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.