Sexual assault victimization and psychopathology: A review and meta-analysis

Existing systematic reviews of SA's impact have been limited to childhood SA or adult SA.

“existing systematic quantitative and qualitative reviews of the impact of SA have limited their scope to childhood SA (Chen et al., 2010; Smolak & Murnen, 2002) or adult SA (Campbell et al., 2009).”

• cites Chen et al., 2010 sourceNot checked — no full text of the source
• cites Smolak & Murnen, 2002 sourceCould not verify

  Two searches of Smolak and Murnen’s 2002 paper returned no full-text snippets. Its title establishes that it examines child sexual abuse and eating disorders, but does not establish the broader claim that existing reviews were limited to childhood or adult sexual assault. An unscoped match in “An ecological approach to understanding the impact of sexual violence” (score 0.808) discusses separate reviews of child and adult sexual violence, but does not establish that the claim was taken from that paper rather than the cited one. The evidence is insufficient to confirm or confidently reattribute the claim. (LLM, conf=0.64)

  Experimental — accuracy not yet measured
• cites Campbell et al., 2009 sourceNot checked — no full text of the source

Cross-national epidemiological evidence indicates that SA is more strongly associated with suicidality than other forms of trauma, independent of co-occurring disorders.

“evidence from cross-national epidemiological studies indicates that SA is more strongly associated with suicidality than other forms of trauma, and this effect appears to be independent of co-occurring disorders (Stein et al., 2010).”

• cites Stein et al., 2010 sourceSupported

Past epidemiological studies controlling for other risk factors are consistent with the finding that SA is associated with increased suicidality.

“This is consistent with past epidemiological studies that have controlled for other risk factors (Ullman & Brecklin, 2002; Stein et al., 2010).”

• cites Ullman & Brecklin, 2002 sourceNot checked — no full text of the source
• cites Stein et al., 2010 sourceSupported

The effects of SA on psychopathology persist across demographic differences in samples.

“Effects endured across differences in sample demographics.”

Samples with a higher proportion of assaults involving physical injury show larger effect sizes.

“Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury.”

Samples with a higher proportion of assaults involving weapons show larger effect sizes.

“Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury.”

Including attempted SA in definitions of SA produces smaller effect sizes.

“Broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) were not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects.”

SA is linked to elevated risk across every psychopathology category examined.

“SA was associated with increased risk for all forms of psychopathology assessed, and stronger associations were observed for posttraumatic stress and suicidality.”

Sexually assaulted individuals show significantly greater psychopathology than those without such assault, with a mean Hedges' g of 0.61.

“Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges’ g=0.61).”

Samples with a higher proportion of assaults by strangers show larger effect sizes.

“Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury.”

Broader definitions of SA, such as those including incapacitated, coerced, or nonpenetrative acts, do not change effect sizes.

“Broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) were not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects.”

There was no observed difference in effects between lifetime and adolescent/adult SA (Δg = −0.02, p = .61).

“Against Hypothesis 6, here was no observed difference in effects as a function of limiting SA to adolescence/adulthood, Δg = −0.02, SE = .04, p = .61”

The average effect size across psychopathology types was g = 0.61 (SE = 0.02), indicating a moderate association between SA and psychopathology.

“The average effect size across types of psychopathology was g = 0.61 (SE = 0.02), suggesting a moderate association between SA and psychopathology.”

Lower-quality SA assessments were associated with larger differences between SA and no-SA groups (β = −0.07, p < .01).

“Hypothesis 3, that lower-quality assessments would be associated with higher effects, was supported, β = −0.07, SE = .03, p < .01, indicating that studies using lower-quality assessments of SA evidenced larger differences between the SA and no-SA groups.”

Operational definitions including attempted SA had significantly smaller effect sizes than completed-SA-only definitions (Δg = −0.10, p = .02).

“Hypothesis 2a was supported: operational definitions that included attempted SA evidenced significantly smaller effect sizes, Δg = −0.10, SE = 0.05, p = .02, as compared to those that included completed SA only.”

Including coercion in SA definitions was not associated with decreased effect sizes compared with forced-SA-only definitions (Δg = −0.04, p = .63).

“Hypothesis 2b was not supported for operational definitions that included coercion, Δg = −0.04, SE = 0.07, p = .63”

Including incapacitation in SA definitions was not associated with decreased effect sizes compared with forced-SA-only definitions (Δg = −0.04, p = .59).

