Negative Responses to Disclosure of Sexual Victimization and Victims’ Symptoms of PTSD and Depression: The Protective Role of Ethnic Identity

Abstract

College-aged women experience high rates of sexual victimization. Their postassault symptoms are associated with the types of responses they receive from the people to whom they disclose these experiences. Negative responses are pervasive and associated with poorer outcomes. The current study examined whether a strong sense of ethnic identity and comfort with the mainstream culture moderate the association between negative responses to the first disclosure of sexual victimization and symptoms of posttraumatic stress disorder (PTSD) and depression. A diverse sample (10% Black/African American, 51% White, 39% Other, and 66% Hispanic) of undergraduate women was recruited from two urban, Eastern United States universities for this online study. Participants reported histories of sexual victimization, demographics, responses to sexual assault disclosure (i.e., victim blame, treating the victim differently, taking control, distraction, and egocentric reactions), symptoms of PTSD and depression, and their ethnic identity and mainstream cultural comfort. Thirty-seven percent (n = 221) endorsed an experience of sexual victimization, and 165 disclosed it to someone. Hierarchical ordinary least squares regressions revealed that a stronger sense of ethnic identity was associated with fewer symptoms of PTSD for those women who experienced higher levels of control, distraction, and egocentric responses from the first disclosure recipient. A strong sense of affiliation with the mainstream culture did not protect survivors who reported receiving negative responses to disclosure against symptoms of PTSD or depression. Ethnic affiliation may protect women against PTSD when they receive high levels of negative messages about sexual victimization experiences.

Keywords

sexual assault ethnic identity disclosure PTSD depression

Sexual assault is a pervasive social and public health problem in the United States with nearly one in five women reporting a history of rape and 45% of women experiencing some sort of sexual violence (Black et al., 2011). Sexual violence is experienced at high rates by women of diverse ethnic and racial backgrounds, with 36% of Hispanic, 41% of Black, and 47% of White women reporting some kind of nonrape sexual victimization and 15% of Hispanic, 22% of Black, and 19% of White women reporting a lifetime prevalence of rape (Black et al., 2011). Young adult women in their adolescent and college-age years are particularly vulnerable to sexual victimization (Brener, McMahon, Warren, & Douglas, 1999; Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010; Orchowski, Untied, & Gidycz, 2013). Rape and other forms of sexual assault lead to a range of negative outcomes including symptoms of posttraumatic stress and depressive disorders (Campbell, Dworkin, & Cabral, 2009; Ullman & Peter-Hagene, 2014).

After an experience of sexual violence, most women disclose it to an informal support source, such as a friend or family member (Orchowski & Gidycz, 2012). Fewer victims seek help from formal support systems, which include police officers, medical personnel, and mental health counselors. In one study of college students, only 8% of victims sought assistance from someone in the formal support capacity, whereas 86% disclosed to a peer (Orchowski & Gidycz, 2012). A body of research suggests that the types of responses that victim-survivors receive when disclosing their assaults are associated with psychological outcomes. Negative responses, such as victim blame, treating the victim differently after the disclosure, responding egocentrically, are risk factors for poorer outcomes (Ahrens, Cabral, & Abeling, 2009; Orchowski & Gidycz, 2015; Ullman & Peter-Hagene, 2014). Although most women report positive responses to sexual assault disclosure, negative responses are reported by 80% to 98% of victims (Campbell, Ahrens, Sefl, Wasco, & Barnes, 2001; Filipas & Ullman, 2001; Golding, Siege, Sorenson, Burnam, & Stein, 1989; Ullman, 1996b). Protective factors that minimize the association of negative responses to disclosure with poorer outcomes for the victims are poorly understood.

The current article is guided by an ecological perspective that considers sexual assault within a series of environments (family/friends, institutions, culture) that interact with individual characteristics to determine postassault outcomes (Campbell et al., 2009). The article considers whether a sense of ethnic identity and comfort with the mainstream culture buffer the impact of negative responses to sexual assault disclosure on victim’s symptoms of posttraumatic stress disorder (PTSD) and depression in a diverse sample of college-aged women.

