Prevalence and consequences of adult sexual assault of men: review of empirical findings and state of the literature

Male victims of adult sexual assault (ASA) are understudied as compared with female victims. Further, commonly-held myths about sexual assault suggest that men cannot be victims or that, if men are victims, they are relatively physically and emotionally unharmed by sexual assault. The goal of this paper was to systematically review the empirical literature on ASA among men to evaluate the veracity of these myths. This paper also sought to examine the methodological quality of the body of research in this area, identify limitations and gaps in the current literature, and suggest directions for future research. Eighty-seven relevant studies were identified through a systematic review of the literature. The reported prevalence of men's sexual aggression varied widely depending on the methods used and the population studied; some populations (e.g., veterans, prison inmates, and gay and bisexual men) reported higher rates of ASA than men in the general population. Few studies have systematically examined the consequences of male ASA; however, those that have suggest that ASA can have notable adverse physical and psychological consequences for some men.     

Sexual assault and physical health: findings from a population-based study of older adults

OBJECTIVE: Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women. METHODS: We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records. RESULTS: Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13-2.76) and breast cancer (OR = 2.21, 95% CI = 1.12-4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08-20.3). CONCLUSIONS: These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.     

Victims of violence and the general practitioner.

BACKGROUND: Violent crime is on the increase in Britain, with 17% of the 15 million incidents of crime reported in 1991 being of a violent nature. Although there is some information on the role of accident and emergency departments for victims who sustain physical injury, little is known about the role of the general practitioner (GP) in managing the acute and longer-term sequelae of violence. AIM: To examine the links between experiencing physical of sexual assault and seeking help from GPs in London. METHOD: A cross-sectional survey of all adult attendees in one large group practice was carried out. The main outcome measures were prevalence of assault, reporting to the doctor and other people, and scores on the General Health Questionnaire (GHQ) and the Impact of Events scale. RESULTS: Of the 195 people who took part, 33 (17%) reported a physical or sexual assault in the previous year. Women were three times more likely than men to report any type of assault. Women rarely spontaneously disclosed these experiences to the GP and yet the experience of violence was associated with higher levels of distress, as measured on the GHQ and the Impact of Events Scale. CONCLUSIONS: Assault is a relatively common event in the lives of people who consult their GP. Doctors could help these patients through gaining an awareness of the problem and by fostering links with voluntary services, such as victim support schemes, which can provide support, practical assistance, and advice on compensation claims and legal procedures.     

Circumstances of sexual and physical victimization of black psychiatric outpatients

A sample of 54 adult psychiatric outpatients, previously identified as victims of sexual or physical assault, were interviewed regarding their childhood and adult victimization experiences. Patients were questioned about the nature of the assaults, their relationship to the perpetrator(s), the number of assaults suffered in each relationship, and whether the assault(s) occurred before or after the onset of their mental illness. Eighty percent of the sample had experienced major physical assault as an adult and 59% had experienced major physical assault as a child; 37% and 31%, respectively, reported major sexual assault as a child and as an adult. Women were more likely than men to report physical and sexual assault as an adult and sexual assault as a child. Childhood assault most often occurred before the onset of the patient's mental illness; whereas, adult sexual assault for women and physical and sexual assault for men was as likely to occur after the onset of the psychiatric disorder, suggesting an increased vulnerability to victimization for the adult mentally ill.     

A longitudinal examination of male college students' perpetration of sexual assault

Self-administered surveys were completed by 197 men in college at 2 time points, 1 year apart. Men who committed sexual assault at multiple time points (repeat assaulters) had the most extreme scores on measures of hostility toward women, past sexual experiences, drinking in sexual situations, and adolescent delinquency. Nonassaulters had the least extreme scores and men who committed sexual assault at only 1 time point had scores that tended to fall in between. Repeat assaulters also expressed significantly less remorse when they described their sexual assault at Time 1 than did past assaulters who committed sexual assault only at the initial time point. These findings demonstrate the importance of initiating prevention and treatment programs in early adolescence, before longstanding attitudes and behaviors tolerant of sexual assault are established.     

Understanding a link between sexual harassment and eating disorder symptoms: a mediational analysis

Using data from 3 samples of working women and men, the present study examines the association between sexual harassment and eating disorder symptoms by studying the processes that may underlie this relationship. The results of structural equation modeling suggest a link between sexual harassment and eating disorder symptoms among women and indicate that this relationship is mediated by psychological distress, self-esteem, and self-blame. Further, sexual harassment was found to predict eating disorder symptoms among women even when experiences of sexual assault were included in the model. No relationship was found between sexual harassment and eating disorder symptoms among men. The theoretical and clinical implications of these results are discussed.     

