Connie L. Best

Criminal Victimization: Lifetime Prevalence, Reporting to Police, and Psychological Impact:

A sample of 391 adult females were interviewed about lifetime criminal victimization experiences, crime reporting, and psychological impact. In total, 75% of the sample (n = 295) had been victimized by crime, and 41.4% of all crimes were reported to the police. Reporting rates differed by crime type. Burglary had the highest reporting rate (82.4%); and sexual assault the lowest (7.1%). Of all crime victims, 27.8% subsequently developed posttraumatic stress disorder (PTSD). Major implications are the following: Prevalence rates are extremely high and reporting rates are low. The prevalence of PTSD indicates that crime has both an immediate and long-term psychological impact. Suggestions for improved victim services are discussed.

Victim and crime factors associated with the development of crime-related post-traumatic stress disorder

This study examined the relationships between the development of Crime-Related Post-Traumatic Stress Disorder (CR-PTSD) and selected victim and crime characteristics. The sample consisted of 391 adult female residents of Charleston County, South Carolina, of whom 294 were crime victims assessed for CR-PTSD. Comparisons of CR-PTSD positive (n=82) and CR-PTSD negative (n=212) groups found significant differences on the variables of current age, years since most recent crime, experiencing a completed rape, perceiving a life threat during a crime, and sustaining physical injury during a crime. No differences existed on other assessed victim or crime variables. Hierarchical multiple regression analysis found that life threat, physical injury, and completed rape each made significant individual contributions to explaining CR-PTSD. Hierarchical discriminant function analysis correctly classified 80.6% of the respondents. Rape, life threat, and physical injury had a synergistic effect on CR-PTSD in that victims whose crime history included all three elements were 8.5 times more likely to have developed CR-PTSD than those with none of the three elements. Rape was associated with CR-PTSD after controlling for the effects of violence and dangerousness, suggesting that rape has other elements important to the development of CR-PTSD.

Delay in disclosure of childhood rape: results from a national survey.

OBJECTIVE This study sought to gather representative data regarding the length of time women who were raped before age 18 delayed prior to disclosing such rapes, whom they disclosed to, and variables that predicted disclosure within 1 month. METHOD Data were gathered from 3,220 Wave II respondents from the National Womens Study (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993), a nationally representative telephone survey of womens experiences with trauma and mental health. Of these, 288 retrospectively reported at least one rape prior to their 18th birthday. Details of rape experiences were analyzed to identify predictors of disclosure within 1 month. RESULTS Fully 28% of child rape victims reported that they had never told anyone about their child rape prior to the research interview; 47% did not disclose for over 5 years post-rape. Close friends were the most common confidants. Younger age at the time of rape, family relationship with the perpetrator, and experiencing a series of rapes were associated with disclosure latencies longer than 1 month; shorter delays were associated with stranger rapes. Logistic regression revealed that age at rape and knowing the perpetrator were independently predictive of delayed disclosure. CONCLUSIONS Delayed disclosure of childhood rape was very common, and long delays were typical. Few variables were identified that successfully predicted disclosure behavior, but older age and rape by a stranger were associated with more rapid disclosure. This suggests that the likelihood of disclosure in a given case is difficult to estimate, and predictions based on single variables are unwarranted.

Rape-related pregnancy: Estimates and descriptive characteristics from a national sample of women

OBJECTIVE We attempted to determine the national rape-related pregnancy rate and provide descriptive characteristics of pregnancies that result from rape. STUDY DESIGN A national probability sample of 4008 adult American women took part in a 3-year longitudinal survey that assessed the prevalence and incidence of rape and related physical and mental health outcomes. RESULTS The national rape-related pregnancy rate is 5.0% per rape among victims of reproductive age (aged 12 to 45); among adult women an estimated 32,101 pregnancies result from rape each year. Among 34 cases of rape-related pregnancy, the majority occurred among adolescents and resulted from assault by a known, often related perpetrator. Only 11.7% of these victims received immediate medical attention after the assault, and 47.1% received no medical attention related to the rape. A total 32.4% of these victims did not discover they were pregnant until they had already entered the second trimester; 32.2% opted to keep the infant whereas 50% underwent abortion and 5.9% placed the infant for adoption; an additional 11.8% had spontaneous abortion. CONCLUSIONS Rape-related pregnancy occurs with significant frequency. It is a cause of many unwanted pregnancies and is closely linked with family and domestic violence. As we address the epidemic of unintended pregnancies in the United States, greater attention and effort should be aimed at preventing and identifying unwanted pregnancies that result from sexual victimization.

Risk Factors for Rape, Physical Assault, and Posttraumatic Stress Disorder in Women: Examination of Differential Multivariate Relationships

The National Womens Study, a 2-year, three-wave longitudinal investigation, employed a national probability sample of 3,006 adult women to: (a) identify separate risk factors for rape and physical assault, and (b) identify separate risk factors associated with post-rape posttraumatic stress disorder (PTSD) and post-physical assault PTSD. This investigation differed from previous studies in that it prospectively examined risk factors at the multivariate, as opposed to univariate level. Overall, past victimization, young age, and a diagnosis of active PTSD increased womens risk of being raped. By contrast, past victimization, minority ethnic status, active depression, and drug use were associated with increased risk of being physically assaulted. Risk factors for PTSD following rape included a history of depression, alcohol abuse, or experienced injury during the rape. However, risk factors for PTSD following physical assault included only a history of depression and lower education.

Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: findings from the National Survey of Adolescents.

A national household probability sample of 4,023 adolescents aged 12 to 17 years was surveyed by telephone via structured clinical interview to determine the impact of familial substance use, sexual and physical assault, witnessed violence, depression and posttraumatic stress disorder (PTSD) on risk of smoking. Results indicated that familial substance use increased risk of smoking only for boys and sexual assault or depression increased risk of smoking only for girls. Age, Caucasian ethnicity, and experiencing physical assault or witnessing violence elevated risk of current cigarette use for both genders. By contrast, PTSD per se was not associated with increased risk of smoking, after the effects of other variables were controlled.

Criminal Victimization, Posttraumatic Stress Disorder, and Comorbid Psychopathology Among a Community Sample of Women

This paper provides information on the relation between victimization status, crime factors, posttraumatic stress disorder (PTSD), and several other psychological disorders among a community sample of women. Results indicated that victims of crime were more likely than nonvictims to suffer from PTSD, major depressive episode, agoraphobia, obsessive-compulsive disorder, social phobia, and simple phobia. Furthermore, life threat was associated with increased risk of major depression, agoraphobia, obsessive-compulsive disorder, and social phobia. Completed rape was strongly related to almost every disorder assessed, while robbery and burglary were not related to any disorder. When demographics, victimization status, and crime factors were entered hierarchically into multivariate logistic regressions with PTSD in the final step, associations between victimization status, other crime characteristics (e.g., life threat, injury), and non-PTSD Axis I disorders were greatly reduced. This suggests that PTSD may be an important mediating factor in the victimization-psychopathology relation for many disorders.

Predictors of Post-Rape Medical Care in a National Sample of Women

BACKGROUND Rape has a negative impact on physical and mental health, health-related behaviors, and health service utilization. Timely medical care is important for preventive services. METHODS Cross-sectional data were obtained from a larger 2-year longitudinal study, the National Womens Study (NWS). A total of 3006 adult women participated in the final data collection wave of the NWS. During a structured telephone interview, women who reported a most-recent or only rape incident during adulthood were asked about rape characteristics, reporting to authorities, medical care, and rape-related concerns. The main outcome measures were receipt and timing of medical care received after an adult rape, and factors influencing whether or not medical care was received. RESULTS Of the sample, 214 (7.1%) had experienced a most-recent or only rape as an adult (aged >/=18), and 56 (26.2%) received rape-related medical care following that incident. The final model multivariable logistic regression indicated that reporting the crime to police or other authorities (odds ratio [OR], 9.45; 95% confidence interval [CI]=3. 34-26.70) and fear of sexually transmitted diseases (OR, 8.61; 95% CI=3.12-23.72) were significant predictors of receipt of post-rape medical care. CONCLUSIONS One in five victims reported an adult rape to police or other authorities; these women were nine times more likely to receive medical care than those who did not. Public health efforts are needed to increase the proportion of rape victims who receive immediate post-rape medical care.

Vulnerability-stress Factors in Development of Posttraumatic Stress Disorder

Log-linear %2 analyses were conducted to examine potential interactions between the presence of precrime axis I psychiatric diagnoses and differential levels of crime stress in association with posttraumatic stress disorder (PTSD) in a community sample of 295 female crime victims. High crime stress was defined as crime that included either perceived life threat, actual injury, or completed rape. Crime stress level was significantly associated with PTSD after the crime. Thirty-five percent of subjects with high crime stress exposure met criteria for PTSD, as opposed to 13% of those with low crime stress exposure. Precrime diagnosis was not associated with high crime stress exposure, indicating that this is not a vulnerability factor for exposure to crime characteristics associated with increased rates of PTSD. There were no significant independent associations between precrime axis I diagnoses and PTSD after the crime. However, a significant interaction was observed among crime stress level, precrime depression, and PTSD such that the rate of PTSD was substantially higher in association with precrime depression only in the high crime stress exposure group. Major findings are consistent with previous results implicating trauma exposure as the primary factor in development of PTSD. However, the results indicate that precrime depression may constitute a vulnerability factor for development of PTSD under conditions of high crime stress exposure.

Current Psychological Functioning of Child Sexual Assault Survivors A Community Study

We interviewed a community sample of 391 women to obtain a thorough history of lifetime victimization experiences, including experiences such as childhood and adult sexual assault, aggravated assault, robbery, and burglary. In order to assess current psychological functioning, participants were administered the Derogatis Symptom Checklist-90 Revised, the Modified Fear Survey, and the Impact of Event scale. Results indicated that childhood sexual abuse victims could be distinguished from nonvictims by a pattern of elevated anxiety, heightened interpersonal sensitivity, increased anger problems, more paranoid ideation, and increased obsessive-compulsive symptoms. The age at which the sexual assault took place was found to be related to current adult functioning, with women assaulted in adolescence displaying more elevations in hostility, interpersonal sensitivity, obsessive-compulsive symptoms, anxiety, and paranoid ideation than nonvictims. Women sexually abused in early childhood displayed only elevated anxiety symptoms as adults, although they also revealed significantly more psychological symptoms on a global mental health measure than did nonvictims. In addition, revictimization was found to be strongly related to increased symptomatology.