“incapacitation, Δg = −0.04, SE = 0.07, p = .59”

Among studies assessing past-year SA and past-year psychopathology, effect sizes did not differ by sample mean age (β=−1.11, SE=.06, p=.86; k=37, m=19).

“Effect sizes did not differ as a function of sample mean age, β = −1.11, SE = .06, p = .86 (k = 37, m = 19).”

Most samples limited the SA group to adolescent and/or adult SA (k = 260, m = 93).

“Most samples limited the SA group to those who experienced SA in adolescence and/or adulthood, k = 260, m = 93.”

The percentage of assaults involving a weapon was positively related to the magnitude of group differences (β = 0.21, p = .02).

“Hypothesis 7b was also supported: the percent of assaults that involved a weapon was positively related to the magnitude of difference between groups, β = 0.21, SE = .09, p = .02.”

Compared with primarily White samples, majority Latino/a samples did not differ significantly in effect size (Δg=−0.04, SE=0.15, p=.80).

“majority Latino/a samples, Δg = −0.04, SE = 0.15, p = .80”

Higher-quality psychopathology assessments were associated with larger differences between SA and no-SA groups (β = 0.04, p = .04).

“Hypothesis 4, predicting that higher-quality assessments would be associated with higher observed effects, was supported: average quality score was 0.71 (SD = 0.26), and this value was significantly associated with the magnitude of effect sizes, β = 0.04, SE = .02, p = .04.”

Other-trauma comparison groups most often comprised people who experienced physical assault (8%) or any non-SA trauma (11%).

“Other-trauma groups were most often comprised of people who had experienced physical assault (8%) or any non-SA trauma (11%).”

Including fondling/nonpenetrative SA in definitions was not associated with decreased effect sizes compared with penetrative-only definitions (Δg = −0.07, p = .14).

“Against Hypothesis 2b, including fondling and other nonpenetrative SA in definitions was not associated with decreased effect sizes as compared to penetrative assault only, Δg = −0.07, SE = 0.05, p = .14.”

The percentage of women in the sample was not associated with effect size magnitude (β=−0.03, SE=.02, p=.17).

“we found that the percentage of women in the sample was not associated with effect size magnitude, β = −0.03, SE = .02, p = .17.”

Compared with primarily White samples, majority Black/African American samples did not differ significantly in effect size (Δg=−0.08, SE=0.09, p=.40).

“majority Black/African American samples, Δg = −0.08, SE = 0.09, p = .40”

Including both coercion and incapacitation in SA definitions was not associated with decreased effect sizes compared with forced-SA-only definitions (Δg = −0.09, p = .12).

“or both coercion and incapacitation, Δg = −0.09, SE = 0.06, p = .12, as compared to those that included forced SA only.”

In the subsample of effects representing past-year psychopathology with time since assault reported (k = 94, m = 47), mean time since SA was 4.55 years (SD = 9.51, median = 0.63, range 0.004 to 49.70).

“We limited the sample to those effects that represented past-year psychopathology and reported time since assault (k = 94, m = 47). The mean time elapsed since SA in this subsample was 4.55 years (SD = 9.51, median = 0.63, range: 0.004 to 49.70).”

The percentage of stranger perpetrators was unrelated to group differences (β = 0.10, p = .07).

“Hypothesis 7c was not supported: the percent of stranger perpetrators was unrelated to group differences, β = 0.10, SE = .06, p = .07.”

Among 153 studies with non-selectively sampled comparison groups and population prevalence estimates, average SA prevalence was 24.12% (SD = 17.56%, range 1.59% to 92.57%).

“Among the m = 153 studies where the comparison group was not selectively sampled and the prevalence of SA was an estimate of the prevalence in the population studied, the average SA prevalence was 24.12% (SD = 17.56%, range: 1.59% to 92.57%).”

Effects did not differ as a function of years since assault (β = −0.02, p = .70).

“Hypothesis 8 was not supported: effects did not differ as a function of years since assault, β = −0.02, SE = .06, p = .70”

Compared with no-SA comparison groups, other-trauma groups did not differ in effect size (Δg = −0.01, p = .82).

“Consistent with Hypothesis 5a, compared to studies using a no-SA comparison group, other trauma groups did not differ, Δg = −0.01, SE = 0.05, p = .82”

Rosenthal's fail-safe N indicated that 2,153,789 null effects would be needed to reduce the summary effect's significance to .05.

