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Cited by 28Posttraumatic Stress Disorder ResearchSexual Assault and Victimization StudiesChild Abuse and Trauma

Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape

Open access
Nöthling, Jani, Abrahams, Naeemah, Jewkes, Rachel, Mhlongo, Shibe, Lombard, Carl, Hemmings, Sian Megan Joanna, Seedat, Soraya·2022·Journal of Affective Disorders
DOI 10.1016/j.jad.2022.04.032
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Abstract

INTRODUCTION: The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design. METHODS: In a sample of 639 rape-exposed women who were assessed within 20 days of rape and over 6 months, baseline data were used to predict PTSD symptom severity scores up to 6 months post-rape. RESULTS: The incidence of PTSD at 3 months was 48.5% and the cumulative incidence at 6 months post-rape was 54.8%. Baseline experience of rape stigma (guilt, shame, self-blame, social devaluation and discredit) and depression were significant predictors of PTSD symptom scores over time, in mixed linear regression models. Higher levels of depression and rape stigma were associated with higher PTSD scores. Assault-related factors were not associated with PTSD scores. LIMITATIONS: We could not measure PTSD symptom trajectories in all rape survivors, some of who may be at greater risk for PTSD e.g. non-disclosing rape survivors, those who declined participation and those who were extremely distressed at the time of recruitment. CONCLUSION: Addressing internalised and externalised stigma and resultant mental health effects on women who present to rape clinics may reduce the long-term adverse effects of rape on mental health outcomes, such as PTSD. Rape survivors who present with high levels of depression soon after a rape should be carefully monitored and appropriately treated in order to reduce PTSD severity.

AI snapshot

Written from the paper’s full text.

TL;DR

In a South African longitudinal cohort of rape-exposed women, PTSD symptoms declined over 6 months but incidence remained high: 48.5% at 3 months and cumulative 54.8% at 6 months. Depression and rape stigma were the only significant baseline predictors of PTSD symptom severity over time; most demographic, trauma, resilience/social support, alcohol, and assault variables were not significant.

Key findings

  • PTSD symptom scores decreased from baseline (M = 68.1, SD = 24.7) to 3 months (M = 39.3, SD = 24.1) and 6 months (M = 31.7, SD = 22.6), with significant declines of 28.7 points from baseline to 3 months and 36.4 points from baseline to 6 months (p < .001).
  • PTSD incidence was 48.5% at 3 months using a DTS cut-off of 40; cumulative incidence at 6 months was 54.8%, with 19.5% retaining PTSD at both 3 and 6 months, 29% at 3 months only, and 6.3% first presenting at 6 months.
  • In the mixed model, rape stigma (β = 0.72, p < .001) and depression (β = 0.63, p < .001) were the only significant predictors of PTSD symptom scores over time; age, education, employment, relationship status, HIV status, childhood trauma, lifetime trauma, social support, resilience, perceived stress, and alcohol use were not significant.
  • Among assault variables, none were significantly associated with PTSD at any timepoint except number of men involved at 3 months (p = .032); single-perpetrator rape was associated with higher 3-month PTSD scores (M = 43.9, SD = 29.4) than multiple-perpetrator rape (M = 36.9, SD = 29.5).

Methods

  • Parent RICE study: 782 rape-exposed women recruited from four rape centres in Durban, South Africa; 639 completed baseline, 368 (57.6%) completed 3 months, 325 (50.9%) completed 6 months, and 274 (42.9%) completed all three visits. Participants were aged 16–40, presented within 20 days post-rape, and were excluded if they met PTSD criteria at baseline from other traumatic events (n = 143); assault variables were assessed in a subgroup of 168 women.
  • Measures included demographic questionnaire, MINI PTSD module, Childhood Trauma Questionnaire–Short Form, Life Events Checklist, Connor-Davidson Resilience Scale, Multidimensional Scale of Perceived Social Support, Perceived Stress Scale, Rape Stigma Scale, AUDIT-C, CES-D, and Davidson Trauma Scale; assault variables came from the Context of Rape Questionnaire.
  • Analysis used non-parametric univariate tests, multiple imputation (30 imputations) for missing DTS data, and a linear mixed regression model with random intercepts and slopes for time; post hoc models categorized continuous predictors into quartiles/categories, and sensitivity analyses used complete-case and inverse probability weighting. Assault variables were analyzed univariately only because they were available for a small subsample.