Responses to Disclosure of Sexual Violence

Ullman (2000) has categorized negative responses to sexual victimization disclosure into five types: (a) blaming the victim; (b) taking control (e.g., making decisions for the victim); (c) distraction (e.g., encouraging the victim to stop thinking about and move on from the experience); (d) treating the victim differently, as if she was damaged; and (e) egocentric responses that focus on the disclosure recipient’s needs. Research studies strongly support the connection between the negative responses to disclosure identified by Ullman and a range of poor outcomes. Victims who receive more negative reactions (i.e., blame, distraction, taking control, treating differently, and egocentric responses) have higher symptoms of anxiety, depression, PTSD, and problematic alcohol consumption (Borja, Callahan, & Long, 2006; Davis, Brickman, & Baker, 1991; Moss, Frank, & Anderson, 1990; Ullman & Filipas, 2001; Ullman, 1996a, 1996b; Ullman, Filipas, Townsend, & Starzynski, 2007; Ullman, Starzynski, Long, Mason, & Long, 2008). Most of the studies on victim-survivor functioning and responses to disclosure are cross-sectional, focus on responses across all the disclosure recipients, and rely on community samples (Ullman, 1996a, 1996b; Ullman & Filipas, 2001; Ullman et al., 2007; Ullman et al., 2008).

In one college-aged sample of sexual assault survivors, Borja and colleagues (2006) have found that the mean number of negative responses (across all the Ullman negative reactions categories) the victim-survivor received from the individuals to whom she disclosed was associated with higher symptoms of PTSD. Similar results were found in the only longitudinal examination known to these authors of the relation between responses to disclosure of sexual victimization and symptomatology among college women (Orchowski & Gidycz, 2015). Orchowski and Gidycz (2015) gathered data on sexual victimization and responses to disclosure at baseline and at 4-month follow-up, and symptomatology at 7-month follow-up. Negative responses to disclosure (across all the Ullman categories) at 4 months were associated with higher fear and hostility at the 7-month follow-up.

Ethnic Identity and Comfort With the Majority Culture

Ethnic identity is defined as a sense of belonging that individuals feel by affiliating with their heritage and culture (Brittian et al., 2015; Malcarne, Chavira, Fernandez, & Liu, 2006). Research shows that ethnic identity is associated positively with psychological well-being in diverse populations, including African Americans, Hispanics, and Native Americans (Smith & Silva, 2011), and Asian Americans (Lee, 2003). Furthermore, studies also suggest that a sense of belonging within the majority culture (the most dominant and powerful culture in a society) and a sense of ethnic identity are not mutually exclusive and can be parallel processes (Berry, 2005; Yoon et al., 2013). An interest and affiliation with the majority culture (Phinney, 1992; Yoon et al., 2013) and acculturation by assimilating or integrating with the majority culture (Yoon et al., 2013) have also been examined as protective factors in past literature. A recent meta-analysis determined that acculturation is associated with positive psychological outcomes of well-being and is protective against mental illness symptomatology across diverse samples (Yoon et al., 2013).

From an ecological perspective, a strong sense of affiliation and belonging, whether to a minority (a less dominant culture within a society with multiple cultures; Berry, 2005) or the majority culture, may buffer against the culturally mediated messages of blame, treating differently, distraction, taking control, and egocentric reactions that the victim of sexual violence receives from the disclosure recipient (Campbell et al., 2009). Victims without a strong sense of affiliation and self may be more likely to internalize these messages and develop higher levels of symptomatology. The potentially protective mechanisms of ethnic or majority culture identity have not been previously explored in research on responses to sexual assault disclosure.

However, ethnic identity and majority culture orientation have been shown to play a protective role in adjustment of individuals from a variety of backgrounds who experience another type of culturally mediated stigmatization—racial/ethnic discrimination. Studies have found that ethnic identity moderated the effects of discrimination on depressive symptoms among Filipino-American (Mossakowski, 2003) and African American adults (Fischer & Shaw, 1999). Ethnic identity achievement also moderated the association between discrimination and self-esteem in a diverse group of adolescents (Greene, Way, & Pahl, 2006) and in a sample of Mexican American adolescents (Romero & Roberts, 2003). However, this association has not been supported by all studies (Khaylis, Waelde, & Bruce, 2007; Lee, 2003), and there are other important factors (e.g., coping strategies) that could help offset the negative effects of discrimination on mental health (Brondolo, Brady Ver Halen, Pencille, Beatty, & Contrada, 2009).

Research also shows that acculturation toward the majority U.S. culture can be protective after a stressful experience. For example, in a nationwide sample of Latina victims of sexual assault, acculturation toward the Anglo-American culture was associated with help-seeking behaviors (Sabina, Cuevas, & Schally, 2012). In a sample of undergraduate Asian Americans, other group orientation was associated with higher well-being for those reporting minority group discrimination (Lee, 2003). However, other studies fail to find protective effects of acculturation and majority culture orientation on mental health in response to discrimination and find ethnic identity and other factors to have the stronger protective roles (Fernandez & Loukas, 2014; Wei, Wang, Heppner, & Du, 2012).

