Sexual Assault Among Women in College: Immediate and Long-Term Associations With Mental Health,Psychosocial Functioning,and Romantic Relationships

Abstract

The current study sought to examine immediate and long-term consequences of college sexual assault (C-SA) among women with no prior sexual assault history. While much is known regarding the short-term negative impact of C-SA, the current study examines whether C-SA is associated with immediate academic and psychosocial consequences as well as long-term poorer mental health (depression, posttraumatic stress [PTS], anxiety) and interpersonal functioning (relationship quality, sexual and emotional intimacy). In addition, the current study explores potential moderators of these associations, including race, the nature of the assault, resulting injury, relation to perpetrator, and whether the assault was reported. A stratified design was used comparing women who experienced C-SA (n = 201) to women with no C-SA history (n = 203) controlling for age, education, race, and ethnicity. Results from a series of repeated-measures analyses of variance (ANOVAs) demonstrated that across race and ethnicity, women with a history of C-SA reported lower grade-point averages, more missed classes, and fewer serious romantic relationships in college following the assault. Furthermore, results from a series of linear and logistic regression revealed that approximately 9 years later, women who experienced C-SA reported greater symptoms of depression, anxiety, and PTS as well as lower emotional and sexual intimacy. These associations differed by a number of assault variables (assault type, relation to perpetrator, amount of fear reported, physical injuries sustained, whether the assault was reported, whether medical treatment was sought). The current study further confirms the significant and pervasive impact of C-SA associated with women’s health and functioning, warranting further intervention to both reduce the incidence of C-SA and expand the reach of existing mental health interventions to survivors.

Keywords

sexual assault rape college sexual assault mental health academic functioning relationship functioning

The prevalence of sexual assault among women in the United States is disconcertingly high, with one in six women identifying as a survivor of an attempted or completed sexual assault (Sinozich & Langton, 2014). Because sexual assault is vastly underreported, the actual assault rates are likely even higher (Kilpatrick, 2000). Given the momentum and focus on increasing sexual assault awareness nationwide, including public policy efforts aimed at preventing sexual assault across the United States both on and off college campuses (e.g., #MeToo movement), it is important to achieve a comprehensive understanding of the immediate and long-term impact of women’s sexual assault.

College-age women (i.e., 18-24 years of age) are more likely to be the victim of sexual assault compared to women of other ages (Sinozich & Langton, 2014), with 23% to 50% of college women experiencing a completed sexual assault through physical force, violence, or incapacitation (Cantor et al., 2015). Indeed, the college years—especially the first year of college—is the highest risk period for sexual assault (Rickert, Vaghan, & Wiemann, 2002). More than half of cases of sexual assault during college (C-SA) are committed by well-known or casual acquaintances, with an additional 24% instigated by an intimate romantic partner (Sinozich & Langton, 2014). C-SA results in physical injuries (e.g., deep tissue bruising, lacerations, strangulation, broken bones) in 57% of cases, leading approximately 40% of students to seek medical attention (Sinozich & Langton, 2014). Despite the high rates and severity of C-SA, only one-fifth of college women report the assault to campus police or local law enforcement (Sinozich & Langton, 2014), though it is possible that these women reported their assaults to other sources (e.g., Title IX officer, faculty member).

Mental Health Consequences

Sexual assault is consistently linked with numerous mental health symptoms and disorders (Campbell, Dworkin, & Cabral, 2009). Posttraumatic stress disorder (PTSD) has been found to be the most common consequence of sexual assault among adult women, with as many as 65% of female survivors meeting diagnostic criteria for PTSD within days, weeks, months, or even years after the event (Campbell et al., 2009). Survivors of sexual assault often also develop symptoms consistent with major depressive disorder (13%-51%) and substance abuse (alcohol use disorder [13%-49%]; illicit drug abuse [23%-44%]; Kirkner, Relyea, & Ullman, 2018). While mental health symptoms remit in some survivors, 43% of women continue to report depressive symptoms 20 years following an assault (Kilpatrick, Saunders, Veronen, Best, & Von, 1987); additionally, PTSD, fear and anxiety, and suicidality are found to persist well beyond the time of the assault (Koss & Figueredo, 2004).

Blame for the C-SA is often directed by friends, family, or health care professionals (Campbell et al., 2009). Following these overt or covert messages of responsibility and blame, survivors internalize stigma and guilt (Campbell et al., 2009), leading not only to greater impairment in mental health (Deitz, Williams, Rife, & Cantrell, 2015) but also reduced treatment seeking (Patterson, Greeson, & Campbell, 2009) and likelihood of reporting the sexual assault to authorities (Miller, Canales, Amacker, Backstrom & Gidycz, 2011).

