Crippling mental health problems common in those sexually assaulted

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Four out of five teenage girls who have been sexually assaulted suffer from crippling mental health problems months after their attack, found a University College London (UCL) study.

The Guardian reports new research has found that victims were found to have anxiety, depression, post-traumatic stress disorder and other serious conditions four to five months after being assaulted. Experts said the findings confirmed that becoming a victim of abuse in childhood can lead to mental health issues that can persist into adulthood and last a lifetime.

The study involved 137 girls aged between 13 and 17 – average age 15.6 years – who were assaulted between April 2013 and April 2015. It was undertaken by academics from University College London (UCL) and specialist staff from King’s College Hospital NHS Trust who work in three sexual assault referral centres around London, where the victims were treated.

When the girls were examined four to five months after being attacked, 80% of them had at least one mental health disorder. More than half (55%) had at least two disorders.

The report says researchers found that girls who had been assaulted were disproportionately likely to be from deprived or troubled backgrounds. Three-quarters were from a poor family, one in five had had a statement of special educational needs and more than half had previously been involved with social services. In addition, half had sought help from UK’s National Health Service (NHS) mental health services in the 12 months before being attacked.

A number of the girls (4%) had become pregnant after being assaulted, 12% had had a sexually transmitted infection and 8% – one in 12 – had been the subject of another sexual assault.

“Although poverty and social vulnerability are well-recognised risk factors for sexual assault, few studies have examined this among adolescents, or looked at the impact of vulnerability on mental health outcomes following sexual assault,” said the lead author, Dr Sophie Khadr, from the UCL Great Ormond Street Institute of Child Health and the Haven Centre based at King’s College Hospital.

“The study findings emphasise the double disadvantage of young women who experience sexual assault,” Khadr said. “Their social vulnerability places them at higher risk of assault, with one in 12 reporting a further assault within four to five months.

“Our study found that many of these vulnerability factors are also risk factors for mental health disorders following assault. Personal characteristics such as a history of self-harm, mental health help or social services involvement were more important than the type of assault as predictors of a later mental health diagnosis.”

Tom Madders, campaigns director at the charity YoungMinds, said: “This worrying research clearly shows the devastating impact that sexual assault can have on mental health and demonstrates the importance of long-term mental health support for survivors.

“The study also suggests that many of the factors that can increase the risk of sexual assault are also factors that can contribute towards poor mental health. Unfortunately, young people who have had difficult or complex upbringings too often do not get the help they need.”

Katharine Sacks-Jones, CEO of Agenda and co-chair of the government’s women’s mental health taskforce, said: “(This) new research is more evidence of a concerning link between women and girls’ mental health, and their experiences of violence and abuse. We ignore this at our peril.”

The report says previous research by Agenda, which campaigns on risks faced by girls and women, has found that more than half of women struggling with a mental health problem had experienced some form of abuse, and that experiencing both abuse and poverty was associated with the poorest outcomes, including poor mental health and using drugs and alcohol to cope.

Abstract
Background: Young people are disproportionately affected by sexual assault, yet longitudinal data are sparse. This paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault.
Methods: This was a prospective cohort study in adolescents aged 13–17 years attending the Sexual Assault Referral Centres serving Greater London, UK, over 2 years. Baseline interviews (T0) were done less than 6 weeks after an assault to collect data on sociodemographic and assault characteristics and psychological symptoms, with follow-up interviews (T1) at 4–5 months after the assault. Four psychological symptom questionnaires were used at T0 and T1: The Child Revised Impact of Events Scale, the Short Mood and Feelings Questionnaire, the Screen for Child Anxiety Related Disorders, and the Strengths and Difficulties Questionnaire. The primary outcome was prevalence of any psychiatric disorder at T1, assessed using the Development and Wellbeing Assessment. Secondary outcomes at T1 were pregnancy, sexually transmitted infections, and sexual health screening since the assault.
Findings: Between April 15, 2013, and April 20, 2015, 141 (29%) of 491 eligible young people were recruited to the study (134 females; mean age 15·6 years [SD 1·27]), and 106 (75%) of 141 participants had T1 interviews (99 female). At T0, psychological symptom scores showed that 115 (88%) of 130 females were at risk for depressive disorder, 90 (71%) of 126 were at risk for anxiety disorders, and 116 (91%) of 128 were at risk for post-traumatic stress disorder, with symptoms largely persisting at T1. 68 (80%) of 85 females who had a diagnostic assessment at T1 had a psychiatric disorder, with multiple disorders in 47 (55%) of 85. Anxiety, post-traumatic stress, and major depressive disorders were the commonest diagnoses. Presence of a psychiatric disorder was associated with baseline psychosocial vulnerability (previous social services involvement, mental health service use, self-harm, or sexual abuse), but not assault characteristics. At T1, four (4%) of 105 females had been pregnant since the assault, 14 (12%) of 119 had a sexually transmitted infection diagnosed between T0 and T1, and nine (8%) of 107 reported re-victimisation since the assault.
Interpretation: Vulnerable adolescents have the double disadvantage of being at risk for both sexual assault and associated psychiatric disorders, highlighting the need for comprehensive support after an assault. Feasibility and effectiveness of prevention programmes should be investigated.

Authors
Sophie Khadr, Venetia Clarke, Kaye Wellings, Laia Villalta, Andrea Goddard, Jan Welch, Susan Bewley, Tami Kramer, Russell Viner

The Guardian report
The Lancet Child and Adolescent Health article summary


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