Context
Despite empirical links between sexual revictimization (ie, experiencing 2 or more sexual assaults) and posttraumatic stress disorder (PTSD), to our knowledge, no epidemiological studies document the prevalence of sexual revictimization and PTSD. Establishing estimates is essential to determine the scope, public health impact, and psychiatric sequelae of sexual revictimization.
Objective
To estimate the prevalence of sexual revictimization and PTSD among 3 national female samples (adolescent, college, and adult household probability).
Design
Surveys were used to collect data from the National Women's Study–Replication (2006; college) as well as household probability samples from the National Survey of Adolescents–Replication (2005) and the National Women's Study–Replication (2006; household probability).
Setting
Households and college campuses across the United States.
Participants
One thousand seven hundred sixty-three adolescent girls, 2000 college women, and 3001 household-residing adult women.
Main Outcome Measures
Behaviorally specific questions assessed unwanted sexual acts occurring over the life span owing to the use of force, threat of force, or incapacitation via drug or alcohol use. Posttraumatic stress disorder was assessed with a module validated against the criterion standard Structured Clinical Interview for DSM-IV.
Results
About 53% of victimized adolescents, 50% of victimized college women, and 58.8% of victimized household-residing women reported sexual revictimization. Current PTSD was reported by 20% of revictimized adolescents, 40% of revictimized college women, and 27.2% of revictimized household-residing women. Compared with nonvictims, odds of meeting past 6-month PTSD were 4.3 to 8.2 times higher for revictimized respondents and 2.4 to 3.5 times higher for single victims.
Conclusions
Population prevalence estimates suggest that 769 000 adolescent girls, 625 000 college women, and 13.4 million women in US households reported sexual revictimization. Further, 154 000 sexually revictimized adolescents, 250 000 sexually revictimized college women, and 3.6 million sexually revictimized household women met criteria for past 6-month PTSD. Findings highlight the importance of screening for sexual revictimization and PTSD in pediatric, college, and primary care settings.
Sexual victimization (SV) is an endemic societal problem associated with a range of mental health sequelae such as anxiety, depression, posttraumatic stress disorder (PTSD), substance abuse, interpersonal difficulties, and health problems including human immunodeficiency virus.1 Sexual victimization disproportionately affects girls and women, with female victims reporting more than 90% of all sexual assaults.2 Epidemiological studies have documented higher PTSD estimates among women,3,4 leading to some speculation that sex differences in the experience of SV account for higher estimates of PTSD observed among women.5 However, some studies have found higher estimates of PTSD to exist among women even after controlling for sex differences in exposure to different traumatic stressors.6 As recently noted,7 more research on the prevalence of PTSD following specific types of victimization experiences is warranted. One such common victimization experience that has received little attention in the epidemiological literature is sexual revictimization (ie, 2 or more sexual assaults/rapes across the life span).
Prevalence estimates of sexual victimization and revictimization
Studies suggest that 20% to 25% of female children experience sexual abuse.8 Among college women, 15% to 20% report a rape or attempted rape during childhood, adolescence, or adulthood,9 and general population estimates suggest that between 13% and 25% of adult women will experience a sexual assault during their lifetimes.10,11 Robust associations between early sexual abuse and subsequent sexual victimization have been well documented among college and community women.12 Meta-analyses suggest a medium effect size (0.59) for the association between early SV and later SV, with stronger effect sizes (0.64) emerging when more restrictive definitions of victimization (eg, penetration) are used compared with broader definitions (0.38) of victimization (eg, exhibitionism).13 Although reviews suggest that 10% to 20% of adolescents who report child sexual abuse will be revictimized prior to age 19 years, as many as 2 of 3 women with a history of child sexual abuse report sexual revictimization.12 Despite cross-sectional and longitudinal evidence of the link between early SV and later revictimization, to our knowledge, there are no epidemiological studies establishing the prevalence of sexual revictimization. Indeed, using the search term sexual revictimization, 117 journal articles were abstracted in PsycINFO for the years 1981 to 2011 as of January 20, 2012; none describe the lifetime prevalence of sexual revictimization among representative samples of women. Thus, the present study addresses this gap by examining the prevalence of sexual revictimization in 3 different populations using national epidemiologic data from adolescent, college, and household-residing women.
Prevalence estimates of ptsd associated with sexual victimization and revictimization
As noted earlier, experiencing a single SV is associated with problems across a number of domains, including substance abuse, interpersonal problems, and psychiatric disorders (eg, PTSD, panic disorder, and depression). Reviews of research with non–nationally representative samples suggest that women who experience revictimization are at even greater risk for such problems, particularly PTSD, in comparison with singly victimized women.12 Posttraumatic stress disorder is costly to the individual, the family, and society at large given its association with increased use of the health care system and both the direct (medical/mental health treatment, pharmacological interventions, and case management) and indirect (eg, loss of wages and productivity) health care costs.14,15 Early screening and treatment may reduce this burden; however, the scope and severity of the problem have not been adequately described in past work. Although the National Women's Study, conducted in 1990, found that nearly one-third of rape victims developed PTSD,16 no representative studies have reported estimates of PTSD among sexually revictimized women specifically. The present study addresses this gap by using data from probability samples to explore the prevalence of PTSD among adolescent, college, and household-residing women reporting sexual revictimization.
The current study
The current study used data from 3 national probability samples of women (adolescent, college, and household-residing women) to better understand the prevalence of sexual revictimization as well as the prevalence of current and lifetime PTSD among revictimized women. For comparison, we also assessed PTSD prevalence among women reporting a single sexual victimization. Based on reviews of studies using samples of convenience,12 it was expected that 10% to 20% of sexually victimized adolescents would report revictimization and 60% to 70% of sexually victimized college and adult household-residing women would report revictimization. Further, given greater severity of PTSD symptoms among revictimized women,1 it was expected that estimates of PTSD among revictimized women would be substantially higher than the 30% prevalence estimates of PTSD observed for singly victimized women. Determining accurate estimates of the prevalence of sexual revictimization, as well as better understanding the role of sexual revictimization in the prediction of PTSD, will inform screening, assessment, and intervention efforts in this domain among mental health providers serving adolescent and adult female populations.
(Publisher abstract provided.)
Downloads
Similar Publications
- Towards a generic framework for trustworthy spatial crowdsourcing
- Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: Results from a national telephone household probability sample
- Intimate Partner Sexual Violence: A Comparison of Foreign- Versus US-Born Physically Abused Latinas