Limitations

  • Stated by the paper: all participants had disclosed rape by seeking help, so non-disclosing survivors could not be assessed; multiple imputation assumes missing at random and this cannot be certain at 3 and 6 months; fear of HIV was not considered; counselling and psychotropic/psychotherapeutic interventions were not included as covariates; assault variables were reported by only a small subsample; and the perceived stress measure showed poor reliability (Cronbach’s alpha = 0.53).
  • Evident from the text: attrition was substantial (only 42.9% completed all visits; 35.2% attended baseline only) and DTS severity scores were missing for 52.9% at baseline, 46.2% at 3 months, and 43.4% at 6 months, so bias may remain despite imputation.
  • Evident from the text: assault-variable findings were univariate and not corrected for multiple testing, and the counterintuitive single-perpetrator result should be interpreted cautiously; prior depression history was not taken into account, so the study cannot determine whether post-rape depression was caused by rape.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jad.2022.04.032

Cites

Statistics

Claims the paper makes

0 of 85 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    PTSD symptom severity decreased significantly by 28.7 points from baseline to 3 months post-rape (p < .001).

    “PTSD symptom severity decreased significantly by 28.7 points from baseline to 3 months post-rape (p < .001)and by 36.4 points from baseline to 6 months post-rape (p < .001).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).
  • Findingown data

    The incidence of PTSD at 3 months post-rape was 48.5% using a score of 40 or more on the DTS as indicative of the clinical threshold for PTSD.

    “The incidence of PTSD at 3 months post-rape was 48.5% (using a score of 40 or more on the DTS as indicative of the clinical threshold for PTSD).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).
  • Findingown data

    PTSD symptom scores decreased from baseline (M=68.1, SD=24.7) to 3 months (M=39.3, SD=24.1) and 6 months (M=31.7, SD=22.6).

    “Different timepoint means (M) for PTSD symptom scores and standard deviations (SD) were as follows: baseline (M = 68.1,SD = 24.7), 3 months (M = 39.3,SD = 24.1)and 6 months (M = 31.7,SD = 22.6).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).
  • Findingown data

    The shared variance between the predictor variables significantly explained PTSD symptom severity over time F(16, 5020) = 42.2, p < .000.

    “The shared variance between the predictor variables significantly explained PTSD symptom severity over time F(16, 5020) = 42.2,p < .000.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).
  • Findingown data

    Participants with baseline depression scores falling in the 3rd (β = -19.01, p < .000) and 4th (β = -22.08, p < .000) quartile also had significantly increased PTSD symptom severity scores at 6 months post-rape compared to those falling in the 1st quartile.

    “Participants with baseline depression scores falling in the 3rd (β = -19.01,p < .000)and 4th (β = -22.08,p < .000)quartile also had significantly increased PTSD symptom severity scores at 6 months post-rape compared to those falling in the 1st quartile.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).
  • Classified as probably not a substantial claim. 15
  • May combine two claims. 23

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    At baseline, the majority of participants were married or in a relationship (80.8%), 57.6% completed secondary school, 78.4% were unemployed and 46.5% were HIV positive.

    “At baseline, the mean age of participants was 24.7 years (range 16-40), the majority of participants were married or in a relationship (80.8%), 57.6% completed secondary school (12 years of basic education), 78.4% were unemployed and 46.5% were HIV positive.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of those with PTSD at 3 months post-rape, 19.5% retained their PTSD status at 6 months post-rape and 29% lost their status.

    “Of those with PTSD at 3 months post-rape, 19.5% retained their PTSD status at 6 months post-rape and 29% lost their status.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).

  • May combine two claims.

    Findingown data

    PTSD symptom scores at one or more timepoint/s were associated with employment, HIV status, childhood trauma, lifetime trauma, social support, perceived stress, rape stigma, alcohol use and depression.

    “PTSD symptom scores at one or more timepoint/s were associated with employment, HIV status, childhood trauma (neglect, domestic violence, emotional abuse, physical abuse and sexual abuse), lifetime trauma (civil unrest/war, serious injury, being close to death, murder of a family member or friend and murder of a stranger), social support, perceived stress, rape stigma, alcohol use and depression.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).

  • May combine two claims.

    Findingown data

    The cumulative incidence of PTSD at 6 months post-rape was 54.8%, with 6.3% of women presenting with PTSD for the first time at this timepoint.

    “The cumulative incidence (total number of participants scoring above the cut-off at 3 months and/or 6 months) at 6 months post-rape was 54.8% with 6.3% of women presenting with PTSD for the first time at this timepoint.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At baseline, the mean age of participants was 24.7 years (range 16-40).

    “At baseline, the mean age of participants was 24.7 years (range 16-40), the majority of participants were married or in a relationship (80.8%), 57.6% completed secondary school (12 years of basic education), 78.4% were unemployed and 46.5% were HIV positive.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Baseline age, education, employment, relationship status, HIV status, childhood trauma, lifetime trauma, social support, resilience, perceived stress and alcohol use were not significant predictors of PTSD symptom scores over time.

