Mental and sexual health outcomes following sexual assault in adolescents : a prospective cohort study

Background Young  people  are  disproportionately  affected  by  sexual  assault,  yet  longitudinal  data  are  sparse.  This  paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault.

Methods This was a prospective cohort study in adolescents aged 13–17 years attending the Sexual Assault Referral Centres  serving  Greater  London,  UK,  over  2  years.  Baseline  interviews  (T0)  were  done  less  than  6  weeks  after  an  assault to collect data on sociodemographic and assault characteristics and psychological symptoms, with follow-up interviews (T1) at 4–5 months after the assault. Four psychological symptom questionnaires were used at T0 and T1: The Child Revised Impact of Events Scale, the Short Mood and Feelings Questionnaire, the Screen for Child Anxiety Related  Disorders,  and  the  Strengths  and  Difficulties  Questionnaire.  The  primary  outcome  was  prevalence  of  any  psychiatric  disorder  at  T1,  assessed  using  the  Development  and  Wellbeing  Assessment.  Secondary  outcomes  at  T1  were pregnancy, sexually transmitted infections, and sexual health screening since the assault.

Findings Between April 15, 2013, and April 20, 2015, 141 (29%) of 491 eligible young people were recruited to the study (134 females; mean age 15·6 years [SD 1·27]), and 106 (75%) of 141 participants had T1 interviews (99 female). At T0, psychological symptom scores showed that 115 (88%) of 130 females were at risk for depressive disorder, 90 (71%) of 126  were  at  risk  for  anxiety  disorders,  and  116  (91%)  of  128  were  at  risk  for  post-traumatic  stress  disorder,  with  symptoms largely persisting at T1. 68 (80%) of 85 females who had a diagnostic assessment at T1 had a psychiatric disorder, with multiple disorders in 47 (55%) of 85. Anxiety, post-traumatic stress, and major depressive disorders were the commonest diagnoses. Presence of a psychiatric disorder was associated with baseline psychosocial vulnerability (previous  social  services  involvement,  mental  health  service  use,  self-harm,  or  sexual  abuse),  but  not  assault  characteristics.  At  T1,  four  (4%)  of  105  females  had  been  pregnant  since  the  assault,  14  (12%)  of  119  had  a  sexually  transmitted infection diagnosed between T0 and T1, and nine (8%) of 107 reported re-victimisation since the assault.

Interpretation Vulnerable  adolescents  have  the  double  disadvantage  of  being  at  risk  for  both  sexual  assault  and  associated  psychiatric  disorders,  highlighting  the  need  for  comprehensive  support  after  an  assault.  Feasibility  and  effectiveness of prevention programmes should be investigated.

Funding National Institute for Health Research Policy Research Programme grant (115/0001).