Current Study

The current study assessed the protective effects of ethnic identity and majority culture orientation in the relation between negative responses to first disclosure of sexual victimization and symptoms of PTSD and depression in a diverse sample of undergraduate women from two urban universities in the Eastern part of the United States. Researchers suggest that first disclosures are particularly important to study because these predict the likelihood of further disclosures and support seeking (Ahrens, Campbell, Ternier-Thames, Wasco, & Sefl, 2007). It was hypothesized that (a) negative responses to disclosure would be associated with higher symptoms of PTSD and depression, (b) a more developed ethnic identity would buffer the associations between negative responses and symptomatology, and (c) a more developed sense of affiliation with the majority culture would buffer the association between negative responses and symptomatology.

Method

Procedure and Participants

Undergraduate women from two urban universities, one in New York City and one in Miami participated in this online study to fulfill their Introduction to Psychology research requirement in 2008 and 2009. They selected the current study among other available studies. Women had to be at least 18 years of age to be eligible for participation. All study procedures were approved by the university and institutional review boards. Women who elected to participate in the survey first completed a demographics questionnaire, followed by the Sexual Experiences Survey (SES). Women who endorsed an experience of sexual victimization completed the rest of the measures. At the completion of the survey, participants were debriefed, thanked, and given referral information for mental health resources in their communities.

Of the 604 students who participated in the study, 37% (n = 221) endorsed a history of sexual victimization. Of the initial sample, 81% (n = 489) were from Miami, their average age was 21 years (SD = 4), 66% (n = 399) identified as Hispanic, and racial background ranged as follows: 51% (n = 308) White, 10% (n = 60) African American/Black, and 39% (n = 233) Other (representing mostly Hispanic women). Of the 221 participants who endorsed a history of sexual victimization, 82% (n = 184) were from Miami, their average age was 21 years (SD = 4), 68% (n = 149) identified as Hispanic, and racial background ranged as follows: 60% (n = 130) White, 10% (n = 22) African American/Black, and 32% (n = 73) identified as other various backgrounds (representing mostly Hispanic women).

Measures

A Demographics Questionnaire asked participants to report their age, race, ethnicity, and birthplace. Participants identified their racial background from a list of available categories (African American or Black, American Indian or Alaskan Native, Asian or Asian American, Caucasian or White, Native Hawaiian or other Pacific Islander, and Other). Participants were able to select more than one category. All categories were collapsed into three groups (White, African American/Black, and Other), which parsimoniously represented the data. Participants also identified as ethnically Hispanic or not and reported their place of birth, which was coded as immigrant or U.S. born.

SES (Koss & Oros, 1982) is a self-report assessment of unwanted sexual experiences. Participants reported whether they had experienced a variety of unwanted sexual experiences ranging from “sex play (fondling, kissing, or petting)” to “sex (anal or oral intercourse)” for a variety of reasons, ranging from “because you were overwhelmed by a man’s continual arguments and pressure” to “because a man threatened or used some degree of physical force.” This survey has been tested with a large number of university students (Koss, Gidycz, & Wisniewski, 1987; Koss & Oros, 1982) and in assessment of responses to sexual assault disclosure (Ullman & Filipas, 2001). Test–retest reliability was assessed in past research, and a mean of 93% agreement was reported for the two administrations 1 week apart.

The Social Reactions Questionnaire (SRQ; Ullman, 2000) was used to assess negative responses to disclosure of sexual victimization. It was modified to assess responses to the first disclosure experience. The scale has 48 items each representing a response to disclosure. For each item, participants reported whether the first person to whom they disclosed the sexual victimization provided that response. The five negative responses to disclosure subscales were the focus of the current study: (a) Blame—insinuating that the victim is somehow responsible for the assault, (b) Taking Control—making decisions for the victim and treating her as if she is not capable of doing so, (c) Distraction—encouraging the victim to stop talking and thinking about the sexual assault experience, (d) Treating Differently—acting differently toward the victim as if she was damaged by the experience, and (e) Egocentric Reactions—focusing on the disclosure recipient’s needs and distress rather than on the victim’s. Cronbach’s alpha for the Being Treated Differently and Take Control subscales were good (α = .72 and .70, respectively). Internal consistency of other SRQ subscales was poorer, and items were removed based on psychometric analyses to improve internal consistency. Two items were removed from the Egocentric Reactions subscale (seek revenge on the perpetrator and the recipient feeling personally wronged by the experiences), which raised Cronbach’s alpha to .70 (from .59). One item each was removed from the Distraction subscale (encouraged you to keep your experience a secret), raising the alpha to .64 (from .63), and from the Victim Blame subscale (told you that you could have done more to prevent experience), raising the alpha to .74 (from .61). Multivariate analyses were run with the original (not shown) and modified subscales and no notable differences were observed in the significance and magnitude of findings. Participants also reported how long they waited to disclose the victimization experience by selecting the appropriate response from the following options: less than a day, less than a week, less than a month, less than a year, 1 to 5 years, and more than 5 years. Participants also indicated their relationship to the first disclosure recipient by selecting the appropriate response from the following categories: female friend, male friend, female relative, male relative, female stranger, male stranger, romantic partner, female health care or mental health professional, male health care of mental health professional, female police officer, male police officer, and others.