“We then calculated Rosenthal’s fail-safe N (Rosenthal, 1979), and determined that 2,153,789 effects evidencing no relationship between SA and psychopathology (g = 0) would be needed to reduce the significance level of the summary effect size to .05.”

• cites Rosenthal, 1979 sourceNot checked — no full text of the source

Sample mean age was not associated with effect size in the full sample (β=0.00, SE=.02, p=.99).

“Hypothesis 9a was supported: effects did not differ as a function of sample mean age, β = 0.00, SE = .02, p = .99.”

The percentage of survivors who were injured was positively related to the magnitude of group differences (β = 0.18, p < .001).

“Hypothesis 7a was supported: the percent of survivors who were injured was positively related to the magnitude of difference between groups, β = 0.18, SE = .04, p < .001.”

Thirty-five percent of coded effect sizes (175/497) came from unpublished data obtained through the authors' requests.

“Ultimately, 35% of the effect sizes that we coded (175/497) used unpublished data obtained through these methods.”

Compared with no-SA comparison groups, no-trauma groups had significantly higher effect sizes (Δg = 0.64, p < .01).

“and consistent with Hypothesis 5b, no trauma groups had significantly higher effect sizes, Δg = 0.64, SE = 0.20, p < .01.”

When limited to studies assessing past-year SA, effect sizes did not differ by time since assault (β = −0.01, p = .78; k = 50, m = 23).

“To account for within-study variation in time since assault, we limited the sample to studies assessing past-year SA, and found no differences in effect sizes, β = −0.01, SE = .05, p = .78 (k = 50, m = 23).”

Published effect sizes were significantly larger than unpublished effect sizes (M = 0.64 vs. 0.50; t = 4.30, p < .0001).

“We first compared published (M = 0.64, SD = .41, k = 322) to unpublished (M = 0.50, SD = .31, k = 175) effect sizes, and concluded that published effect sizes were significantly larger, t(443.74) = 4.30, p < .0001.”

Compared with primarily White samples, majority Native American samples did not differ significantly in effect size (Δg=0.47, SE=0.31, p=.13).

“majority Native American samples, Δg = 0.47, SE = 0.31, p = .13”

Among studies with participant age SD <5 years, past-year psychopathology effect sizes did not differ by sample mean age (β=0.01, SE=.03, p=.76; k=140, m=72).

“again found no difference in past-year psychopathology, β = 0.01, SE = .03, p = .76 (k = 140, m = 72).”

Lower-quality SA assessment methods tended to overestimate group differences.

“Lower-quality SA assessment methods—which we defined as those using measures that contained a single item only, were unpublished, did not behaviorally define SA, and/or did not specify a tactic through which SA could have occurred—tended to overestimate group differences.”

Including lifetime SA studies did not reduce effects.

“we did not find that including lifetime SA studies—which likely included survivors of child SA in their SA groups—reduced effects.”

The included studies varied widely in the quality of SA assessments.

“It is notable that the population of studies included in this analysis varied widely in the quality of SA assessments.”

SA was significantly positively related to all forms of psychopathology studied.

“SA was significantly positively related to all forms of psychopathology studied”

Studies that included both attempted and completed assaults still evidenced moderate-sized effects.

“studies that included both attempted and completed assaults still evidenced moderate-sided effects.”

Studies with larger proportions of survivors of assaults likely involving more life threat (e.g., weapon use) evidenced larger effect sizes.

“in the current analysis, studies with larger proportions of survivors of assaults that likely involved more life threat (e.g., weapon use) evidenced larger effect sizes.”

Compared with primarily White samples, no-majority samples did not differ significantly in effect size (Δg=0.02, SE=0.05, p=.76).

“no-majority samples, Δg = 0.02, SE = 0.05, p = .76”

Survivors of SA appear to be at substantially increased risk for suicidal ideation and attempts.

“Survivors of SA appear to be at substantially increased risk for suicidal ideation and attempts”

Compared with college samples, mixed samples had significantly higher effect sizes (Δg=0.20, SE=.08, p=.02).

“and mixed samples, Δg = 0.20, SE = .08, p = .02, had significantly higher effect sizes.”

Relative to other conditions, SA was associated with the highest increases in risk for suicidality.

“relative to other conditions, SA was associated with the highest increases in risk for suicidality.”

Assault characteristics such as stranger perpetrators, weapon use, and resulting physical injury are associated with higher risk for psychopathology.

