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

Jani Nöthling; Naeemah Abrahams; Rachel Jewkes; Shibe Mhlongo; Carl Lombard; Sian Megan Joanna Hemmings; Soraya Seedat

doi:10.1016/j.jad.2022.04.032

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

J Affect Disord. 2022 Jul 15:309:151-164. doi: 10.1016/j.jad.2022.04.032. Epub 2022 Apr 13.

Authors

Jani Nöthling¹, Naeemah Abrahams², Rachel Jewkes³, Shibe Mhlongo³, Carl Lombard⁴, Sian Megan Joanna Hemmings⁵, Soraya Seedat⁵

Affiliations

¹ Department of Psychiatry, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa; Gender and Health Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa; South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa. Electronic address: janinothling@sun.ac.za.
² Gender and Health Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa; Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Private Bag X3, Rondebosch 7701, South Africa.
³ Gender and Health Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa.
⁴ Gender and Health Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa; Biostatistics Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.
⁵ Department of Psychiatry, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa; South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa.

PMID: 35427719
DOI: 10.1016/j.jad.2022.04.032

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.

Keywords: Depression; Interpersonal violence; Posttraumatic stress disorder; Rape; Risk and protective factors; Stigma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Prospective Studies
Protective Factors
Rape* / psychology
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / psychology
Survivors / psychology