Research Shows Increase in Psychiatric Disorders, Stress-related Medical Conditions, and Health Care Use
By Brett Israel
In the year after a sexual assault, women had significantly greater increases in psychiatric disorders, stress-related medical conditions, and use of psychiatric and gynecological services compared to women without a sexual assault.
In the United States, an estimated 19 percent of women have been raped and an estimated 44 percent have experienced other forms of sexual violence during their lifetimes, according to a 2014 CDC report on sexual violence. Previous research has shown that women who experience sexual assault are more likely to have chronic diseases and mental health problems, but these studies had limitations that the new study overcomes.
For the study, researchers at Kaiser Permanente compared the prevalence of psychiatric and medical conditions, as well as use of health care services, in adult women with and without a clinician documented sexual assault. The study’s results suggest that sexual assault increases the risk for psychiatric and stress-related conditions and results in greater use of psychiatric and women’s health services.
“This is one of the first longitudinal studies to show that sexual assault is associated with increases in psychiatric and medical conditions and use of health care services using a robust statistical model,” said the study’s lead author, Kelly Young-Wolff, a clinical psychologist and research scientist at the Kaiser Permanente Northern California Division of Research.
Using EHR Member Data
The study, “Changes in Psychiatric and Medical Conditions and Healthcare Utilization Following a Diagnosis of Sexual Assault: A Retrospective Cohort Study,” was published online on May 21 in the journal Medical Care.
“Previous research in this area was primarily based on self-reported data and used cross-sectional study designs, which can only demonstrate an association between groups, and may overestimate those associations,” Young-Wolff said. “Health care systems with electronic health records, such as Kaiser Permanente, provide unique longitudinal data to examine whether sexual assault is associated with changes in health and healthcare utilization.”
Using a retrospective cohort design, researchers tested whether Kaiser Permanente Northern California female members with a documented sexual assault in their electronic health record had greater increases in psychiatric and medical conditions and health care utilization in the year after the sexual assault compared to members without a sexual assault diagnosis during the same time. The study included 1,350 adult women with a clinician-diagnosed sexual assault between 2009 and 2015.
Matching for Comparison
Researchers used a process called matching to compare each woman with a documented sexual assault to three women without documented sexual assault who were the same age, attended the same medical facility and were continuously enrolled as Kaiser Permanente Northern California members during the study period. Member data was examined with strict security and privacy protocols and Institutional Review Board approval. The researchers used a conservative statistical significance threshold (p < .001, compared to the common threshold of p < .05).
Rape and sexual violence are alarmingly common experiences. The findings from this study show the significant medical and mental health impact.
– Brigid McCaw, MD, medical director, Family Violence Prevention Program
The study found that the prevalence of certain medical conditions and types of health care utilization increased significantly more among women in the year following a sexual assault than among women without a sexual assault, even after adjusting for differences in income and race/ethnicity. For example, the prevalence of psychiatric disorders increased from 54 percent to 67 percent, and prevalence of stress-related somatic disorders increased from 25 percent to 31 percent. Notably, the prevalence of posttraumatic stress disorder more than doubled, from 11 percent to 24 percent. There were also significant increases in the average number of psychiatry and gynecology visits. Comparable increases were not seen among women without a documented sexual assault.
“Rape and sexual violence are alarmingly common experiences. The findings from this study show the significant medical and mental health impact. It is imperative that health care settings ensure that women who experience sexual assault are offered caring and effective services, and this study is a call to action to re-double efforts to prevent sexual violence,” said study co-author Brigid McCaw, MD, MPH, MS, a Kaiser Permanente internist and the medical director of the Kaiser Permanente Northern California Family Violence Prevention Program.