DURHAM, N.C. -- A survey of nearly 3,000 North Carolina residents has found
that women with a history of sexual assault are six times more likely to
attempt suicide at some point in their lives, according to a study at Duke
University Medical Center. Women at particular risk are those who reported
having been sexually assaulted prior to the age of 16, the survey showed.
The Duke researchers say their findings convey an important message to
primary care and mental health providers who are assessing potential suicide
risks among their patients. Results of the study, funded by a grant from
the National Institutes of Mental Health, were reported in the June 13 issue
of the Archives of General Psychiatry.
"The immensely damaging effects of an event such as sexual assault
cannot be stressed too strongly, particularly in individuals with other
vulnerability factors such as family dysfunction and emotional or developmental
problems," said Dr. Jonathan Davidson, professor of psychiatry and
principal investigator of the study. Co-authors of the study were Dana Hughes,
Linda George and Duke psychiatrist Dr. Dan Blazer, who is dean of medical
education at Duke.
The link between sexual assault and suicide remained strong even when researchers
accounted for the effects of other suicide risk factors, such as major depression,
panic attacks, substance abuse, and demographic factors like age and health
status, the survey found. The researchers said they were careful to distinguish
between the effects of the sexual assault itself versus the recurrent emotional
symptoms associated with a traumatic event, a condition known as post traumatic
stress syndrome.
To help identify women at risk, the researchers suggest that all health
care providers -- from nurses and physician assistants to emergency doctors
and primary care physicians -- raise their awareness of how sexual assault
influences the risk of attempted suicide, especially since a significant
number of sexual assault victims never seek mental health care.
"Women may not be seeking help for problems specifically related to
their sexual assaults, but they are going to the doctor for other reasons,"
said Davidson, who noted that sexual assault victims visit health care providers
more often for physical and mental health symptoms.
The survey consisted of two-hour, face-to-face interviews with 2,918 adults
in the Piedmont region of North Carolina. Respondents were asked about demographic
characteristics, history of sexual assault, history of suicide attempts,
post traumatic stress symptoms, alcohol abuse, chronic medical conditions,
and a variety of mental health issues. Each respondent was given the Diagnostic
Interview Schedule, which screens for all major psychiatric disorders.
Of the respondents, 62 women and five men reported a history of one or
more sexual assaults. The survey showed that nine of these 67 subjects,
or 14.9 percent, reported one or more attempted suicides. Among those who
did not report a sexual assault, only 1.4 said they had attempted suicide.
After controlling for demographic variables and other risk factors, the
researchers concluded that assaulted women were six times more likely to
attempt suicide. The sample size of sexually assaulted men was too small
to draw any conclusions.
The researchers also said their data do not prove that sexual assault is
the cause of a higher attempted suicide rate in women -- only that the two
factors are strongly related. Future studies will need to examine the cause-and-effect
relationship between the two variables, Davidson said.