“It appears that assault characteristics like stranger perpetrators, weapon use, and resulting physical injury, are associated with higher risk for psychopathology.”

Trauma and stressor-related conditions had one of the strongest associations with a history of SA.

“trauma and stressor-related conditions evidenced one of the strongest associations with a history of SA”

In the current meta-analysis of 497 estimates from 238,623 participants, people who experienced SA showed significantly more psychopathology across diagnostic categories than people who had not experienced SA.

“In the current meta-analysis, which included 497 estimates of the relationship between SA and psychopathology representing 238,623 individual participants, people who experienced SA evidenced significantly more psychopathology across diagnostic categories than people who have not experienced SA.”

Compared with college samples, general population samples had significantly higher effect sizes (Δg=0.12, SE=.05, p=.01).

“only general population samples, Δg = 0.12, SE = .05, p = .01”

Including coerced and incapacitated SA in operational definitions did not significantly alter observed group differences in psychopathology.

“we found that including coerced, and incapacitated SA in operational definitions did not significantly alter observed group differences in psychopathology.”

The overall effect size observed in the current analysis was g=0.61.

“The overall effect size of g = 0.61 observed in the current analysis”

Effect sizes were significantly higher for studies using no-trauma comparison groups than for studies using no-assault or other-trauma comparison groups.

“effect sizes were significantly higher for studies using no-trauma comparison groups than for studies using no-assault or other-trauma comparison groups.”

SA was associated with greater risk for PTSD than for depression, anxiety, disordered eating, and substance abuse/dependence.

“although SA was associated with greater risk for PTSD than depression, anxiety, disordered eating, and substance abuse/dependence”

Lower-quality psychopathology assessment methods appeared to underestimate group differences.

“lower-quality assessment methods appeared to underestimate group differences.”

Survivors of SA appear to be at relatively lower risk of substance use disorders than for other conditions.

“survivors of SA appear to be at relatively lower risk of substance use disorders than other conditions.”

Including attempted SA reduced group differences in psychopathology.

“Although including attempted SA reduced group differences”

Decades of research have shown that SA is linked to many types of psychological dysfunction.

“Over the following decades, research accumulated to demonstrate that SA is associated with many forms of psychological dysfunction.”

• cites Campbell et al., 2009 sourceNot checked — no full text of the source

A meta-analysis of child sexual abuse found no differences based on victim-offender relationship.

“Similarly, a meta-analysis of psychopathology related to child sexual abuse did not find differences based on victim-offender relationship (Paolucci & Genuis, 2001)”

• cites Paolucci & Genuis, 2001 sourceNot checked — no full text of the source

Some evidence suggests SA is an especially harmful trauma.

“In addition, there is some evidence to suggest that SA is a particularly harmful form of trauma (Kessler et al., 1995; Kelley et al., 2009).”

• cites Kessler et al., 1995 sourceNot checked — no full text of the source
• cites Kelley et al., 2009 sourceNot checked — no full text of the source

In an earlier meta-analysis of 50 studies, the only demographic factors linked to distress were the proportion of women in the sample and age at victimization.

“In a past meta-analysis of 50 studies assessing the association between interpersonal violence and psychopathology, however, the only demographic characteristics related to distress were the percent of women in the sample and age at the time of victimization (Weaver & Clum, 1993).”

• cites Weaver & Clum, 1993Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The results support SA as a broad risk factor for several kinds of psychological dysfunction across different populations and assault types.

“In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.”

Interpersonal violence does not always lead to psychopathology.

“Interpersonal violence does not inevitably lead to psychopathology (Weaver & Clum, 1995)”

• cites Weaver & Clum, 1995 sourceNot checked — no full text of the source

In a meta-analysis of distress and interpersonal violence, longer time since the stressor was linked to smaller effect sizes.

“In a meta-analysis of the association between distress and interpersonal violence, time since stressor was negatively associated with effect sizes (Weaver & Clum, 1995)”

• cites Weaver & Clum, 1995 sourceNot checked — no full text of the source

SA seems to affect mental health more severely than other types of trauma.

“Indeed, SA appears to have a more significant impact on mental health than other forms of trauma (Kelley, Weathers, McDevitt-Murphy, Eakin, & Flood, 2009; Kessler et al., 1995).”

• cites Kelley, Weathers, McDevitt-Murphy, Eakin, & Flood, 2009 sourceNot checked — no full text of the source
• cites Kessler et al., 1995 sourceNot checked — no full text of the source

Meta-analytic evidence indicates that younger age at trauma exposure is linked to higher PTSD risk.