    “Baseline age, education, employment, relationship status, HIV status, childhood trauma, lifetime trauma, social support, resilience, perceived stress and alcohol use were not significant predictors of PTSD symptom scores over time.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).

  • May combine two claims.

    Findingown data

    Depression and rape-stigma had a significant adverse impact on the PTSD recovery trajectory following rape.

    “In conclusion, we found that depression and rape-stigma had a significant adverse impact on the PTSD recovery trajectory following rape.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The multiple imputation model used in the analysis to replace missing values assumes that data is missing at random.

  • May combine two claims.

    Findingown data

    None of the assault variables were significantly associated with PTSD symptom scores at any timepoint, with the exception of the number of men involved in the rape incident which was associated with PTSD symptom scores at 3 months post-rape (p = .032).

    “None of the assault variables were significantly associated with PTSD symptom scores at any timepoint, with the exception of the number of men involved in the rape incident which was associated with PTSD symptom scores at 3 months post-rape (p = .032).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Rape stigma (β = 0.72, p < .001) and depression (β = 0.63, p < .001) were the only significant predictors of PTSD symptom scores in the model, with depression being the strongest predictor.

    “Rape stigma (β = 0.72, p < .001)and depression (β = 0.63, p < .001)were the only significant predictors of PTSD symptom scores in this model.”
    • Also stated in: § 4. Discussion · plain
      “Depression and rape stigma post-assault were the only significant predictors of PTSD, with depression being the strongest predictor.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing values in the study were missing at random (MAR).

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Women are more likely to be victims of sexual assault/rape and they have a higher relative risk for PTSD than men.

    “Women are more likely to be victims of sexual assault/rape and they have a higher relative risk for PTSD than men (Campbell et al., 2011;Elklit and Christiansen, 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Campbell et al., 2011 source

      Not checked in the free run.

    • cites Elklit and Christiansen, 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Depression and alcohol use are associated with an increased risk for sexual assault exposure.

    “Depression and alcohol use is associated with an increased risk for sexual assault exposure (Breslau et al., 2000;Resnick et al., 2013;Resnick et al., 2012;Simpson and Miller, 2002;Logan et al., 2002)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Breslau et al., 2000 source

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    • cites Resnick et al., 2013 source

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    • cites Resnick et al., 2012 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The aggregated lifetime PTSD prevalence rate in survivors of sexual assault is 36.2%.

    “A recent review and meta-analysis reported an aggregated lifetime PTSD prevalence rate of 36.2% in survivors of sexual assault (Dworkin, 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dworkin, 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One study reported a cumulative incidence rate of 38.6% at 6 months post-rape.

    “Few studies have investigated rape and/or sexual assault beyond 3 months, but one study reported a cumulative incidence rate of 38.6% at 6 months post-rape (Möller et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Möller et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Women living with HIV are more likely to be victims of sexual violence and are at higher risk for developing PTSD.

    “Women living with HIV are also more likely to be victims of sexual violence and are at higher risk for developing PTSD (Machtinger et al., 2012;Koegler and Kennedy, 2018).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Machtinger et al., 2012 source

      Not checked in the free run.

    • cites Koegler and Kennedy, 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prospective studies have reported PTSD prevalence rates of between 12.7% and 45% at 3 months post-rape/sexual assault in women.

    “Prospective studies have reported PTSD prevalence rates of between 12.7% and 45% at 3 months post-rape/sexual assault in women (Elklit and Christiansen, 2010;Nickerson et al., 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Elklit and Christiansen, 2010

      Not checked in the free run.

    • cites Nickerson et al., 2013 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rape stigma is a barrier to social support, which is considered a protective factor against the development of PTSD.

    “Rape stigma is also a barrier to social support which is considered a protective factor against the development of PTSD (Bryant-Davis et al., 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bryant-Davis et al., 2011 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Depression, perceived stress and problematic alcohol use are highly comorbid with PTSD and prevalent following rape.

    “Depression, perceived stress and problematic alcohol use are highly comorbid with PTSD and prevalent following rape (Möller et al., 2014;Mgoqi-Mbalo et al., 2017;Bryant-Davis et al., 2010;Breslau et al., 2000;Resnick et al., 2013;Resnick et al., 2012;Testa et al., 2007;Kaysen et al., 2006;Kilpatrick et al., 2003).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Möller et al., 2014

      Not checked in the free run.

    • cites Mgoqi-Mbalo et al., 2017 source

      Not checked in the free run.

