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

In the paper

“Some studies use the Sexual Experiences Survey (Koss et al., 2007), which includes a variety of types of SA (e.g., coerced, incapacitated, and forced; attempted and completed; fondling and penetrative SA) and, given its specificity, is considered to be a gold standard self-report measure for assessing SA victimization.”

What the sources say

• Partly supported

  The Appendix A victimization survey covers fondling, penetration and attempted penetration, with tactics including verbal coercion, incapacitation and force. The “Strengths and Weaknesses Identified” section says the SES is widely used and behaviorally specific, but the paper does not call it a gold standard; it also cautions that treating existing versions as a standardized measure is becoming less justifiable. Page numbers are unavailable in our copy. (LLM, conf=0.86)

  cites Koss et al., 2007 sourceExperimental — accuracy not yet measured

In the paper

“These other disorders are thought to be associated with or exacerbated by a trauma, but are not dependent on an experience of trauma in most cases (Friedman, Resick, Bryant, & Brewin., 2011).”

What the sources say

• Supported

  In “The A1 (Stressor) Criterion” (page not specified), the paper says depression, other anxiety disorders, and substance use disorder may follow traumatic exposure. It contrasts PTSD’s required trauma criterion with affective and other anxiety disorders that are diagnosed on symptoms alone, supporting the distinction in the citing sentence. (LLM, conf=0.84)

  cites Friedman, Resick, Bryant, & Brewin., 2011 source

In the paper

“Thirteen effects were identified as outliers, which is in the expected range for a meta-analysis of this size (Viechtbauer & Cheung, 2010). Comparing these outliers to nonoutliers on study characteristics (e.g., country of data collection) using bivariate analyses revealed no significant differences.”

What the sources say

• ?Could not verify

  Semantic Scholar returned no full-text snippets for either query in Viechtbauer and Cheung’s “Outlier and influence diagnostics for meta-analysis,” so the reported count and study-characteristic comparison cannot be checked there. The closest unscoped result, “Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care,” scores 0.514 but reports 22 outlying participants, not thirteen outlying effects. It is a different topic and does not establish an alternative source for the claim. (LLM, conf=0.73)

  cites Viechtbauer & Cheung, 2010 sourceExperimental — accuracy not yet measured

In the paper

“Using Egger’s regression test for funnel plot asymmetry in a model with standard error as a predictor (Egger, Davey Smith, Schneider, & Minder, 1997), we found that this asymmetry was not statistically significant, z = 1.69, p = 0.09. Thus, there is no evidence for publication bias based on the funnel plot.”

What the sources say

• ?Could not verify

  Egger et al. (1997), “Bias in meta-analysis detected by a simple, graphical test,” is the source of the test, but the paper-scoped searches returned no snippets supporting the reported z = 1.69 and p = .09 result. The strongest unscoped matches describe results from other meta-analyses with different statistics; for example, “Risky decision-making in major depressive disorder” reports z = 1.17 and p = .241 (score 0.877). These matches do not establish which study produced the claimed result, so misattribution cannot be determined confidently. (LLM, conf=0.70)

  cites Egger, Davey Smith, Schneider, & Minder, 1997 sourceExperimental — accuracy not yet measured

In the paper

“All effect sizes were in the moderate range (Cohen, 1988), except for disordered eating and substance abuse/dependence, which were in the small range.”

What the sources say

• ?Could not verify

  Cohen’s 1988 book, *Origins and Evolution of the Arab-Zionist Conflict*, is not indexed in Semantic Scholar, so its text could not be checked. Its subject is unrelated to effect sizes for disordered eating and substance abuse/dependence, making the attribution doubtful. Unscoped searches found mental-health papers with only partial, low-scoring matches (highest score 0.553), not the stated result; there is no verified alternative source. (LLM, conf=0.70)

  cites Cohen, 1988 sourceExperimental — accuracy not yet measured

In the paper

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

In the paper

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

In the paper

“For most effects, the measure was previously published (88% of effects) and included multiple items (91% of effects), but fewer were administered via interview (47% of effects) or were explicitly stated to be based on and/or validated against DSM criteria (53% of effects).”

In the paper

“Again, effect sizes did not differ as a function of sample gender, β = −0.02, SE = .06, p = .30.”

