A new study published in Lancet Psychiatry finds that experiencing sexual violence in mid-adolescence is associated with a heightened risk of self-harm, attempted suicide, and psychological distress.
Francesca Bentivegna and Praveetha Patalay estimate that without instances of sexual violence, boys in their cohort would experience 3.7% – 10.5% fewer adverse mental health outcomes compared to 14% – 18.7% for girls. This research in the UK joins many similar studies indicating that a gender gap exists in internalizing mental health conditions and associating sexual violence with adverse mental health outcomes. They write:
“In our sample of individuals from the UK Millennium Cohort Study who reported experiencing sexual violence in the 12 months before age 17 years reported worse mental health outcomes at age 17 years than adolescents who did not. These effects persisted even after accounting for previous depressive symptoms and self-harm, and a wide range of relevant confounders, and were robust to multiple methodological approaches and sensitivity checks.”
The current work aims to better understand the psychological consequences of sexual violence during adolescence while estimating its effect on mental health outcomes. Using data from the UK Millennium Cohort Study, the authors compare 5119 girls to 4852 boys born in the UK between 2000 and 2002. The participants answered self-report survey questions about previous suicide attempts, self-harm behavior and sexual violence in the past 12 months, and psychological distress over the past 30 days.
The authors also identified and adjusted for confounding variables other than adolescent sexual violence that could lead to poor mental health outcomes using previous research, including depressive symptoms, self-harm, and previous sexual violence reported at age 14, ethnicity, sexuality, parent education, family income, number of siblings and parents/carers, pubertal status, early sexual activity, relationship status, bullying, BMI, risky behaviors, truancy, disability, and life satisfaction.
20.2% of girls reported sexual violence in the previous 12 months, with 5.3% experiencing assault and 19.4% experiencing unwelcome sexual approach. 5.4% of boys reported sexual violence in the past 12 months, with 1% experiencing sexual assault and 5.2% experiencing unwelcome sexual approaches.
Girls and Boys that had experienced sexual violence in the past 12 months reported higher mean rates of psychological distress (1.35 – 2.09 for girls and 2.56 – 2.73 for boys), increased relative risk of high psychological distress (1.30 – 1.65 for girls and 1.55 – 1.97 for boys), increased risk for self-harm behaviors (1.42 – 1.79 for girls and 1.92 – 2.16 for boys), and increased suicide risk (1.37 – 1.75 for girls and 2.28 – 2.73 for boys).
The authors estimate that erasing all instances of sexual violence would decrease adverse mental health outcomes for girls in their study at the age of 17 by 14% – 18.7%. Suicide attempts by girls would drop from the observed rate of 11% to 9.1%, with rates of high psychological distress dropping from 22.6% to 19.5%.
Boys would likely experience 3.7% – 10.5% fewer adverse mental health outcomes, with rates of attempted suicide dropping from 4.3% to 3.9% and rates of high psychological distress dropping from 10.2% to 9.8%.
The authors acknowledge several limitations to the current work. Data was collected on sexual violence and mental health simultaneously despite evidence that poor mental health can affect remembering and reporting adverse experiences. The questions about self-harm and suicide attempts asked about lifetime prevalence leading to some timing issues that could not be resolved.
While instances of sexual violence were high in the current sample, they were lower than expected, given what other research has found. Some questions were limiting; for example, the question about sexual violence was only about the past 12 months, excluding any previous experiences. Sexual violence questions were yes/no, excluding important details such as severity, frequency, and perpetrator. There could have also been additional confounding factors. The participants in the study, while representative of the overall makeup of the UK, were overwhelmingly white (80.8%)
The authors conclude:
“Reductions in sexual violence via policy and societal changes would benefit the mental health of adolescents and might contribute to narrowing the gender gap in internalizing mental ill health. Clinicians and others working to support adolescents should be aware that sexual violence has a widespread, gendered nature and an impact on mental health.”
Research from the UK indicates that women are three times more likely to experience common mental health problems than men. Several possible explanations for this imbalance include economic disparities like the wage gap, domestic violence, and higher rates of sexual violence.
Previous research has linked child sexual abuse (CSA) to adverse mental health outcomes such as psychosis and diagnoses like schizophrenia. While many studies have found a link between CSA and negative mental health outcomes, at least one controversial meta-analysis indicated that a poor family environment and CSA could not be teased apart, with a poor family environment typically more predictive of adverse mental health outcomes.
Child sexual abuse is common in many different institutions. Both the Catholic and Southern Baptist Churches have enabled abusers and mistreated victims. One report found that 80% of sexual violence victims are diagnosed with a psychiatric disorder once they seek support. Unfortunately, the inpatient psychiatric treatment facilities where they may seek help are yet another institution with a sexual assault problem.
Bentivegna, F., & Patalay, P. (2022). The impact of sexual violence in mid-adolescence on Mental Health: A UK population-based longitudinal study. https://doi.org/10.1101/2022.04.22.22274142 (Link)