Depressive symptoms after a sexual assault among women: understanding victim-perpetrator relationships and the role of social perceptions

Abstract

Objective: Although mental health impact of gender based violence has been documented for many decades, the impact of the socio-cultural dimensions and type of perpetrator on mental health outcomes has not been described outside of developed countries. We explore depression symptomatology four to six weeks post-rape in South Africa and examine whether this differs according to the circumstances of the rape. Method: 140 participants recruited from public hospital services in the Eastern and Western Cape provinces were interviewed within two weeks after completing the post exposure prophylaxis (PEP) medication. A structured questionnaire was used to collect data on socio-demographic and sexual assault characteristics including perpetrator. Depressive symptomatology was measured using the Centre for Epidemiological Studies Depression Scale. Results: 84.3% (95% CI: 78.1-90.3) women were found to have high levels of depressive symptoms, but lower levels were found among women raped in circumstances in which there was a lesser likelihood of blame such as those raped by strangers rather than intimate partners (Odds Ratio: (OR) 0.28 (95% Confidence Intervals (CI): 0.11-0.69) and higher levels were associated with experiencing four or more side effects related to PEP medication (OR: 3.79: CI: 1.03-13.94). Receiving support and severe sexual assaults (involving weapons and multiple perpetrators) were not associated with depression. Conclusion: The study does not support the general assumption that more violent rape causes more psychological harm. These results have important implications for individual treatment because it is more generally assumed that multiple perpetrator rapes, stranger rapes and those with weapons would result in more psychological trauma and thus more enduring symptoms. Our findings point to the importance of understanding the socio-cultural dimensions, including dynamics of blame and stigma, of rape on mental health sequelae.

Risk factors for PTSD and depression in female survivors of rape.

“…In addition to the individual demographic background factors, correlates of PTSD have been identified to also include the sexual assault characteristics (e.g. physical injury, severity of sexual victimization) in predicting the risk of PTSD in victims of sexual assault (Abrahams, Jewkes and Mathews,2013; Ulman & Philipas, 2001; Acierno, Resnick, Kilpatrick, Saunders and Best, (1999). The findings in these studies suggest injury during rape as one of the risk factors for post-traumatic stress disorder and depression in rape victims (Cook et al, 2013; Tiihonen Möller et al, 2014).…”

“…In a study on the depression symptomatology among adults and adolescent female survivors of rape in Eastern and Western Cape provinces of South Africa, Abrahams, Jewkes and Mathews (2013) found race, ethnicity, and unemployment status to be associated with greater likelihood of symptoms of depression. Black (African and Colored) rape survivors from Cape Town reported very high levels of depression symptoms than those in other sites of the study.…”

“…Black (African and Colored) rape survivors from Cape Town reported very high levels of depression symptoms than those in other sites of the study. Further, unemployment has also been significantly associated with symptoms of depression post rape (Abrahams et al, 2013, Möller et al, 2014). Conversely, inconsistent results have been found for the other demographic characteristics of age, marital status, education and ethnicity (Frazier et al, 1997, Möller et al, 2014, Ullman & Filipas, 2001).…”

“…Whilst some of the studies have strongly confirmed the effects of rape severity in PTSD, these are mixed partially because other research has found no association between the severity of assault and development of PTSD following rape victimization (Abrahams et al, 2013). …”

Mental ill health in structural pathways to women’s experiences of intimate partner violence

“…We therefore assumed a possibility of bi-directionality between mental ill health and IPV implying that PTSD, depression and alcohol could increase women’s risk for IPV experience in addition to being effects of IPV experiences. By elucidating pathways between the interrelated variables, this study will be a significant addition to the body of existing literature [28,31,56–58]. …”