In the paper

“Most studies were conducted in the US (77%) and were published journal articles (76%) or dissertations/theses (20%)”

In the paper

“In contrast, the following effects were not significantly different than trauma and stressor-related conditions: obsessive-compulsive conditions, Δg = 0.00, SE = 0.12, p = .98, suicidality, Δg = −0.03, SE = 0.05, p = .54, and bipolar conditions, Δg = −0.06, SE = 0.11, p = .60.”

In the paper

“In this unconditional model, the heterogeneity within studies (due to differences in domains/measures of psychopathology) was τ22 = 0.04 (SE = 0), and the heterogeneity between studies (controlling for differences in domains/measures of psychopathology), or was τ23 = 0.06 (SE = 0.01). Both were significant at p < .001”

In the paper

“In this sample of studies, most operationalized SA narrowly—28% included attempted SA, 44% included fondling/nonpenetrative SA, 34% included coerced SA, and 37% included incapacitated SA.”

In the paper

“Average effects were largest for suicidality, g = 0.74, SE = 0.05, k = 38, m = 26, and smallest for substance abuse/dependence, g = 0.37, SE = 0.04, k = 59, m = 33. All domain-level average effect sizes were significantly different from zero (p < .001).”

In the paper

“SA assessment quality varied across effects. Most included multiple items (68% of effects), described at least one sex act behaviorally (70% of effects), and specified at least one tactic through which the sex act occurred (68% of effects), but fewer were previously published (46% of effects). Mean percent quality was 0.68 (SD = 0.35).”

In the paper

“In our sample, depression was the most common domain studied, k = 129, m = 102, followed by trauma and stressor-related conditions, k = 121, m = 103. The most infrequently-studied domain was bipolar conditions, k = 6, m = 4.”

In the paper

“Eighteen effects were missing from the right side of the funnel and no effects were missing from the left side. Including the 18 imputed missing values, the summary effect was 0.63 (SE = 0.03), as compared to a summary effect of 0.56 (SE = 0.03) without these effects using a fixed-effects meta-analysis using the randomly selected published data.”

What the sources say

• ?Not matched

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

  cites Duval & Tweedie, 2000a, 2000b

In the paper

“On average, 24% of assaults involved a stranger perpetrator (SD = 23%, range: 0–90%, k = 90, m = 33), 26% involved physical injury (SD = 13%, range: 11–49%, k = 30, m = 8), and 21% involved the use of a weapon (SD = 23%, range: 2–66%, k = 27, m = 11).”

In the paper

“Most studies (81%) used comparison groups that had not experienced SA (i.e., no-assault groups), fewer (17%) used comparison groups that had experienced another form of trauma (i.e., other-trauma groups), and very few (1%) used comparison groups that were selected for their lack of trauma experience (i.e., no/low-trauma groups).”

In the paper

“The full dataset included k = 497 estimates of effect from 204 sources and m = 195 studies (i.e., independent samples).”

• Also stated in: § Sample · plain

  “Aggregating sample sizes across studies (using the minimum N used to calculate effect sizes in a given study), this meta-analysis represents N = 238,623 individuals (study range: 27 to 32,075).”

In the paper

“Compared to effects representing trauma and stressor-related conditions, g = 0.71, SE = 0.03, effect sizes were significantly smaller for depression, Δg = −0.11, SE = 0.03, p < .001, anxiety, Δg = −0.19, SE = 0.03, p < .001, disordered eating, Δg = −0.33, SE = 0.07, p < .001, and substance abuse/dependence, Δg = −0.35, SE = 0.04, p < .001.”

In the paper

“In all, we sent 124 requests for additional data, 48 (38.71%) of which yielded usable data, with a total of 108 effects coded from these requests.”

In the paper

“SA also appears to be associated with substantially increased risk for bipolar conditions and obsessive-compulsive conditions.”

In the paper

“No other differences were observed.”

In the paper

“An earlier meta-analysis on psychological distress related to interpersonal violence found no difference between SA and other interpersonal trauma types in terms of their level of distress (Weaver & Clum, 1995), but did not compare SA to non-interpersonal traumas.”

