The ‘hidden’ costs of sexual violence: A multi-dimensional approach to the impact and experience of trauma”

This multi-stage mixed methods study was designed to assess the impact and experience of sexual violence (SV) in a sample of Irish women with a history of rape/sexual assault. A secondary aim was to explore the appropriateness of the trauma response model as a means of contextualising and explaining women’s post-rape experiences. Stage One involved a series of one-to-one interviews with a selection of stakeholders (n=18) who were providing services to Irish victims of SV. Several important themes were identified from the analysis of these data including: barriers to services, current gaps in service provision; and the perceived impact of SV. Stage Two comprised a detailed quantitative assessment of a sample of Irish women with an experience of SV (n=65). Participants completed a battery of measures in order to assess a number of key constructs/aspects of their life including: experience of trauma symptoms, recent psychological distress; recent life stress; social support; overall Quality of Life (QoL); and alcohol and drug use. A frequency distributionmatched sample of women (COM group) without a history of SV (n=57) also completed these measures (with the exception of the trauma symptoms measure). The average length of time since the incident of SV was almost 13 years) (M=12 years, 9 months) and approximately one third of the sample had also experienced SV under the age of 16. More than eight women in every ten knew the perpetrator, to a greater or lesser degree. The SV sample was characterised by significantly higher rates of recent psychological distress and negative life events than their comparison group counterparts as well as significantly worse QoL, and lower rates of social support. They also obtained significantly higher scores on all scales of the trauma symptoms measure when compared to the norm group. The relationship of the victim to the perpetrator emerged as a significant factor in relation to current marital status, histoiy of a mental health diagnosis and age at the time of the incident. Women who were older at the time of the sexual assault were found to have significantly lower rates of QoL and were experiencing more psychological distress than younger women. A number of significant and interesting correlations were also found between various subscales of the measures. Stage Three explored the impact and experience of SV in more detail by means of a series of one-to-one interviews with a reduced sub-sample of women selected from Stage Two (n=14). These qualitative data supplemented and amplified the findings from the previous two stages of the study. A number of key superordinate themes and subthemes were identified including: reactions to the experience of SV; impact of the experience of SV; service utilisation; disclosure; recovery and healing; and experiences of participation in the research. The findings from this study have highlighted a number of important issues in the area of SV in Ireland whilst also adding to the small, but growing pool of literature that is beginning to question the utility of the widely accepted trauma response model as a means of comprehensively and accurately contextualising and explaining women’s post-rape experiences. Collectively, the findings demonstrate the often ‘hidden’ impact of SV and, in particular, the pervasive and long-term effects on both self-esteem and sexual and intimate relationships. Future understanding of the effects of SV would be enhanced by allowing for the possibility for growth and recovery in rape victims as evidenced by the high level of education attainment in the SV sample. The results suggest that current medico-legal responses to SV in Ireland should incorporate appropriate training and awareness-raising initiatives in relation to victims of SV. It is hoped that improvements such as these would result in a measurable increase in, for example, the uptake of formal mental health services by these women. Furthermore, well co-ordinated public education campaigns are urgently required to dismantle the prevailing ‘rape supportive’ culture. Future research that includes, for example, men, and minority groups is needed while the role of alcohol misuse in the management or exacerbation of PTSD symptoms and factors moderating engagement in sexual risktaking behaviours post-assault are two additional areas worthy of further investigation