The Beck Depression Inventory–Second Edition (BDI-II; Beck, Steer, & Brown, 1996) is a 21-item self-report measure of dysphoria that assesses a range of depressive symptoms, including sadness, anhedonia, hopelessness, guilt, and changes in sleep and appetite. Standard administration and scoring guidelines were followed. On each item, participants are asked to pick a response that best represents how they have been feeling in the past 2 weeks from four available options representing degrees of severity of a symptom tapped by that item. Each item is scored on a 4-point scale (0-3) with possible total scores ranging from 0 to 63. The BDI-II is a widely used measure with considerable reliability and validity (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Beck, Steer, & Garbin, 1988), including in samples of sexual assault victims (Cheastey, Clare, & Collins, 2002). In the current study, Cronbach’s alpha is equal to .93 and victims reported an average of 10.54 (SD = 10.3) symptoms.

The PTSD Symptoms Scale (PSS; Foa, Riggs, Duncan, & Rothbaum, 1993) is a 17-item, self-report measure utilized to assess participants’ symptoms of PTSD over the past 2 weeks. Sample items include “In the past 2 weeks, have you had upsetting thoughts or images about the assault that came into your head when you didn’t want them to?” and “In the past 2-weeks, have you felt distant or cut-off from others around you?” The responses are on a Likert-type scale ranging from 0 (not at all) to 3 (5 or more times per week/very much/almost always). Participants completed the assessment in reference to the most severe sexual assault experience reported on the SES and disclosed to someone. Total PTSD severity score was used in this study. In the current study, PSS has a Cronbach’s alpha of .91, and victims reported 8.33 (SD = 8.80) symptoms on the average.

The Scale of Ethnic Identity (SEI; Malcarne et al., 2006) is a 32-item self-report measure of ethnic identity that includes four subscales of ethnicity-related cognitive constructs: Ethnic Identity, Perceived Discrimination, Mainstream Comfort, and Social Affiliation. Participants were asked to report on a Likert-type scale (0 = strongly agree to 5 = strongly disagree) the degree to which they agreed with each item. In this study, subscales representing the two constructs of interest, ethnic identity (Ethnic Identity, Cronbach’s α = .88) and comfort with the majority culture (Mainstream Comfort, Cronbach’s α = .80), were used. The construct of ethnic identity reflects the degree to which the participant affiliates with her ethnic group, including pride in her background and ethnic activities. Mainstream comfort reflects a sense of comfort with the American culture and the degree to which the participant beliefs herself to be a typical American.

Data Analysis

All data were analyzed with SPSS v. 22. First bivariate associations were assessed between responses to disclosure scales, ethnic identity scales, and symptoms of PTSD and depression with Pearson correlations. The rest of the analyses were carried out with hierarchical ordinary least squares regressions. Two regressions were run for each negative responses subscale (i.e., Blame, Treat Differently, Distraction, Taking Control, and Egocentric Reaction): one with depression and the other with PTSD symptoms as outcomes. Step 1 of each regression included covariates (demographic characteristics, type of assault, and the relationship between the first disclosure recipient and the victim), the main effects for ethnic identity, mainstream comfort, and one negative response to disclosure subscale. Covariates were selected based on past literature on variables associated with victim functioning to establish that the current findings predicted PTSD and depression over and above known risk factors (Ahrens et al., 2009; Bownes, O’Gorman, & Sayers, 1991; Filipas & Ullman, 2001). The second step of each regression included two interaction terms: between ethnic identity and the negative responses subscale and between mainstream comfort and the negative responses subscale. Interaction terms between responses to disclosure and ethnic identity and mainstream comfort subscales were created by centering and multiplying the interacting predictors (e.g., victim blame by ethnic identity; Cohen, Cohen, West, & Aiken, 2003).