Emergency evaluation and intervention with female victims of rape and other violence

Given the high prevalence of crime within the general population and the increased rates of victimization among those seeking medical care, professionals who work in emergency departments, primary care medical facilities, or mental health settings need to be prepared to address physical and psychological problems related to sexual and physical assault. In this paper, interpersonal violence prevalence studies are reviewed in terms of study design and findings for sexual assault and physical assault. Common injuries following both forms of assault are documented, followed by a review of long-term medical outcomes. In addition to a review of physical health outcomes, primary psychological effects of violence are also reviewed. Strategies with which to screen for interpersonal violence in the medical setting are offered, and issues related to mandatory reporting are summarized. Interventions for assault victims that can be implemented in the medical setting are outlined, and a new hospital-based treatment for victims of rape is described.     

Acute management of the sexual assault victim.

Sexual assault victims usually seek emergency medical care at urban hospitals. The incidence of over 52,000 cases a year reported by the FBI does not include instances in which the victim died, cases of statutory rape (victim below the age of consent), or cases not confirmed by the police. It is well known that sexual assault is one of the most unreported crimes. The incidence of this crime in affluent communities is unknown. Rape occurs in any community but nonhospital professional services may be more easily available in some.     

Neighborhood sexual violence moderates women's perceived safety in urban neighborhoods

Perceptions of neighborhood safety are positively associated with perceptions of neighborhood violence. However, research has yet to examine whether this relationship is moderated by specific types of violence, such as sexual violence, that are more salient for women. Using street‐intercept interviews with 343 adults in 9 neighborhoods of a U.S. city with high rates of poverty, unemployment, and crime, we examine the relationship of perceived neighborhood violence to perceived safety in the context of gender while controlling for neighborhood assets that moderate perceptions of neighborhood safety and violence. We hypothesized that gender would moderate the relationship between perceived neighborhood violence and safety, and that women's perceptions of neighborhood safety would be significantly influenced by neighborhood sexual violence, but not other types of violence. Although women and men in these high crime, urban neighborhoods did not differ in their perceptions of neighborhood safety or violence, perceived sexual violence did significantly moderate safety by gender; women's perceptions of neighborhood sexual violence predicted perceived safety in their neighborhood. Importantly, gender did not moderate perceived safety for other types of violence. These results illustrate the importance of taking gender and perceived sexual violence into account to understand neighborhood safety in adults, particularly women.     

Advocacy Services for College Victims of Sexual Assault: Navigating Complicated Confidentiality Concerns

ABSTRACT

Recent policy reforms related to campus sexual assault may pose confidentiality concerns for victims. The current study aimed to understand current issues in providing confidential advocacy services for college victims of sexual assault, as well as the differential roles that campus-based and community-based advocacy play for college victims. For this qualitative study, semi-structured interviews were conducted with 22 national experts on campus sexual assault from a variety of disciplinary backgrounds. The results indicate that campus-based advocates face challenges in maintaining confidentiality of victims’ information, whereas community-based advocates are more likely to have legal confidentiality protections. Consequently, participants noted that an ideal advocacy model for college victims might be one in which campus- and community-based services are closely coordinated to ensure access to services that are both confidential and meet the unique needs of college students. Implications for advocacy services are discussed, as well as future directions for research and evaluation on the effects of evolving policy aimed at improving institutional responses to sexual assault.     

Challenges in conducting research on sexual violence and HIV and approaches to overcome them

Studies have implicated sexual violence as a strong correlate of HIV acquisition in women. Characterizing how such violence affects the female immune system may provide insight into the biological mechanisms of HIV transmission and ultimately improve global HIV prevention strategies. Little research has been carried out in this domain, and the obstacles to investigation can be daunting. Here, we describe methodological challenges encountered and solutions explored while implementing a study of dysregulation of immune biomarkers potentially indicative of increased HIV susceptibility in women following sexual assault. Challenges included accessing sexual assault survivors and defining sexual assault, promoting study participant well‐being during research engagement, reducing selection and information bias, collecting and processing biological samples, and adjusting for confounders such as reproductive tract infections and emotional and physical abuse. We found that many survivors of sexual assault welcomed the attention from study staff and felt empowered by the opportunity to help other women at risk for violence. Well‐trained research staff and well‐articulated community and medical partnerships were key methods to overcoming challenges while promoting the safety and welfare of vulnerable study participants.     

