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Post-traumatic stress disorder associated with sexual assault among women in the WHO World Mental Health Surveys

Published online by Cambridge University Press:  19 June 2017

K. M. Scott ,
K. C. Koenen ,
A. King ,
M. V. Petukhova ,
J. Alonso ,
E. J. Bromet ,
R. Bruffaerts ,
B. Bunting ,
P. de Jonge  and
J. M. Haro
...Show all authors
K. M. Scott*
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
K. C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
A. King
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
M. V. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
J. Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
B. Bunting
Affiliation:
School of Psychology, Ulster University, Londonderry, Northern Ireland
P. de Jonge
Affiliation:
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
J. M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
E. G. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
S. Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
M. E. Medina-Mora
Affiliation:
National Institute of Psychiatry Ramón de la Fuente, Mexico, D.F., Mexico
F. Navarro-Mateu
Affiliation:
IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
V. Shahly
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
D. J. Stein
Affiliation:
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Y. Torres
Affiliation:
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
*
*Address for correspondence: K. M. Scott, Ph.D., M.A. (ClinPsych), Department of Psychological Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. (Email: kate.scott@otago.ac.nz)
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Abstract

Background

Sexual assault is a global concern with post-traumatic stress disorder (PTSD), one of the common sequelae. Early intervention can help prevent PTSD, making identification of those at high risk for the disorder a priority. Lack of representative sampling of both sexual assault survivors and sexual assaults in prior studies might have reduced the ability to develop accurate prediction models for early identification of high-risk sexual assault survivors.

Methods

Data come from 12 face-to-face, cross-sectional surveys of community-dwelling adults conducted in 11 countries. Analysis was based on the data from the 411 women from these surveys for whom sexual assault was the randomly selected lifetime traumatic event (TE). Seven classes of predictors were assessed: socio-demographics, characteristics of the assault, the respondent's retrospective perception that she could have prevented the assault, other prior lifetime TEs, exposure to childhood family adversities and prior mental disorders.

Results

Prevalence of Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD associated with randomly selected sexual assaults was 20.2%. PTSD was more common for repeated than single-occurrence victimization and positively associated with prior TEs and childhood adversities. Respondent's perception that she could have prevented the assault interacted with history of mental disorder such that it reduced odds of PTSD, but only among women without prior disorders (odds ratio 0.2, 95% confidence interval 0.1–0.9). The final model estimated that 40.3% of women with PTSD would be found among the 10% with the highest predicted risk.

Conclusions

Whether counterfactual preventability cognitions are adaptive may depend on mental health history. Predictive modelling may be useful in targeting high-risk women for preventive interventions.

Keywords

Post-traumatic stress disorderPTSDsexual assault
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 1 , January 2018 , pp. 155 - 167
Copyright
Copyright © Cambridge University Press 2017 

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