Significant interactions were plotted using the “pick a point” approach with zero (the response not provided by the first disclosure recipient) and high (one standard deviation above the mean) levels of responses to disclosure; and low (one standard deviation below the mean) and high (one standard deviations above the mean) levels of ethnic identity and mainstream comfort (Bauer & Curran, 2005; Cohen et al., 2002; Rogosa, 1980). These values were selected because they represent meaningful comparison points for experiences of women in the sample and help graphically demonstrate the findings. Significant interactions were followed up with simple slope analyses to clarify whether the relationship of ethnic identity and mainstream comfort with depression and PTSD was significant at different levels (zero, average, and high) of negative responses (Bauer & Curran, 2005; Cohen et al., 2002; Rogosa, 1980). A significant slope at one level of negative response (zero, average, or high) suggests that the relation between the predictor (ethnic identity or mainstream comfort) and the outcome (PTSD or depression) is significant at that response level. Conversely, a nonsignificant simple slope of the relation between ethnic identity or mainstream comfort and the outcome means that there is no significant association at that response level. Although simple slopes were tested for zero, average, and high numbers of responses to disclosure, for parsimony and ease of interpretation, only zero and high levels were graphed.

Results

Descriptive Statistics and Bivariate Associations

Two hundred twenty-one participants reported a history of sexual victimization. The most traumatic sexual experiences of the participants were 41% sex play by either pressure or force, 20% attempted intercourse by either force or drugs, 20% intercourse due to pressure, and the rest 17% experienced intercourse or other sex acts due to force or drugs (n = 5 individuals could not qualify their experience). Thirty-nine percent reported experiencing more than one type of victimization.

Seventy-five percent of those with a history of sexual victimization reported that they disclosed the most traumatic victimization experience. Fifty-two percent disclosed their experience within a week of the assault, 26% within a year, and 22% waited over a year. Most (63%) victims who disclosed did so to a female friend. Seventy-three percent of women reported at least one reaction of distraction, 43% reported at least one egocentric reaction, 25% reported at least one response of blame, 25% reported at least one response of being treated differently, and 43% reported at least one response of the disclosure recipient taking control of the situation. Bivariate associations between demographics, negative responses to disclosure, ethnic identity, mainstream comfort, and symptomatology are presented in Table 1.

Table 1.

Correlations Between Demographics, Negative Responses to Disclosure, Ethnic Identity, Mainstream Comfort, and Symptomatology.

	1	2	3	4	5	6	7	8	9
1. PTSD	—
2. BDI-II	.61***	—
3. Blame	.23**	.24**	—
4. Treat differently	.18*	.19*	.27***	—
5. Egocentric	.28***	.15	.08	.04	—
6. Distraction	.24**	.20*	.19*	−.06	.09	—
7. Control	.27***	.22**	.39***	.55***	.16*	.19*	—
8. Ethnic identity	−.06	−.01	−.15	−.06	−.20**	−.14	−.05	—
9. Mainstream comfort	.07	.06	−.02	.13	.02	−.04	.10	−.16*	—
10. Disclosed assault^a	−.11	.01	NA	NA	NA	NA	NA	−.08	.18*
11. New York	.16*	.23***	−.06	−.02	.17*	−.04	.07	.07	−.12
12. Age	−.06	−.05	−.01	−.03	−.18*	−.08	−.14	.07	.17*
13. Non-White	.19**	.17*	−.03	.05	.07	.16*	.03	−.10	.20*
14. Hispanic	−.02	.03	−.08	−.09	−.01	−.10	.01	.10	−.04
15. Immigrant	.02	−.01	.05	.01	−.12	.05	.09	−.09	.34***
16. Disclosed after year	.35***	.15	−.01	.02	.04	.14	.00	−.14	.10
17. Disclosed to other than friend	.20**	.09	.18*	.15	.25**	−.06	.16*	−.08	.06
18. Assailant used force	.20**	.11	−.08	−.10	.09	.01	.04	.01	−.06
19. Intercourse assault	.12	.19**	.16*	.14	−.02	.14	.18*	.06	−.12

Note. NA = not applicable because those victims who did not disclose the experience did not have any responses to disclosure to report. Numbers (1-9) in the first row of the table refer to the variables with the corresponding numbers in the first column. Chi-square analyses (not shown) were run to assess whether the likelihood of disclosure differed by assault characteristics (use of force and intercourse), race, ethnicity, and immigrant status, and these were not significant. PTSD = posttraumatic stress disorder symptoms; BDI-II = Beck Depression Inventory-II.

The experience the victim reported to be most traumatic.

p < .05. **p < .01.***p < .001.

