Smith (2020) Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault,
A systematic review of short and medium-term mental health outcomes in young people following sexual assault Introduction Sexual assault is common worldwide, peaking in mid-to-late adolescence. Global estimates for women having ever experienced non-partner sexual violence were 7.2% in 2010, with the highest rates of up to 21% of women in areas of Sub-Saharan Africa [1]. Intimate partner sexual violence against women is also common worldwide, with prevalence varying by countryfrom 5%, to up to 69% of women having ever experienced this form of sexual violence [2]. Adolescents are the group at the highest risk of sexual assault in the UK [3] with 17.8% of females aged 18-24 disclosing previous sexual abuse [4]. Figures globally appear similar, with 17.4% of females and 4.2% of males from age 1 month to 17 years experiencing sexual assault at some time in the USA [5], and 14.61% of females and 9.99% of males aged 15-17 reporting lifetime sexual victimization in South Africa [6]. Associations between sexual abuse and adverse psychiatric outcomes have long been reported in the literature, with the strongest evidence for links with depression, post-traumatic stress disorder (PTSD), eating disorders, and suicide attempts [7-11]. However, the cross-sectional design of most studies limits the inferences that can be drawn from the results. This also makes it difficult to distinguish between the acute consequences of an index assault, lifetime psychiatric outcomes, and the progress of symptoms over time. We conducted a comprehensive systematic review to evaluate the evidence around short and medium-term (i.e. within three years of assault) mental health outcomes in young people sexually assaulted between the ages of 10 and 24 years. Methods The protocol for this review was developed by clinicians and academics working in the fields of child and adolescent psychiatry, adolescent medicine, and sexual assault. The reporting of results was based on the guidelines provided by the Meta-analyses and Systematic Reviews of Observational Studies group (MOOSE guidelines) [12]. Study question What are the short and medium-term effects on mental health of sexual assault between the ages of 10 and 24 years? Databases and search strategies Five databases (Medline (Ovid), Embase (Ovid), CINAHL (Ebscohost), OpenGrey, and PsycINFO were searched on the 30 th of October 2013 by two reviewers. This search was updated in 2016 and again in November 2018, using Medline and Embase databases only.
Purpose
To describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users’ perceived needs and experiences.
Method
Longitudinal, mixed methods cohort study of adolescents aged 13–17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13–15 months post-assault.
Results
75/141 participants were followed to study end (53% retention; 71 females) and 19 completed an in-depth qualitative interview. Despite many participants accessing support services, 54%, 59% and 72% remained at risk for depressive, anxiety and post-traumatic stress disorders 13–15 months post-assault. Physical symptoms were reported more frequently. Persistent (> 30 days) absence from school doubled between study entry and end, from 22 to 47%. Enduring mental ill-health and disengagement from education/employment were associated with psychosocial risk factors rather than assault characteristics. Qualitative data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault. Baseline levels of smoking, alcohol and ever drug use were high and increased during the study period (only significantly for alcohol use).
Conclusion
Adolescents presenting after sexual assault have high levels of vulnerability over a year post-assault. Many remain at risk for mental health disorders, highlighting the need for specialist intervention and ongoing support. A key concern for young people is disruption to their education. Multi-faceted support is needed to prevent social exclusion and further widening of health inequalities in this population, and to support young people in their immediate and long-term recovery.
The present research used linked surveillance systems (British Paediatric Surveillance Unit; and the Child and Adolescent Psychiatry Surveillance System) over a 19 month period (1 November 2011–31 May 2013) to notify of young people (4–15.9 years) presenting to secondary care (paediatrics or child and adolescent mental health services) or specialist gender services with features of gender dysphoria (GD). A questionnaire about socio-demographic, mental health, and GD features was completed. Presence of GD was then assessed by experts in the field using then-current criteria (DSM-IV-TR). Incidence across the British Isles was 0.41–12.23 per 100,000. 230 confirmed cases of GD were noted; the majority were white (94%), aged ≥12 years (75.3%), and were assigned female at birth (57.8%). Assigned males presented most commonly in pre-adolescence (63.2%), and assigned females in adolescence (64.7%). Median age-of-onset of experiencing GD was 9.5 years (IQR 5-12); the majority reported long-standing features (2–5 years in 36.1%, ≥5 years in 26.5%). Only 82.5% attended mainstream school. Bullying was reported in 47.4%, previous self-harm in 35.2%, neurodiversity in 16%, and 51.5% had ≥1 mental health condition. These findings suggest GD is rare within this age group but that monitoring wellbeing and ensuring support for co-occurring difficulties is vital.
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