“Indeed, evidence from meta-analyses that younger age at trauma exposure is associated with increased risk for PTSD (Brewin, Andrews, & Valentine, 2000; Ozer et al., 2003) suggests that studies of lifetime SA might not be directly comparable to studies of adolescent/adult SA.”

• cites Brewin, Andrews, & Valentine, 2000 sourceNot checked — no full text of the source
• cites Ozer et al., 2003 sourceNot checked — no full text of the source

Child sexual abuse tends to involve different perpetrator types than adult SA.

“although child sexual abuse tends to involve different perpetrator types (e.g., family members) than adult SA (Tjaden & Thoennes, 2006).”

• cites Tjaden & Thoennes, 2006 sourceNot checked — no full text of the source

One meta-analysis found that a higher proportion of women in the sample was linked to a stronger relationship between interpersonal victimization and psychological distress.

“One meta-analysis found that the percentage of women in the sample was positively associated with the magnitude of the relationship between interpersonal victimization and psychological distress (Weaver & Clum, 1995)”

• cites Weaver & Clum, 1995 sourceNot checked — no full text of the source

In that meta-analysis, trauma characteristics such as amount of force and survivors' subjective appraisals were also linked to recovery.

“Characteristics of traumas experienced, such as the amount of force used and survivors’ subjective appraisals of the trauma (e.g., self blame), were also associated with recovery in this analysis.”

• cites Weaver & Clum, 1993Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Less-educated SA survivors report more self-blame than college-educated survivors.

“and less-educated SA survivors evidence more self blame compared to college-educated survivors (Long, Ullman, Starzynski, Long, and Mason, 2007).”

• cites Long, Ullman, Starzynski, Long, and Mason, 2007 sourceNot checked — no full text of the source

Several earlier meta-analyses examined only one form of psychopathology.

“Second, several assessed only a single form of psychopathology (e.g., Brewin et al., 2000; Ozer et al., 2003; Smolak & Murnen, 2002)”

• cites Brewin et al., 2000 sourceNot checked — no full text of the source
• cites Ozer et al., 2003 sourceNot checked — no full text of the source
• cites Smolak & Murnen, 2002 sourceNot checked — no full text of the source

Most studies have not found a link between race/ethnicity and SA-related psychopathology.

“Results for racial/ethnic differences appear more clear: most studies have not identified an association between race/ethnicity and SA-related psychopathology (Campbell et al., 2009)”

• cites Campbell et al., 2009 sourceNot checked — no full text of the source

A second meta-analysis found no gender differences in the link between child sexual abuse and psychopathology.

“and a second also did not identify gender differences in the association between child sexual abuse and psychopathology (Paolucci & Genuis, 2001).”

• cites Paolucci & Genuis, 2001 sourceNot checked — no full text of the source

There is not enough evidence to indicate that the strength of the association between SA and past-year psychopathology differs between lifetime and adolescent/adult assault.

“suggesting that there is not enough evidence to indicate that the strength of the association between SA and past-year psychopathology differs when examining lifetime versus adolescent/adult assault.”

Except for attempted SA, more evidence is needed to conclude that changing SA operationalizations is associated with changes in observed group differences.

“This suggests that, with the exception of the inclusion of attempted SA, more evidence would be needed to conclude that changing operationalizations of SA is associated with changes in observed differences between assaulted and nonassaulted samples on psychopathology.”

SA survivors show significantly greater psychopathology when compared with people who have not experienced trauma than when compared with people who have experienced a different trauma or who have not experienced SA.

“This indicates that SA survivors evidence significantly greater psychopathology when compared to people who have not experienced trauma, relative to comparisons to people who have experienced a different trauma or who have not experienced SA.”

The most recent similar meta-analysis of broad trauma exposure and PTSD was published in 2003.

“the most recent similar meta-analysis—assessing associations between trauma exposure broadly and PTSD—was conducted in 2003 (Ozer et al., 2003).”

• cites Ozer et al., 2003 sourceNot checked — no full text of the source

Some indices of assault severity are associated with greater severity or frequency of psychopathology.

“Together, this provides evidence that some indices of assault severity are associated with greater severity or frequency of psychopathology.”

The review used several strategies to seek unpublished data and reduce publication bias.