Interaction of Negative Responses to Disclosure With Ethnic Identity and Mainstream Comfort Predicting PTSD Symptoms

Table 2 shows that ethnic identity buffered the association between high numbers of distraction, egocentric reaction, and control responses from the first disclosure recipient and symptoms of PTSD. As can be seen in Figure 1, for those women who experienced high numbers of control, egocentric, and distraction responses, a more developed sense of ethnic identity is associated with fewer symptoms of PTSD (simple slopes analyses of the relation between ethnic identity and PTSD at high level of responses: control [t = −2.23; p < .05]; egocentric [t = −1.99; p < .05]; distraction [t = −2.36; p < .05]). Ethnic identity was not protective against symptoms of PTSD for women who received no or an average number of these negative responses (simple slopes analyses of the relation between ethnic identity and PTSD at zero responses: control [t = .67; p > .10]; egocentric [t = 1.25; p > .10]; distraction [t = 1.14; p > .10]; simple slopes analyses of the significance of the relation between ethnic identity and PTSD at the average number of responses: control [t = −.85; p > .10]; egocentric [t = −.28; p > .10]; distraction [t = −.42; p > .10]).

Table 2.

Interactions between Negative Responses to Sexual Victimization Disclosure Subscales and Ethnic Identity and Mainstream Comfort Predicting Symptoms of PTSD.

	Negative Responses to Disclosure (β)
	Blame	Treat Differently	Egocentric	Distraction	Take Control
Step 1
New York	.06	.07	−.01	.10	.04
Age	−.10	−.10	−.10	−.08	−.07
Non-White	.16*	.15^†	.17*	.11	.16*
Hispanic	.04	−.00	.05	.05	−.01
Immigrant	.05	.03	.09	.01	−.01
Waited over a year to disclose	.32***	.31***	.33***	.30**	.32***
Disclosed to someone other than a friend	.03	.05	.02	.10	.04
Assailant used force	.14^†	.13^†	.12	.09	.13^†
Ethnic identity	.00	−.07	−.02	−.03	−.06
Mainstream comfort	.06	.03	.02	.08	.04
Negative response	.25**	.12	.22*	.17*	.22**
Step 2
Ethnic identity by negative response interaction	−.07	−.13	−.17*	−.17*	−.18*
Mainstream comfort by negative response interaction	−.14^†	.08	−.04	−.12	.07
Adjusted R²	.24***	.17***	.21***	.22***	.23***
Second step R² change	.02	.01	.03^†	.04*	.03^†

Note. PTSD = posttraumatic stress disorder.

†

p < .10. *p < .05. **p < .01. ***p < .001.

Figure 1.

For those victims who receive high numbers of negative response, a stronger ethnic identity protects against PTSD symptomatology.

Significant interactions were not present for responses of victim blame and differential treatment after disclosure. In multivariate analyses, there was no main effect of being treated differently on symptoms of PTSD (β = .12; p > .10), but blame was positively associated with symptoms (β = .30; p < .001).

Interaction of Negative Responses to Disclosure With Ethnic Identity and Mainstream Comfort Predicting Symptoms of Depression

Symptoms of depression were predicted by the interaction of distraction and mainstream comfort (see Table 3). Victims who received no or average distraction responses reported higher levels of depression if they were more comfortable with the mainstream society than if they were less comfortable with the mainstream (Figure 2; simple slope analyses of the relation between mainstream comfort and PTSD at zero distraction [t = 3.99; p < .00]; simple slope analyses of the relation between mainstream comfort and PTSD at average distraction [t = 2.71; p < .00]). These associations were not present for those reporting high numbers of distraction responses (simple slope of the relation between mainstream comfort and PTSD at high distraction [t = .04; p > .10]). Multivariate analyses showed that egocentric reactions (β = .10; p > .10) and being treated differently (β = .08; p > .10) were not associated with depression; however, experiencing blame (β = .25; p < .01) and control (β = .23; p < .01) are positively associated with symptoms of depression.

Table 3.

Interactions between Negative Responses to Sexual Victimization Disclosure Subscales and Ethnic Identity and Mainstream Comfort Predicting Symptoms of Depression.