    • cites Bryant-Davis et al., 2010 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The assault-related variables were investigated using univariate analyses only, and findings were not corrected for multiple testing.

    “the assault-related variables were investigated using univariate analyses only and findings were not corrected for multiple testing”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Factors contributing to non-disclosure may be associated with PTSD symptom severity and may have introduced bias.

    “Factors contributing to non-disclosure (e.g.emotionally unable to disclose, ongoing legal case) may be associated with PTSD symptom severity and may have introduced bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Inconsistent findings have been reported for rape and sexual assault survivors regarding childhood trauma and cumulative lifetime trauma as predictors of PTSD, with some support for the non-significant multivariate findings in our study.

    “but inconsistent findings have been reported for rape and sexual assault survivors, with some support for the non-significant multivariate findings in our study (Elklit and Christiansen, 2013;Möller et al., 2014;Mgoqi-Mbalo et al., 2017;Ullman et al., 2007;Bryant-Davis et al., 2010;Nishith et al., 2000).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Elklit and Christiansen, 2013

      Not checked in the free run.

    • cites Möller et al., 2014

      Not checked in the free run.

    • cites Mgoqi-Mbalo et al., 2017 source

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  • May combine two claims.

    Premisecitation

    Rape compared to non-penetrative sexual assault may have further exacerbated emotional distress especially if it was accompanied by physical violence or threats of violence.

    “Rape compared to non-penetrative sexual assault may have further exacerbated emotional distress especially if it was accompanied by physical violence or threats of violence (Möller et al., 2014;Ullman et al., 2007;Ullman and Filipas, 2001;Kaysen et al., 2010).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Möller et al., 2014

      Not checked in the free run.

    • cites Ullman et al., 2007 source

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    • cites Ullman and Filipas, 2001

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  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Identifying risk factors present before trauma exposure and manifesting soon after a traumatic event could potentially guide early interventions and reduce the number of PTSD cases resulting from rape and sexual violence.

    “Identifying risk factors present before trauma exposure and manifesting soon after a traumatic event could potentially guide early interventions and reduce the number of PTSD cases resulting from rape and sexual violence (Campbell et al., 2011;Möller et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Campbell et al., 2011 source

      Not checked in the free run.

    • cites Möller et al., 2014

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Decreased social support and increased self-blaming is likely to hinder treatment seeking and long-term recovery.

    “Decreased social support and increased self-blaming is also likely to hinder treatment seeking and long-term recovery (Elklit and Christiansen, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Elklit and Christiansen, 2013

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    A complete case and IPW analysis yielded similar findings to the multiple imputed data analysis, although the effect of rape stigma was less pronounced.

    “A complete case and IPW analysis yielded similar findings to the multiple imputed data analysis, although the effect of rape stigma was less pronounced.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some studies have found significant relationships between PTSD and multiple perpetrators, multiple sexual acts, physical injury during rape, longer assault duration, and perceived life threat, while other studies have not.

    “Some studies have found a significant relationship between PTSD and multiple perpetrators (Möller et al., 2014), multiple sexual acts (Möller et al., 2014), physical injury inflicted during the rape (Möller et al., 2014;Ullman and Filipas, 2001) longer duration of assault (Kaysen et al., 2010) and perceived life threat (Ullman et al., 2007;Ullman and Filipas, 2001;Kaysen et al., 2010) while other”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Möller et al., 2014

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    • cites Ullman and Filipas, 2001

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    • cites Kaysen et al., 2010 source

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  • May combine two claims.

    Study design and conductown data

    All women in the study were exposed to a homogenous trauma (rape), in contrast to most previous longitudinal studies that grouped sexual assault, rape, and attempted rape together.

    “Second, all women in this study were exposed to a homogenous trauma (i.e.rape), in contrast to most previous longitudinal studies that have grouped sexual assault, rape and attempted rape together.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    The study was adequately powered to investigate a variety of risk and protective factors previously documented to be associated with PTSD in mixed trauma samples.

    “Third, the study was adequately powered to investigate a variety of risk and protective factors that have previously been documented to be associated with PTSD in mixed trauma samples.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    A mixed linear regression model was used, which allowed consideration of individual symptom trajectories over time.

    “We also used a mixed linear regression model which allowed us to consider individual symptom trajectories over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Counselling could not be included as a predictor of PTSD scores in the multivariate analyses because this information was not available for those lost to follow-up.

    “We could not include counselling as a predictor of PTSD scores in the multivariate analyses since we did not have this information for those who were lost to follow-up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The study highlights the need for long-term mental health care post-rape.

    “The study highlights the need for long term mental health care post-rape.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Guided self-help interventions that include psychoeducation, stress management, and addressing stigma around rape could be delivered by lay facilitators or trained counsellors attending to those reporting a rape.