What the sources say

• ?Not checked — no full text of the sourcecites Weaver & Clum, 1995 source

In the paper

“There is evidence that survivors internalize this stigma, leading to self-blame, shame, and unwillingness to seek help (Kennedy & Prock, 2016).”

What the sources say

• ?Not matched

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

  cites Kennedy & Prock, 2016

In the paper

“In contrast, one meta-analysis suggested that the association between interpersonal violence and PTSD is not stronger for women than men (Tolin & Foa, 2006)”

What the sources say

• ?Not checked — no full text of the sourcecites Tolin & Foa, 2006 source

In the paper

“In addition, survivors who choose to disclose their assault to friends, relatives, and professionals often experience negative social reactions, such as victim blame, that have been found to increase risk for PTSD in longitudinal research (Ullman & Peter-Hagene, 2014).”

What the sources say

• ?Not matched

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

  cites Ullman & Peter-Hagene, 2014

In the paper

“In a past qualitative review of the relationship of these SA assault characteristics to psychopathology, only physical injury was associated with psychopathology (Campbell et al., 2009).”

What the sources say

• ?Not checked — no full text of the sourcecites Campbell et al., 2009 source

In the paper

“Indeed, in the DSM-5, PTSD was moved out of the anxiety disorders into a new diagnostic category, called “trauma and stressor-related disorders” (APA, 2013).”

What the sources say

• ?Not matched

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

  cites APA, 2013

In the paper

“From this work, it is clear that SA remains a highly stigmatized experience (Kennedy & Prock, 2016)”

What the sources say

• ?Not matched

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

  cites Kennedy & Prock, 2016

In the paper

“This may be because injury increases perceived life threat, which a past meta-analysis has found to predict PTSD across types of trauma (Ozer, Best, Lipsey, & Weiss, 2003).”

What the sources say

• ?Not checked — no full text of the sourcecites Ozer, Best, Lipsey, & Weiss, 2003 source

In the paper

“A qualitative review of associations between SA specifically and multiple forms of trauma identified mixed findings regarding the importance of current age in post-SA psychopathology: most studies identified no relationship between age and distress, and several identified either positive or negative associations between age and specific forms of psychopathology (Campbell et al., 2009).”

What the sources say

• ?Not checked — no full text of the sourcecites Campbell et al., 2009 source

In the paper

“and a review of the impact of intimate partner violence on psychopathology found that rates of depression decline over time (Golding, 1999).”

What the sources say

• ?Not checked — no full text of the sourcecites Golding, 1999 source

In the paper

“Because SA is thought to have a stronger relationship with psychopathology than other interpersonal forms of trauma (Kessler et al., 1995)”

What the sources say

• ?Not checked — no full text of the sourcecites Kessler et al., 1995 source

In the paper

“Although a past meta-analysis on the relationship between interpersonal violence and distress did not find evidence that indicators of validity were associated with the magnitude of observed effects (Weaver & Clum, 1995)”

What the sources say

• ?Not checked — no full text of the sourcecites Weaver & Clum, 1995 source

In the paper

“Indeed, an ongoing debate over the appropriate operational definition of SA (Cook, Gidycz, Koss, & Murphy, 2011; Koss, 2011) has centered on concerns that broad definitions of SA may obscure its connection with psychopathology.”

What the sources say

• ?Not checked — no full text of the sourcecites Cook, Gidycz, Koss, & Murphy, 2011 source
• ?Not checked — no full text of the sourcecites Koss, 2011 source

In the paper

“This focus on PTSD is based in a theoretical understanding of PTSD as a unique phenotype arising from trauma that is conceptually different from other disorders that often are seen in trauma survivors (e.g., depression, anxiety disorders) in that its etiology necessarily involves an external trauma event (APA, 2013).”

What the sources say

• ?Not matched

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

  cites APA, 2013

In the paper

“we used a multilevel structural equation modeling procedure using the metaSEM package (Cheung, 2012) in R 3.3.1 (R Development Core Team, 2008) to account for nonindependence of effect sizes.”

What the sources say

• ?Not matched

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

  cites Cheung, 2012
• ?Not matched

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

  cites R Development Core Team, 2008

In the paper

“However, because many studies assessed SA across the lifespan (i.e., combined child and adolescent/adult), we coded lifetime effects when no separate data for adolescent/adult SA was available to ensure that the population of studies was not overly restricted, consistent with a similar meta-analysis (Brewin et al., 2000).”