	Negative Responses to Disclosure (β)
	Blame	Treat Differently	Egocentric	Distraction	Take Control
Step 1
New York	.21*	.24*	.19^†	.27**	.20*
Age	−.03	−.03	−.03	.00	−.02
Non-White	.10	.10	.10	.06	.11
Hispanic	.04	−.01	.04	.05	.00
Immigrant	−.05	−.06	−.03	−.07	−.08
Waited over a year to disclose	.12	.10	.10	.10	.11
Disclosed to someone other than a friend	.06	.09	.09	.14^†	.08
Sexual intercourse victimization	.19*	.22*	.23**	.23**	.18*
Ethnic identity	.04	−.03	−.00	.01	−.01
Mainstream comfort	.17*	.15	.14^†	.17^†	.16^†
Negative response	.23**	.06	.09	.17^†	.13
Step 2
Ethnic identity by negative response interaction	−.08	.12	−.08	−.07	−.14^†
Mainstream comfort by negative response interaction	−.05	−.11	−.03	−.21**	.00
Adjusted R²	.17***	.12**	.11**	.20***	.13**
Second step R² change	.01	.01	.01	.05*	.01

†

p < .10. *p < .05. **p < .01. ***p < .001.

Figure 2.

Comfort with mainstream culture is positively associated with symptoms of depression for those who receive few distraction responses.

Discussion

The current study examined whether ethnic identity and comfort with the majority culture buffered the associations between negative responses to sexual assault disclosure and symptoms of PTSD and depression in a diverse sample of undergraduate women. The findings suggest that a strong sense of ethnic identity buffers against symptoms of PTSD, but not depression, for women who report negative responses from the first person to whom they disclose an experience of sexual victimization.

In the current study, a strong sense of ethnic identity was protective against PTSD symptoms when the disclosure recipient provided a high number of responses that took control of the victim’s situation, distracted the victim from her experience, or were egocentric. Experiences of sexual victimization frequently include a sense of lost control in a threatening situation, and survivors’ symptoms of PTSD (e.g., reexperiencing, avoidance) are associated with attempting to control responses to trauma cues (Gershuny, Cloitre, & Otto, 2003). The three types of negative responses may reinforce the victims feelings of helplessness because they represent the disclosure recipient’s attempt to control the survivor, her functioning, and her disclosure experience: (a) by communicating that the survivor is helpless and needs protection (taking control), (b) by suggesting that the victim should have moved on from the sexual assault experience and should no longer bring it up (distraction), and (c) by communicating that the recipient’s reactions are more important than what had occurred to the victim and warrant the victim’s sympathy during the disclosure experience (egocentric). A strong sense of ethnic identity may be indicative of a developed sense of self which may help the survivor remain resilient in the face of others’ attempts to control her (Dumas, Ellis, & Wolfe, 2012). Drawing from the literature on discrimination, ethnic identity may also help the victim depersonalize controlling and invalidating messages and attribute them to perceptions of her ethnic or gender group (Brondolo et al., 2009; Phinney, 1990) and in turn minimize self-blame, which is a risk factor for PTSD symptomatology (Ullman et al., 2007). Although gender affiliation was not assessed in the current study, it is possible that women who identify more strongly with their ethnicity have a stronger affiliation with being a female in their culture and attribute the taking control, distraction, and egocentric messages to their gender rather than to the stigma of the victimization experience, and in turn experience fewer symptoms. Alternatively, it is possible that women who affiliate more strongly with their background are also higher on other protective attributes such as self-esteem and general well-being (Brondolo et al., 2009; Martinez & Dukes, 1997; Phinney, Cantu, Lou, & Kurtz, 1997; Roberts et al., 1999), which help buffer the negative messages they experience and are associated with fewer symptoms of PTSD.

In addition, in the current study, ethnic identity was assessed across cultures without considering the person’s unique background. Therefore, the findings suggest that a sense of connection with one’s background may be protective across ethnicities. Perhaps victims with a stronger sense of affiliation are also embedded within a network of social support (Phinney & Ong, 2007), which is protective against PTSD symptomatology (Fazel, Reed, Panter-Brick, & Stein, 2012; Pietrzak et al., 2014), and may help minimize the consequence of receiving a high number of negative messages from the first disclosure recipient.

Responses of blame were associated with elevated symptoms of PTSD and depression and these relationships were not buffered by ethnic identity. Research shows that blame may be received differently by victims than other types of negative responses (Ahrens et al., 2009; Campbell et al., 2001). Although victims typically perceive egocentric responses, distraction and taking control, negatively, these responses may also be seen as helpful by some survivors (Ahrens et al., 2009; Campbell et al., 2001). Blaming reactions, however, are consistently perceived as negative by victims. Perhaps a sense of cultural identity is not sufficiently potent to buffer the more stigmatizing response.