“To accomplish this, we took several steps. First, we searched for eligible dissertations and theses. Second, we posted a notice on the APA Division 56 (Traumatic Stress) listserv requesting unpublished data.”

There is not enough evidence to indicate that the strength of the association between SA and past-year psychopathology differs by time since assault.

“suggesting that there is not enough evidence to indicate that the strength of the association between SA and past-year psychopathology differs by time since assault.”

Earlier meta-analyses that covered multiple psychopathology domains did not statistically compare those domains.

“and those that assessed multiple domains of psychopathology did not conduct statistical comparisons across domains (e.g., Chen et al., 2010; Golding, 1999; Paolucci & Genuis, 2001).”

• cites Chen et al., 2010 sourceNot checked — no full text of the source
• cites Golding, 1999 sourceNot checked — no full text of the source
• cites Paolucci & Genuis, 2001 sourceNot checked — no full text of the source

Lack of a college education is linked to a higher likelihood of suicide attempts among SA survivors.

“There is evidence that a lack of a college education is associated with higher likelihood of suicide attempts among SA survivors (Ullman & Brecklin, 2002b)”

• cites Ullman & Brecklin, 2002b sourceNot checked — no full text of the source

Some evidence suggests racial differences exist in SA victimization.

“there is some evidence to suggest that racial differences exist in SA victimization (Acierno, Resnick, & Kilpatrick, 1998)”

• cites Acierno, Resnick, & Kilpatrick, 1998Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The evidence is insufficient to conclude that the strength of the SA-psychopathology association differs by age.

“These results suggest that there is not enough evidence to suggest that the strength of the association between SA and psychopathology differs by age.”

The evidence is insufficient to conclude that the SA-psychopathology association differs by gender.

“These results suggest that there is not enough evidence to suggest that the association between SA and psychopathology differs by gender.”

The most similar earlier quantitative analysis assessed dysfunction broadly, not psychopathology specifically.

“First, the most thematically similar quantitative analysis (Weaver & Clum, 1995) assessed dysfunction broadly (e.g., including problems in living) rather than psychopathology specifically.”

• cites Weaver & Clum, 1995 sourceNot checked — no full text of the source

Only baseline data from repeated-measures studies were used to avoid underestimating effect sizes by averaging across assessment periods.

“We included only baseline data for repeated-measures studies (m = 23, 12% of studies), consistent with similar meta-analyses (Ozer et al., 2003), to avoid underestimating the effect size by averaging across assessment periods.”

• cites Ozer et al., 2003 sourceNot checked — no full text of the source

Substantial publication bias would be required to nullify the observed summary effect.

“This suggests that substantial publication bias would need to be present to nullify the observed effect.”

People exposed to SA still evidence higher levels of psychopathology relative to those unexposed, even in populations likely to have better psychological functioning.

“but regardless, people exposed to SA still evidence higher levels psychopathology relative to those unexposed to SA.”

Prospective studies found no effect of SA on problem substance use when controlling for pre-assault drinking.

“Prospective studies have found no effect for SA on problem substance use when controlling for pre-assault drinking (Testa & Livingston, 2000; Testa, Livingston, & Hoffman, 2007).”

• cites Testa & Livingston, 2000 sourceNot checked — no full text of the source
• cites Testa, Livingston, & Hoffman, 2007 sourceNot checked — no full text of the source

An experience of SA is associated with more than half a standard deviation increase in psychopathology.

“indicates that an experience of SA is associated with more than half a standard deviation increase in psychopathology”

It does not appear that any particular demographic group evidences relatively higher post-assault psychopathology.

“However, it does not appear that any particular demographic group evidences relatively higher post-assault psychopathology.”

A causal relationship between SA and psychopathology cannot be inferred from this body of work.

“It is clear that SA and psychopathology have a robust association, but a causal relationship between SA and psychopathology cannot be inferred from this body of work.”

Across populations such as college students, people seeking healthcare, military/veterans, prison inmates, and people seeking support for crime-related needs, the impact of SA appears similarly substantial.

“Across populations like college students, people seeking healthcare, military/veterans, prison inmates, and people seeking support for crime-related needs, the impact of SA appears to be similarly substantial.”

The findings do not suggest that studies of lifetime SA and adolescent/adult SA are so distinct as to be incomparable.

“Nevertheless, these findings do not suggest that studies of lifetime SA and adolescent/adult SA are so distinct as to be incomparable.”

Intentionally selecting a comparison group comprised of no/low trauma resulted in large differences from a SA group.