What the sources say

• ?Not checked — no full text of the sourcecites Brewin et al., 2000 source

In the paper

“which makes it particularly important to attempt to minimize publication bias in meta-analyses (Lipsey & Wilson, 2001).”

What the sources say

• ?Not matched

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

  cites Lipsey & Wilson, 2001

In the paper

“The file drawer effect is a perennial problem in the academic literature (Rosenthal, 1979)”

What the sources say

• ?Not checked — no full text of the sourcecites Rosenthal, 1979 source

In the paper

“For example, studies that compared people who had experienced military SA to those who had not were likely to have included survivors of non-military SA in the no-SA group, and were excluded.”

In the paper

“A comparison group was needed to compute an effect size representing risk for psychopathology associated with experiencing SA; comparisons between people who experienced SA were outside of the scope of the analysis.”

In the paper

“Every effect was coded by at least two coders (i.e., a primary and secondary coder), but review by three coders was common, and the first author reviewed every effect.”

In the paper

“Effects with studentized deleted residuals ≥ 2 were considered to be outliers (Viechtbauer & Cheung, 2010). Following Gnambs (2013), these outliers were truncated to the upper bound of the 95% confidence interval of the true effect for the applicable domain of psychopathology”

What the sources say

• ?Not checked — no full text of the sourcecites Viechtbauer & Cheung, 2010 source
• ?Not checked — no full text of the sourcecites Gnambs (2013) source

In the paper

“The variable “operational definition includes both forced and coerced SA or forced SA only” had substantial agreement (κ = 0.77 for first vs. second author and κ = 0.77 for first vs. third author)”

In the paper

“We excluded these studies to avoid clinical selection bias (du Fort, Newman, & Bland, 1993), consistent with meta-analyses on related topics (Brewin et al., 2000; Tolin & Foa, 2006).”

What the sources say

• ?Not checked — no full text of the sourcecites du Fort, Newman, & Bland, 1993 source
• ?Not checked — no full text of the sourcecites Brewin et al., 2000 source
• ?Not checked — no full text of the sourcecites Tolin & Foa, 2006 source

In the paper

“These results suggest that SA is associated with all domains of psychopathology studied, and is more strongly related to suicidality and trauma and stressor-related conditions (and, tentatively, obsessive-compulsive and bipolar conditions) than depression, anxiety, disordered eating, and substance abuse/dependence.”

In the paper

“We excluded effects that were based on chart diagnoses or self-reports of past diagnoses made by a clinician, as these captured help-seeking behavior for mental health rather than the existence of the condition itself.”

In the paper

“we recorded this information to ensure that we retained only one effect for each form of psychopathology per sample and assigned a shared identification number across effects representing different forms of psychopathology from a single sample.”

In the paper

“Given the large number of results obtained and the targeted efforts to obtain relevant studies described next, these search terms and databases were deemed sufficiently comprehensive.”

In the paper

“Importantly, though, the effects for obsessive-compulsive conditions and bipolar conditions were based on a small number of studies and effects and had large confidence intervals.”

In the paper

“past reviews suggest that the impact of interpersonal violence broadly on distress appears to decrease over time (Weaver & Clum, 1995), as does the impact of intimate partner violence on depression (Golding, 1999).”

What the sources say

• ?Not checked — no full text of the sourcecites Weaver & Clum, 1995 source
• ?Not checked — no full text of the sourcecites Golding, 1999 source

In the paper

“results suggest that symptoms decrease rapidly over the first month post-SA for survivors who do not ultimately develop PTSD, but are relatively durable over time for survivors with PTSD (Rothbaum et al., 1992).”

What the sources say

• ?Not checked — no full text of the sourcecites Rothbaum et al., 1992 source

In the paper

“Of the disorders assessed in this analysis, suicidality is explicitly included as part of the diagnostic criteria in DSM-5 for depression only, which evidenced a significantly smaller effect size relative to suicidality (APA, 2013).”

