An analysis of nearly 200 independent studies involving more than 230,000 adult participants finds that having been sexually assaulted is associated with significantly increased risk of anxiety, depression, suicidality, post-traumatic stress disorder, substance abuse, obsessive-compulsive disorder and bipolar disorder.
The analysis, reported in the journal Clinical Psychology Review, represents a summary of 40 years of research on the subject.
"We compared people who had been sexually assaulted with those who hadn't and found a significant difference in mental health," said Emily Dworkin, who conducted the study as a graduate student with University of Illinois psychology professor Nicole Allen. "We also compared people who had been sexually assaulted with people who had experienced other forms of trauma and found that the difference was still there, suggesting that sexual assault is associated with significantly increased risk for these mental health conditions as compared with other types of trauma."
The association between sexual assault and mental health conditions was generally apparent across studies, regardless of how researchers defined sexual assault, Dworkin said. Some studies only examined forced assault, others included coercion or incapacitation, while others included any unwanted sexual contact.
"It doesn't seem to matter how broadly or narrowly you define sexual assault -- if you're only looking at penetrative forms of assault or if you're also including people who experienced assaults limited to fondling -- the association is still there," Dworkin said.
About 24 percent of participants across studies had been victims of a sexual assault, the researchers report.
The analysis also found that adults who had experienced a sexual assault were at higher risk of some mental health problems than others. The risk of contemplating or attempting suicide, for example, was highest relative to other conditions. The risks of PTSD, obsessive-compulsive conditions and bipolar conditions were almost as high as those for suicidality. (See graphic.)
"We often think of obsessive-compulsive conditions and bipolar conditions as more biological or genetic in origin," Dworkin said. "While these findings are based on a smaller number of studies, they suggest that maybe those conditions are more trauma-related than we previously thought."
The risk of mental disorders associated with sexual assault was consistent regardless of the age, race or gender of the participants in a study, the researchers found. The analysis also suggests that having been assaulted by a stranger or by someone using a weapon "appears to be associated with more risk of mental health consequences," Dworkin said.
Not all sexual assault survivors experience mental health problems after an assault, the researchers said. The analysis suggests only that sexual assault survivors are at higher risk.
"Just because you've had this experience doesn't mean you will have a negative mental health effect," Allen said. "But if you do, our findings demonstrate that you are most definitely not alone. These are not uncommon responses to sexual assault."
"I want to emphasize that conditions like post-traumatic stress disorder, suicidality, depression and anxiety disorders are very treatable, and they're often treatable within the course of a few months," said Dworkin, now a postdoctoral fellow at the University of Washington. "As a clinician, I see such tremendous benefits of cognitive behavioral therapy for people who have experienced a sexual assault. They say that they feel like they got their lives back."