adults completed structured telephone interviews measuring violence exposure, mental health diagnoses, and loss of a family member or close friend to a drunk driving accident (vehicular homicide) or murder (criminal homicide). The prevalence of homicide survivorship was 15%. African Americans were more highly represented among criminal homicide survivors. Logistic regression analyses found that homicide survivors were at risk for past year posttraumatic stress disorder (OR = 1.88), major depressive episode (OR = 1.64), and drug abuse/dependence (OR = 1.77). These findings highlight the significant mental health needs of homicide survivors.

Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: a multi-site study.

This study examined the nature and prevalence of sexual assault (SA), as well as its relationship to psychiatric sequelae and service use, among the veteran population. We performed a secondary data analysis of a cross-sectional dataset consisting of 643 male and 173 female veterans seen in four Veterans Affairs (VA) primary care clinics. Original data were obtained through semi-structured clinic assessments, structured telephone interviews, and medical chart reviews. Analyses included descriptive statistics, chi-square, analysis of variance (ANOVA), and logistic regression. The lifetime prevalence of SA was 38% among women and 6% among men. Of veterans reporting a history of SA, most experienced child sexual abuse and sexual revictimization. SA victims also had a more extensive trauma history and demonstrated greater psychological impairment in comparison to veterans reporting other types of trauma. However, only 25% of male SA survivors and 38% of female SA survivors used mental health services in the past year. These findings suggest that VA primary care clinics may benefit from expanding the current mandated screen for military sexual trauma to include lifetime experiences and trauma-related symptoms, thereby connecting more veterans with needed mental health services.

Child sexual abuse, early family risk, and childhood parentification: pathways to current psychosocial adjustment.

In this study, the authors examined the role of parentification (children assuming adult-like roles in the family) as it relates to family risk (parental psychopathology, parental illness, and domestic violence), child sexual abuse (CSA), and psychosocial adjustment in 499 college women. Structural equation modeling was used to test a model of direct, indirect, and mediational pathways through which CSA, family risk, and parentification contributed to later psychosocial maladjustment. Results indicate that CSA and family risk independently and directly predicted higher levels of maladjustment, but only family risk positively predicted parentification in childhood. Parentification was unexpectedly related to less maladjustment. Parentification failed to mediate the relation between early family risk and maladjustment. Findings suggest that family risk factors may contribute to parentification and that parentification is not always related to poorer psychosocial outcomes. Future research should examine the impact of parentification on other aspects of functioning and should assess how individual, familial, and cultural variables (e.g., age, gender, duration, perceived fairness, ethnicity, and family support) moderate the impact of parentification on long-term adjustment.

Trauma among female veterans: a critical review.

This article reviews the literature documenting the nature and prevalence of traumatic experiences, trauma-related mental and physical health problems, and service use among female veterans. Existing research indicates that female veterans experience higher rates of trauma exposure in comparison to the general population. Emerging data also suggest that female veterans may be as likely to be exposed to combat as male veterans, although not as directly or as frequently. Female veterans also report high rates of posttraumatic stress disorder, which has been associated with poor psychiatric and physical functioning. Although sexual assault history has been related to increased medical service use, further research is needed to understand relationships between trauma history and patterns of medical and mental health service use. Researchers also are encouraged to employ standardized definitions of trauma and to investigate new areas, such as treatment outcomes and mediators of trauma and health. Policy and practice implications are discussed.

Correlates and reasons for mental health treatment dropout among active duty soldiers.

Many soldiers who seek treatment for mental health problems drop out of treatment before it is complete. The present study examined factors that are associated with dropout among active duty soldiers. Soldiers who had sought treatment (N = 260) responded to measures of beliefs about mental health treatment, mental health symptoms, treatment-seeking behaviors, and treatment dropout. Fifty-seven soldiers reported dropping out before treatment was completed. Commonly endorsed reasons for dropout were that soldiers were too busy with work and a preference to handle the symptoms oneself. A series of logistic regressions revealed that depression symptoms (odds ratio [OR] = 1.07), functional impairment (OR = 1.49), career stigma (OR = 1.70), differential treatment stigma (OR = 1.62), practical barriers (OR = 1.76), negative beliefs about treatment (OR = 1.98), and self-reliance (OR = 1.78) were associated with an increased likelihood of dropout. Positive beliefs about treatment were associated with a decreased likelihood of dropout (OR = 0.60). Functional impairment, career stigma, and self-reliance remained unique predictors in a final forward conditional regression. These findings highlight the need for interventions to support service members in treatment by educating them on the benefits of treatment and reducing practical barriers. (PsycINFO Database Record

Understanding Disparities in Service Seeking Following Forcible Versus Drug- or Alcohol-Facilitated/Incapacitated Rape.

Victims of drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) are substantially less likely to seek medical, rape crisis, or police services compared with victims of forcible rape (FR); however, reasons for these disparities are poorly understood. The current study examined explanatory mechanisms in the pathway from rape type (FR vs. DAFR/IR) to disparities in post-rape service seeking (medical, rape crisis, criminal justice). Participants were 445 adult women from a nationally representative household probability sample who had experienced FR, DAFR/IR, or both since age 14. Personal characteristics (age, race, income, prior rape history), rape characteristics (fear, injury, loss of consciousness), and post-rape acknowledgment, medical concerns, and service seeking were collected. An indirect effects model using bootstrapped standard errors was estimated to examine pathways from rape type to service seeking. DAFR/IR-only victims were less likely to seek services compared with FR victims despite similar post-rape medical concerns. FR victims were more likely to report fear during the rape and a prior rape history, and to acknowledge the incident as rape; each of these characteristics was positively associated with service seeking. However, only prior rape history and acknowledgment served as indirect paths to service seeking; acknowledgment was the strongest predictor of service seeking. Diminished acknowledgment of the incident as rape may be especially important to explaining why DAFR/IR victims are less likely than FR victims to seek services. Public service campaigns designed to increase awareness of rape definitions, particularly around DAFR/IR, are important to reducing disparities in rape-related service seeking.

Subclinical Posttraumatic Stress Disorder Symptoms: Relationships with Blood Pressure, Hostility, and Sleep.

The purpose of this study was to examine the relationships among subclinical PTSD symptoms, blood pressure, and several variables linked to both frank PTSD and the basic psychobiological adaptation to stress. The authors recruited a sample of 91 healthy, young men and women between 18 and 35 years. We examined links among subclinical posttraumatic stress disorder symptoms, blood pressure, sleep quality, and hostility. Posttraumatic stress disorder symptoms were associated with poorer sleep quality and higher hostility scores in both women and men. In men, PTSD symptoms were also associated with elevated resting diastolic blood pressure, and sex was an important moderator of that relationship. Moreover, sleep quality and hostility are substantive mediators of the relationship between diastolic blood pressure and PTSD. Behavioral interventions designed to increase sleep quality and restructure hostile attitudes could potentially serve as preventive interventions for PTSD and the underlying cardiovascular comorbidities in young adults.