What the sources say

• ?Not matched

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

  cites APA, 2013

In the paper

“the broader field of developmental psychopathology has moved away from diathesis-stress models towards gene-by-environment interplay models, in which environments have an interactive, rather than an additive effect on psychopathology (Kendler et al., 1997; Kendler et al., 2003).”

What the sources say

• ?Not checked — no full text of the sourcecites Kendler et al., 1997 source
• ?Not checked — no full text of the sourcecites Kendler et al., 2003 source

In the paper

“A meta-analysis identified gender differences in the impact of interpersonal violence on distress (Weaver & Clum, 1995), but this previous analysis’s study population lacked representation from men and contained no men-only samples, which could have underestimated the impact of SA on men.”

What the sources say

• ?Not checked — no full text of the sourcecites Weaver & Clum, 1995 source

In the paper

“social support has been identified as a correlate of PTSD (Brewin et al., 2000; Ozer et al., 2003).”

What the sources say

• ?Not checked — no full text of the sourcecites Brewin et al., 2000 source
• ?Not checked — no full text of the sourcecites Ozer et al., 2003 source

In the paper

“Because people who have experienced SA are particularly likely to have also experienced past traumas, like CSA, distress from these multiple traumatic experiences may be cumulative (Arata, 1999).”

What the sources say

• ?Not checked — no full text of the sourcecites Arata, 1999 source

In the paper

“Although these conditions are typically thought to be highly genetically-based (Etain et al., 2008; Hettema, Neale, & Kendler, 2001)”

What the sources say

• ?Not checked — no full text of the sourcecites Etain et al., 2008 source
• ?Not checked — no full text of the sourcecites Hettema, Neale, & Kendler, 2001 source

In the paper

“Although prior meta-analyses found that age at trauma exposure was associated with PTSD (Brewin et al., 2000; Ozer et al., 2003)”

What the sources say

• ?Not checked — no full text of the sourcecites Brewin et al., 2000 source
• ?Not checked — no full text of the sourcecites Ozer et al., 2003 source

In the paper

“although having a past trauma generally increased the risk for PTSD in a different meta-analysis, this effect was strongest when the current trauma was interpersonal violence (Ozer et al., 2003).”

What the sources say

• ?Not checked — no full text of the sourcecites Ozer et al., 2003 source

In the paper

“adult SA was one of the only traumas that did not appear to have a higher frequency or severity of PTSD in women as compared to men”

What the sources say

• ?Not checked — no full text of the sourcecites Tolin & Foa, 2006 source

In the paper

“This indicates that broadening operational definitions to include attempted SA may reduce effect sizes somewhat, but they are not lowered to the point of inconsequentiality.”

In the paper

“While a past meta-analysis on the relationship between interpersonal violence and distress did not find evidence that indicators of validity were associated with effects, this prior analysis was not limited to diagnostic constructs (Weaver & Clum, 1995).”

What the sources say

• ?Not checked — no full text of the sourcecites Weaver & Clum, 1995 source

In the paper

“It is also unclear whether the study-level moderators (e.g., percent of women in the sample, percent of assaults involving weapons) tested would evidence similar effects in relation to psychopathology when directly comparing survivors with these characteristics.”

In the paper

“A limitation of this body of work identified through this review is the use of single-item, unpublished assessments of SA without behaviorally-based descriptions, which fail to capture a large minority of SA survivors (Cook et al., 2011) and appear to overestimate effects.”

What the sources say

• ?Not checked — no full text of the sourcecites Cook et al., 2011 source

In the paper

“People are more likely to remember events that match their mood at the time of recall (Bower, 1981)”

What the sources say

• ?Not checked — no full text of the sourcecites Bower, 1981 source

In the paper

“Such a meta-analysis should include studies without comparison groups, which the current study did not (302 studies were excluded for this reason).”

In the paper

“our sophisticated analytic strategy involving attention to publication bias and dependency in effects increases our confidence in the study findings.”

In the paper

“our exhaustive study retrieval strategy led to the identification of a large number of effects, many of which were unpublished, which minimizes publication bias while also increasing confidence in effects.”

In the paper

“we did not assess every outcome of SA. Several forms of psychopathology (e.g., personality disorders), externalizing behaviors (e.g., substance use), and problems in living (e.g., health problems), as well as co-occurring problems within and across these domains, were not within the scope of this analysis”