Characteristics of Sexual Abuse Among Individuals with Severe Mental Illnesses

Purpose: Sexual abuse (SA) is a major social problem, with prevalence rates suggesting that 1 in 8 individuals worldwide will experience SA. Past studies have identified prevalence rates of SA both in the general public and among individuals with severe mental illnesses (SMIs), but there are few studies that specifically examine the characteristics of those SA issues in clinical samples. This study attempts to identify characteristics of SA among people with SMIs, and identify the differences between individuals who experienced SA and those individuals who did not experience SA.

Methods: This study was conducted by utilizing data from the MacArthur Violence Risk Assessment Study. A total of 1136 individuals with SMIs were recruited from three psychiatric inpatient units in different cities. Participant data were collected in the hospital by research clinicians and interviewers. Incidents of sexual abuse (up to three) were assessed by participant self-report. If SA was confirmed by the participant, additional follow-up questions were asked. These included the relationship to the perpetrator; the nature and frequency of the abuse; and the age when the abuse occurred. If there was more than one incident of sexual abuse, then two additional incidents were documented using the same follow-up questions. For this study, participants who refused to answer the abuse question or didn’t know or remember if abuse had occurred were excluded from the analysis (N = 36).

Results: Of the 1136 participants, 1100 answered the sexual abuse screening question, with 46.5% (N=511) reporting at least one incident of sexual abuse. Regarding the first incident, the perpetrator was commonly a “stranger/various others” (43.4%); with “sexual intercourse” (29.4%) occurring “too many times to count” (32.7%) at a mean age of 11.22 (SD = 7.3) years. Those who experienced SA were frequently single (53.1%), Caucasian (72%), females (64%) who are almost 30 years old (M = 29.63, SD = 6.23), have children (53%), were voluntary psychiatric admissions (72.6%), and describe themselves as psychologically unwell (79.3%). Chi-square and t-test results found that those who experienced SA were more likely to be diagnosed with depression (p < .001), less likely to have a diagnosis of substance dependence (p < .001), and have higher GAF (p = .036) and BPRS (p < .001) scores, indicating lower functioning and greater psychiatric symptomology, than individuals who did not experience SA.

Implications: These results suggest similarly prevalence rates to prior studies. However, in contrast to other study findings, SA was found to commonly occur outside of the family, with survivors commonly indicating multiple incidents. Therefore, individuals with SMIs should be screened for SA issues at the time of SMI diagnosis in an effort to ensure early SA support and intervention, in addition to possible safety issues. Additionally, individuals that meet any of the aforementioned characteristics should be routinely screened for SA issues, and functioning and symptomology should be a focus of clinical attention. Early intervention can be of paramount importance for helping SA survivors overcome the abuse and enable them to proceed with a healthy and happy life.