Sexual assault prevention programs: current issues, future directions, and the potential efficacy of interventions with women.

Current problems facing the primary prevention of sexual assault are reviewed. Effective sexual assault prevention programs for both males and females have been slow to develop due to the fact that the etiologies of sexual assault have not been identified. Although dissemination of prevention programs has become increasingly popular in recent years, few programs have evaluated the extent to which the constructs identified in the interventions are effective at decreasing rates of sexual assault. This article discusses previous studies in sexual assault prevention programs, methodological and conceptual problems that currently exist in the field, pragmatic difficulties regarding program implementation and evaluation, and recommendations for future research with an emphasis on interventions with female participants.     

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.     

Assault injury rates,social capital,and fear of neighborhood crime

This study develops an explanatory framework for fear of neighborhood crime based on respondents' social context and local rates of assault injuries. Rates of assault injuries within zip codes are based on hospital discharge records. We find that only four variables have a significant unique contribution to fear of crime: respondent's sex, perceptions of neighborhood social capital, and the rates of struck by/against assault injuries for the 10–24 and 50+ age groups. We also find that the perception of neighborhood social capital moderates the impact of assault injury rates on fear of crime; those who perceive a high level of neighborhood social capital exhibit less sensitivity to assault injury rates. We include a map of assault injury rates and fear of crime by ZIP Code and describe the community context related to our results. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 483–498, 2007.     

How to Right a Wrong: Empirically Evaluating Whether Victim,Offender, and Assault Characteristics can Inform Rape Kit Testing Policies

ABSTRACT

Hundreds of thousands of previously untested sexual assault kits (SAKs) have been uncovered in police property storage facilities across the United States, representing a national failure in institutional response to sexual assault. Faced with this discovery, jurisdictions must now decide if and how they should test these kits. Some stakeholders have suggested prioritizing kits for testing by victim, offender, or assault characteristics, based on the belief that these characteristics can predict the likely utility of DNA testing. However, little research has examined the empirical merits of such prioritization. To address this gap in the literature and inform SAK testing policies, we randomly sampled 900 previously untested SAKs from Detroit, MI. The sampled SAKs were submitted for DNA testing, and eligible DNA profiles were entered into Combined DNA Index System (CODIS), the federal DNA database. Police records associated with each SAK were coded for victim, offender, and assault characteristics, and logistic regression analyses were conducted to test whether these characteristics predict which SAKs yield DNA profiles that match (“hit”) to other criminal offenses in CODIS. Testing this sample of previously-untested SAKs produced a substantial number of CODIS hits, but few of the tested variables were significant predictors of CODIS hit rate. These findings suggest that testing all previously-unsubmitted kits may generate information that is useful to the criminal justice system, while also potentially addressing the institutional betrayal victims experienced when their kits were ignored.     

“NOBODY DESERVES THIS”: ADOLESCENT SEXUAL ASSAULT VICTIMS’ PERCEPTIONS OF DISBELIEF AND VICTIM BLAME FROM POLICE

Prior research reveals that many police engage in victim blaming, skeptical reactions to adult sexual assault survivors. However, little is known about adolescent survivors’ experiences with police. To address this gap, qualitative interviews were conducted with 20 adolescent rape survivors to understand adolescents’ perceptions of their interactions with the police (specifically the messages the officers conveyed about the assault and the victims themselves). Positive perceptions occurred when the adolescents perceived police behavior as indications of believing their story, validating their decision to report, and refraining from judgment of their behavior. On the other hand, negative perceptions were associated with behaviors that were viewed as indications of skepticism, blame, or judgment. Specific behaviors that were associated with each of these themes are discussed. Interactions with the police influenced survivors’ emotional well‐being and their hope for their case's success. Implications for improving interactions between police and adolescent sexual assault victims are discussed.     

Offense type and two-point MMPI code profiles: discriminating between violent and nonviolent offenders

Offense data and MMPI profiles were examined for 67 men who had been remanded by the courts to a psychiatric hospital forensic unit for pretrial assessment. They were classified as violent or nonviolent offenders based upon the nature of their offenses. Violent offenders were those charged with assault, robbery, sexual assault, and all degrees of homicide. Nonviolent offenders were those charged with break, enter and commit, uttering threats, and fraud. The controversial issue of two-point MMPI code types (4-3, 4-8/8-4) was addressed. Neither of these commonly employed two-point types successfully discriminated between violent and nonviolent offenders.     

Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women.     

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.