“so it is not surprising that intentionally selecting a comparison group comprised of no/low trauma resulted in large differences from a SA group.”

• AssumptionRests on an assumption: No-assault comparison groups are mostly composed of people who experienced some other form of trauma.

Having PTSD related to SA could interfere with obsessive-compulsive disorder treatment.

“having PTSD related to SA could interfere with obsessive-compulsive disorder treatment (Gershuny et al., 2002).”

• cites Gershuny et al., 2002 sourceNot checked — no full text of the source

The results suggest that researchers may introduce bias to their estimates of the impact of psychopathology on SA by using lower-quality assessments.

“these results suggest that researchers may introduce bias to their estimates of the impact of psychopathology on SA by using lower-quality assessments.”

Past studies found that including nonpenetrative SA increased the size of the SA group by 94-232%.

“including nonpenetrative SA increased the size by 94–232% (Koss et al., 1987)”

• cites Koss et al., 1987 sourceNot checked — no full text of the source

The evidence is insufficient to conclude that racial differences exist in the effect of SA on psychopathology.

“Thus, there was not enough evidence to conclude that racial differences exist in the effect of SA on psychopathology.”

The effect of SA on psychopathology appears stronger than previously estimated.

“Further, the effect of SA on psychopathology appears to be stronger than previously estimated.”

The results provide evidence that many survivors of SA experience increased frequency or severity of psychopathology.

“and provides evidence that many survivors of SA experience increased frequency or severity of psychopathology.”

Research on general population samples appears to evidence the greatest differences in psychopathology between assaulted and unassaulted groups.

“As a result, research on general population samples appears to evidence the greatest differences in psychopathology between assaulted and unassaulted groups.”

There is some evidence from the SA revictimization literature, albeit mixed, that psychosocial consequences of childhood SA increase risk for adolescent/adult SA via increased contact with potential perpetrators and/or increased likelihood of being targeted.

“there is some evidence from the SA revictimization literature, albeit mixed, that the psychosocial consequences of childhood SA increase risk for adolescent/adult SA via increased contact with potential perpetrators (e.g., as a result of using alcohol) and/or an increased likelihood that perpetrators will target the individual (e.g., due to impaired risk recognition) (Classen et al., 2005; Messman”

• cites Classen et al., 2005 sourceNot checked — no full text of the source
• cites Messman-Moore & Long, 2003 sourceNot checked — no full text of the source

A prior meta-analysis of 38 studies estimated an average effect size of r=.21 (roughly g=.43) for the association between adult SA and distress.

“The only prior meta-analysis to examine the association between adult SA and distress (broadly defined to include both psychopathology and distress across domains of life functioning) across 38 studies estimated an average effect size of r = .21 (Weaver & Clum, 1995), which is roughly equivalent to g = .43.”

• cites Weaver & Clum, 1995 sourceNot checked — no full text of the source

SA commonly co-occurs with other forms of trauma like intimate partner violence and child sexual abuse.

“SA commonly co-occurs with other forms of trauma like intimate partner violence and child sexual abuse (Campbell, Greeson, Bybee, & Raja, 2008).”

• cites Campbell, Greeson, Bybee, & Raja, 2008 sourceNot checked — no full text of the source

Past studies found that including coerced SA increased the size of the SA group by 77-164%.

“including coerced SA increased the size of the SA group by 77–164% (Koss et al., 1987)”

• cites Koss et al., 1987 sourceNot checked — no full text of the source

A literature review identified pre-assault mental health difficulties as a predictor of post-assault psychopathology.

“a literature review on associations between SA and psychopathology identified pre-assault mental health difficulties as a predictor of post-assault psychopathology (Campbell et al., 2009).”

• cites Campbell et al., 2009 sourceNot checked — no full text of the source

Past studies found that including attempted rape increased the size of the SA group by 65-79%.

“including attempted rape increased the size of the SA group by 65–79% (Fisher et al., 2000; Koss et al., 1987)”

• cites Fisher et al., 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Koss et al., 1987 sourceNot checked — no full text of the source

The effect of SA on psychopathology appears relatively durable over time.

“The effect of SA on psychopathology appears to be relatively durable over time.”

The results provide evidence that narrowing operational definitions in terms of acts and tactics included does not significantly obscure group differences.

“Thus, in spite of these limitations, our results provide evidence that narrowing operational definitions in terms of the acts and tactics included does not significantly obscure group differences.”

