Forced Sexual Incidents Among Individuals with Serious Mental Illness (SMI)

Background and Purpose: Forced sex, or a sexual activity where consent is not clearly given, is a problematic form of sexual violence. Prevalence rates suggest that 1 in 8 individuals worldwide will experience some form of sexual violence during their lifetime. While studies have identified prevalence rates of sexual assault, sexual abuse, and rape in the general public and certain samples, there is a dearth of studies that specifically examine incidents of forced sex among individuals with serious mental illnesses (SMI). This study attempts to identify the differences between individuals with SMI who experienced forced sex and those individuals who did not experience forced sex.

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 forced sex were assessed by participant self-report. Researchers also gathered demographics and information on a participant’s psychiatric and social history. For this study, participants who refused to answer or didn’t know or remember if forced sex had occurred were excluded from the analysis (N = 3).

Results: Of the 1136 participants, 1133 answered the forced sex screening question, with 10.3% (N=117) reporting an incident of forced sex. Chi-square results found that those who experienced forced sex were significantly more likely to be female (p < .001), previously married (p < .018), have children (p < .028), and be diagnosed with co-occurring mental illness and substance use disorder (p < .05). Results from independent t-tests found that those who experienced forced sex had significantly less children (p < .007), were married fewer times (p < .026), and had fewer family members in their social network (p < .007). In reference to functioning, individuals who experienced forced sex had lower verbal IQ scores (p < .001) but higher BPRS (p = .001) scores, indicating lower verbal intelligence and greater psychiatric symptomology than individuals who did not experience forced sex.

Implications: These results suggest that forced sex could have a significant impact on the lives of individuals with SMI. However, the cross-sectional nature of this study does not allow the establishment of a time line from forced sexual incidents to measured outcomes. Regardless, individuals with SMIs should be thoroughly screened for incidents of forced sex, including sexual assault and abuse, at the time of SMI diagnosis in an effort to ensure support and intervention for these issues. Additionally, social functioning, psychiatric symptomology, and substance use should be a focus of clinical attention. Early intervention can be of paramount importance for helping individuals who experienced forced sex process the incident while enabling them to proceed with healthy life development. Future studies should continue to examine forced sexual incidents in individuals with SMI and compare the results to studies of SMI who experienced other forms of sexual violence.