    “Guided self-help interventions that include psychoeducation, stress management and addressing stigma around rape, could be delivered by lay facilitators or trained counsellors attending to those reporting a rape (Tol et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Tol et al., 2020 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Participants with missing data were not excluded; missing values were imputed using a multiple imputation model, which limits bias caused by drop-out and other associated factors.

    “Finally, we did not exclude participants with missing data but imputed missing values using a multiple imputation model which limits bias caused by drop-out and other associated factors.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The multiple imputation model used in the analysis to replace missing values assumes that data is missing at random.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Targeted early interventions are especially important in low- and middle-income countries characterised by limited resources and overburdened mental health care facilities, because treatment of severe psychopathology is more resource intensive with higher costs and burden for the healthcare system.

    “Targeted early interventions are especially important in low-and middle-income countries characterised by limited resources and overburdened mental health care facilities since treatment of severe psychopathology is more resource intensive (e.g.longer duration of treatment, medical interventions, hospitalisation, management of comorbid disorders) with higher costs and burden for the healthcare”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kearns et al., 2012 source

      Not checked in the free run.

    • cites Tol et al., 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Some participants received counselling at the rape crisis centres at which they presented and/or at the study site.

    “Some participants received counselling at the rape crisis centres at which they presented and/or at the study site.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Fear of contracting HIV may have contributed to emotional distress, but this was not considered in the analyses.

    “Fear of contracting HIV may have contributed to emotional distress, but this was not considered in the analyses.”
    Quote in the paperNot a substantial claim
35 of 35

  • The authors state this as an assumption.

    Missing values in the study were missing at random (MAR).

    “Missing values were treated as missing at random (MAR) and imputation”

  • The authors state this as an assumption.

    The multiple imputation model used in the analysis to replace missing values assumes that data is missing at random.

    “The multiple imputation model used in the analysis to replace missing values assumes that data is missing at random.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(16, 5020) = 42.2reported p < 0 · recomputed p < .001

    “F(16, 5020) = 42.2,p < .000”

    The paper rounds a very small p to zero

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • PTSD persistence percentage uses the wrong denominator

    Major

    The 19.5% who had PTSD at both follow-ups is a percentage of the full sample, not of those with PTSD at 3 months. Among the 48.5% with PTSD at 3 months, approximately 40.2% retained that status.

    Reported 19.5 · recomputed 40.206186

  • Incorrect percentage of missing 3-month severity scores

    Minor

    There were 368 participants at the 3-month visit, so 127 missing severity scores represent 34.5%, not 46.2%.

    Reported 46.2 · recomputed 34.51087

  • Follow-up attendance categories do not match visit totals

    Minor

    The reported 368 and 325 follow-up visits, including 274 participants who attended both, imply 145 participants attended exactly one follow-up and 220 attended neither. The paper instead reports 140 and 225, respectively.

  • Social-support category percentage is too high

    Minor

    The 332 participants in this category are 52.0% of the baseline sample of 639, not 52.9%.

    Reported 52.9 · recomputed 51.956182

  • Hazardous-alcohol group mean is below its stated cutoff

    Minor

    Table 2 gives the hazardous-consumption group a mean score of 2.0, although the measure defines hazardous use as a score of at least 3. Its mean also falls outside the row's stated range of 3-12.

  • Lifetime-trauma range excludes participants reporting none

    Minor

    Table 2 gives the number of lifetime traumas a minimum of 1, but the same table lists 119 participants with no lifetime trauma.

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References 65 · Cited by 28

Authors
Nöthling, J., Abrahams, N., Jewkes, R., Mhlongo, S., Lombard, C., Hemmings, S. M. J., & Seedat, S.
Affiliations
South African Medical Research Council (ZA)
Corresponding author
Nöthling, Jani
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2022-07
Volume
309
Pages
151-164
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2022.04.032
OpenAlex
W4223602932
Semantic Scholar
7da3d31924fb1f3ab49e8365c9c8722adfd09518
Cited by
28
References
65
Citations by year
2026: 3 · 2025: 10 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 1
FWCI
5.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • SUNScholar (Stellenbosch University) (submittedVersion)
Funders
  • National Research Foundation
  • Department of Science and Technology, Ministry of Science and Technology, India
  • Universiteit Stellenbosch
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
post-traumatic stress disorder, rape victims, sexual assault, depression, risk factors, protective factors, PTSD symptom trajectories, women's mental health, guilt and shame, social devaluation
MeSH terms
Female, Humans, Prospective Studies, Rape, Stress Disorders, Post-Traumatic, Survivors, Protective Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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