Furthermore, a strong sense of ethnic identity did not protect women against symptoms of depression in response to negative responses to disclosure. Furthermore, a comfort with mainstream culture was associated with higher levels of depressive symptoms for women who received fewer responses of distraction. An in-depth study of victims of sexual violence found that distraction can be perceived positively by some survivors (Ahrens et al., 2009). In the qualitative portion of the Ahrens and colleagues’ (2009) study, one survivor expressed that family efforts to distract her helped her not “to talk about it anymore” (p. 90). Given these previous findings and the results of the current study, it may be that some types of distraction and/or some amount of distraction are helpful and perhaps minimizes rumination. Rumination on negative life-experiences is associated with elevated symptoms of depression among women (Nolen-Hoeksema, 2001). Therefore, it may be that when those victims who affiliate strongly with the U.S. culture and are also in tune with the messages of victim blame (Rozee & Koss, 2001) receive no distraction, they tend to ruminate and experience symptoms of depression.

The rate of sexual victimization (37%) endorsed by women in the current sample is consistent with other studies of college samples (Orchowski et al., 2013), highlighting the importance of studying this population. Consistent with other studies, a majority of victims disclosed their experience to a female friend (Ahrens et al., 2007; Filipas & Ullman, 2001; Ullman, 1996; Ullman et al., 2007). However, this is one of the few studies to focus on the first disclosure (Ahrens et al., 2007) and adds to the literature knowledge that female friends are disproportionally the first disclosure recipients who in that role communicate messages about blame and coping to the victim. These findings highlight the importance of considering these messages from a broader cultural and public health perspective and educating the general population about sexual victimization.

The clinical implications of the current study point to the importance of considering the postassault experiences of victims within the cultural context. In light of the American Psychological Association’s (2009) focus on cultural competence in psychological practice, this study highlights the importance of considering the ethnic identity of sexual assault victims as a possible protective mechanism against the negative messages they receive from those around them. The findings of this study are consistent with prior research on the link between messages of blame and control and survivor’s symptomatology, which is an important consideration for clinicians (Jackson, Witte, & Petretic-Jackson, 2001; Ullman et al., 2007).

The conclusions of the current work should be considered in light of limitations. This was a study of undergraduates in Eastern universities in the United States, and the findings may not generalize to women living in other parts of the United States and those of other developmental stages. This was a cross-sectional data collection and the temporal relationship between symptoms, reports of responses to disclosure, and ethnic identity and mainstream comfort cannot be disentangled. Longitudinal studies would greatly add to this body of literature and help understand the relationships between symptomatology, responses to disclosure, and cultural constructs. In addition, the current conceptualization of ethnic identity and mainstream comfort examined these constructs across cultures and did not take into consideration the unique experience of individuals from different cultures, races, and ethnicities. Future studies with large sample sizes of individuals from different backgrounds could help understand whether the association between ethnic identity, responses to disclosure, and symptomatology is consistent across backgrounds. Although the diverse sample of the current study is a strength of the current work that suggests that, to some extent, identifying with one’s background may be protective across different cultures, future research should also consider within-group and within-culture differences.

Despite the above limitations, this is one of the few studies to consider the associations between responses to disclosure of sexual victimization and symptomatology from a cultural lens and to study the role of ethnic identity in these associations. It highlights the importance of ethnic identity in the private experience of the victim and the messages she receives from those around her. Although sexual assault is a deeply intimate and private violation, it is laden with cultural messages of responsibility and recovery that influence victim outcomes (Campbell et al., 2009). The current findings suggest that the victim’s own sense of belonging and identity could help counter some of these negative messages. The findings highlight the importance of culturally minded examinations of responses to disclosure and victim symptomatology.

Footnotes

Acknowledgements

The authors thank the women who participated in this study and shared their victimization experiences with the researchers. The authors also thank the psychology departments of the involved institutions for supporting this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Valentina Nikulina, PhD, is an assistant professor in the Psychology Department at Queens College and the Graduate Center at the City University of New York. Her research examines the consequences of traumatic experiences from an ecological perspective. She is also interested in efficacy-based treatment of trauma sequelae.

Adrian Bautista, BA, graduated with an undergraduate degree in psychology from Queens College at the City University of New York. His research interests are in the contributions of cultural factors to the etiology and outcomes of severe psychopathology. He has extensive clinical experience in working with individuals with developmental disabilities.

Elissa J. Brown, PhD, is the founder and executive director of the Child HELP Partnership and professor of Psychology at St. John’s University in New York City. Her primary clinical and research interests include the prevention and treatment of child trauma and posttraumatic stress disorder. She has participated in research on the assessment and treatment of sexual assault, child physical abuse, and bereavement related to traumatic circumstances, such as September 11, 2001.

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