The findings on operational definitions reflect only the operational definition of SA, not the actual inclusion of assaults under broader definitions in the SA group.

“An important limitation of these findings is that they only reflect the operational definition of SA, and not the actual inclusion of assaults that fall under these broader operational definitions in the SA group.”

There is evidence that PTSD can be misdiagnosed as bipolar disorder.

“there is some evidence that PTSD can be misdiagnosed as bipolar disorder (Hernandez et al., 2013)”

• cites Hernandez et al., 2013 sourceNot checked — no full text of the source

The results suggest that SA has a stronger association with psychopathology than other forms of trauma.

“These results also suggest that SA has a stronger association with psychopathology than other forms of trauma, consistent with past work (Kelley et al., 2009; Kessler et al., 1995).”

• cites Kelley et al., 2009 sourceNot checked — no full text of the source
• cites Kessler et al., 1995 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: No-assault comparison groups are mostly composed of people who experienced some other form of trauma.

A meta-analysis failed to find differences in psychopathology between penetrative and nonpenetrative child sexual abuse.

“a meta-analysis failed to find differences in psychopathology between penetrative and nonpenetrative child sexual abuse (Paolucci & Genuis, 2001)”

• cites Paolucci & Genuis, 2001 sourceNot checked — no full text of the source

All types of psychopathology included in the analysis have been associated with elevated risk for suicidality.

“all types of psychopathology included in this analysis have been associated with elevated risk for suicidality (Harris & Barraclough, 1997; Panagioti et al., 2012; Preti et al., 2011)”

• cites Harris & Barraclough, 1997 sourceNot checked — no full text of the source
• cites Panagioti et al., 2012 sourceNot checked — no full text of the source
• cites Preti et al., 2011 sourceNot checked — no full text of the source

Emerging empirical evidence suggests that trauma may play a bigger role in the development of bipolar and obsessive-compulsive conditions than previously thought.

“emerging empirical evidence suggests that trauma may play a bigger role in their development than previously thought (Cromer, Schmidt, & Murphy, 2007; Etain et al., 2008).”

• cites Cromer, Schmidt, & Murphy, 2007 sourceNot checked — no full text of the source
• cites Etain et al., 2008 sourceNot checked — no full text of the source

The findings for bipolar and obsessive-compulsive conditions must be interpreted with caution because they are based on relatively few studies and have large confidence intervals.

“These results must be interpreted with caution, given the relatively small number of studies on which they were based coupled with their large confidence intervals”

Capturing only syndromal psychopathology is likely to underestimate group differences because trauma survivors may drop below diagnostic threshold but continue to evidence chronic distress.

“Because trauma survivors may drop below a diagnostic threshold as they recover but continue to evidence chronic distress, capturing only syndromal psychopathology is likely to underestimate group differences (Ozer et al., 2003).”

• cites Ozer et al., 2003 sourceNot checked — no full text of the source

The study cannot rule out biased reporting as an explanation for the effects.

“we are not able to rule out biased reporting as an explanation for effects.”

There is strong evidence that SA victimization is associated with increased risk for multiple forms of psychopathology across most populations, assault types, and methodological differences in studies.

“There is strong evidence that SA victimization is associated with increased risk for multiple forms of psychopathology across most populations, assault types, and methodological differences in studies.”

The approach did not violate assumptions of independence of observations because multiple effect sizes were drawn from many studies.

“our approach meant that we did not violate assumptions of independence of observations because we drew multiple effect sizes from many studies.”

The study did not assess survivor characteristics that could explain observed heterogeneity, including pre-trauma, peri-traumatic, and post-traumatic factors.

“we did not assess a number of characteristics of survivors that could explain observed heterogeneity, including pre-trauma factors (e.g., past history of victimization), peri-traumatic factors (e.g., peri-traumatic dissociation, perceptions of life threat), and post-traumatic factors (e.g., self-blame, social support).”

Using both continuous and categorical measures of psychopathology means the findings reflect both syndromal and subsyndromal psychopathology, providing a more accurate representation of the range of effects on survivors.

“because we used both continuous and categorical measures of psychopathology to calculate effect sizes, our findings reflect both syndromal and subsyndromal psychopathology, and thus provide a more accurate representation of the range of effects on survivors than a study including only categorical data.”

Causal inferences cannot be made because only cross-sectional data were coded.

“we are not able to make causal inferences because we coded cross-sectional data only”