Service Utilization and Help Seeking in a National Sample of Female Rape Victims

Abstract

Objective: Many women with mental health problems do not seek help. Despite substantial research on predictors of help seeking, little is known about factors associated with help seeking in at-risk populations (e.g., rape victims). This study examines various forms of help seeking for emotional problems in relation to key variables in a national sample of female rape victims. Methods:We interviewed via telephone a representative sample of 3,001 women (aged 18-76 years). Those endorsing a lifetime history of rape were included in the present analyses (n=556). Demographic characteristics, rape history, rape characteristics, psychopathology, and substance abuse were assessed. Help seeking was assessed by asking if participants ever sought help, and if so, what type(s) of services were sought (medical professional, religious figure, or mental health professional).Results: Help seeking was endorsed by 60% of the sample. Final multivariable model showed that ever seeking help was positively associated with white race (OR=2.61), being single/divorced/ widowed (OR=2.30), and having PTSD (OR=3.45). Specific forms of help seeking revealed unique predictor sets. Conclusions:Although help seeking among rape victims was high, 40% of victims did not seek services. Odds of help seeking were generally increased by the presence of a mental health disorder. Because mental health professionals were not the only types of professionals from whom rape victims sought emotional support, education and training regarding rape and associated disorders should be available to other professionals to support provision of care. Public policy should be strengthened regarding professionals' service provision, and should include reimbursement for mental health services.A growing body of literature reveals a significant imbalance between the prevalence of mental health disorders and utilization of mental health services. The Epidemiologic Catchment Area study, conducted from 1980-1985, reported that diagnosed individuals sought past-year treatment (1) and that help-seeking was more likely to occur among individuals with sexual assault histories (2). The National Comorbidity Survey, conducted from 1990-1992, estimated that only 25% of respondents with a mental health disorder received treatment within the past year (3). The National Comorbidity Survey Replication (4), conducted between 2001-2003, estimated that 41% of diagnosed respondents received past-year treatment. Taken together, these studies suggest that increases in mental health service utilization among those with mental health disorders have occurred over the past two decades, but that levels of use among those in need of care remain low. NIH-PA Author ManuscriptA key finding of the NCS-R was that the type of disorder was associated with differential patterns of service use (4). That is, significant variability exists across populations in perceived need for treatment and it follows that determinants of help seeking may also differ by disorder. This underscores the potential va...

African American and White Women’s Experience of Sexual Assault and Services for Sexual Assault

“…However, Campbell and Bybee (1997) found African American women were less likely to receive follow-up care, treatment for sexually transmitted diseases or pregnancy, emergency contraception, and information related to SA. This is also consistent with data indicating White women are more likely to seek help (i.e., from a medical professional, mental health professional, or religious figure) postassault than women of color (Amstadter et al, 2008) and with findings indicating woman of color are notably less likely to have their injuries treated, receive follow-up medical care or information on HIV, or contact an SA recovery center than White women (Campbell et al, 2001). More recently, Campbell and Raja (2005) examined a sample of predominantly low-income African American women veterans and reservists who were sexually assaulted as adults and found most of the survivors who sought help in military or civilian systems (medical or legal) felt guilty, were depressed, felt anxious, distrusted others, and were hesitant to seek further assistance.…”

“…For example, results from a sample of SA survivors (N = 125) indicate that one third will file charges, half will delay reporting by several years (if they report), and even fewer will seek treatment for the assault (9%; Monroe et al, 2005). This trend is particularly true for African American women, who are less likely to seek mental health services in comparison to their White counterparts (Alvidrez, Shumway, Morazes, & Boccellari, 2011;Amstadter, McCauley, Ruggiero, Resnick, & Kilpatrick, 2008). Evidence indicates neither inequity in symptom sequelae nor intervention accessibility contributes to nonreceipt of services by African American women (Alvidrez et al, 2011); thus, there might be other factors contributing to the help seeking.…”

Does negative affect mediate the relationship between daily PTSD symptoms and daily alcohol involvement in female rape victims? Evidence from 14 days of interactive voice response assessment.

“…Alcohol involvement and alcohol use disorders (AUDs), which have a high degree of co-occurrence with PTSD, also show complex relationships to rape and sexual assault as both risk factors and consequences (Testa, Hoffman, & Livingston, 2010). A substantial body of literature has established that alcohol use inhibits post-assault recovery and is a major barrier to post-rape service utilization, police reporting, and help-seeking (Amstadter et al 2008; Wolitzky-Taylor et al 2012). Understanding the specific mechanisms that maintain problem drinking in relation to PTSD symptoms among female rape victims has been relatively overlooked in the extant literature.…”

“…Finally, Simpson et al (2012) used a sample of individuals seeking treatment for an AUD. Findings generally from help-seeking individuals with PTSD and AUD might not translate to non-help seeking populations (Amstadter, McCauley, Ruggiero, Resnick, & Kilpatrick, 2008; Kilpatrick, 2007). …”

To Tell or Not to Tell

“…Only a small number of women seek treatment with one fifth or 21% who sought treatment from a medical provider for an emotional injury, and almost half (49%) from a counselor or therapist. This pattern is somewhat lower than Amstadter, McCauley, Ruggiero, Resnick, and Kilpatrick (2008), who reported that 38% sought treatment from a medical professional, and 54% from a mental health specialist. Medication use in our study was low in contrast to Smith et al (2005), who reported that visits to providers to obtain prescriptions for anti-depressants rose dramatically between 1995-1996 from 13.8 visits to 35.5 visits.…”