The chronicity and impairment of mental health symptoms have been associated with the severity of the sexual assault (Bownes, O’Gorman, & Sayers, 1991). Greater sustainment of physical injury and perception that one’s life was at risk during the assault have also been linked to greater PTSD symptom severity (Ullman & Filipas, 2001). Furthermore, research has demonstrated that lesbian or bisexual women, compared to heterosexual women, experience greater psychological symptoms and greater difficulty recovering following sexual victimization. Furthermore, Black lesbian or bisexual women have more negative outcomes compared to White lesbian or bisexual women (Sigurvinsdottir & Ullman, 2015). In contrast, age, type of sexual assault (i.e., penetrative versus nonpenetrative), and relation to the perpetrator does not predict differential symptom severity (Ullman & Filipas, 2001). However, few studies have addressed more nuanced severity indicators such as assault severity, whether or not mental health treatment was sought, whether the assault was reported, or whether more than one type of assault in a single event are associated with greater declines in functioning.

Interpersonal Consequences

Survivors of sexual assault tend to retract from social engagement, especially if accompanied by comorbid depressive symptoms (Nguyen et al., 2017). Survivors also commonly experience social stigma or blame upon endorsing or reporting a sexual assault (Kelley & Gidycz, 2017), which further exacerbates the tendency of survivors to socially withdraw. In fact, as many as 61% of survivors refrain from reaching out to even a single social support (Dworkin, Newton, & Allen, 2018). This withdraw likely contributes to difficulty engaging with romantic partners. Indeed, the experience of sexual assault is associated with emotional distancing, fear and mistrust of others (including the romantic partner), and difficulties with emotional intimacy (Georgia, Roddy, & Doss, 2018). In addition, survivors of sexual trauma report sex or physical intimacy with their current partners to be burdensome and/or physically painful (Goodcase, Love, & Ladson, 2015). Women with a history of adult sexual assault report higher levels of sexual dissatisfaction (De Silva, 2001), lower frequency of sex (Georgia et al., 2018), and higher levels of anxiety during sexual activity (Jozkowski & Sanders, 2012). As a result, global relationship satisfaction is impacted (Georgia et al., 2018; Godbout, Sabourin, & Lussier, 2009).

Academic Functioning

A third important area of functioning often impacted by C-SA is academic functioning. C-SA is associated with a decline in academic performance (Jordan, Combs, & Smith, 2014), including poorer class attendance, decreased quality and quantity of work (van Roosmalen & McDaniel, 1998), and ultimately lower rates of graduation (Potter, Howard, Murphy, & Moynihan, 2018). Furthermore, women experiencing penetrative sexual assault (as opposed to nonpenetrative) subsequently earn lower grade-point averages (Jordan et al., 2014). Studies examining the pathways through which sexual assault impacts academic functioning indicate that C-SA’s negative impact on psychological symptoms, lower academic satisfaction, and physical health symptoms create disengagement from the scholarly environment and subsequent decline in performance (Huerta, Cortina, Pang, Torges, & Magley, 2006).

Limitations of the Extant Literature

The extant research is not without limitation. First and most importantly, most previous research has, on these three domains, focused on the impact of sexual assault occurring during childhood or combined sexual assaults occurring in childhood and adulthood. However, the age at which women typically attend college (i.e., 18-24 years) is described as an important time period for identity exploration and development regarding personal relationships, education, and family as well as an internal value system, self-esteem, and self-reliance (Arnett, 2000; Zuschlag & Whitbourne, 1994). Therefore, it is important to elucidate the impact of a first instance of sexual assault occurring during this time. Furthermore, research on the long-term impacts of C-SA is lacking. In addition, while there have been links demonstrated between the severity of sexual assault and subsequent outcomes (e.g., mental health—Ullman & Filipas, 2001; academic functioning—Jordan et al., 2014), previous studies have also not examined the moderating effect of assault severity on long-term relationship outcomes. Finally, although rates of sexual assault are generally comparable among non-Hispanic Caucasian, Black, and Hispanic college women (Sinozich & Langton, 2014), it is not clear whether there are racial differences in mental health, relationship, and academic outcomes following C-SA.

The Present Study

The current study sought to more fully examine both the short- and long-term impairments associated with C-SA among women who had not experienced a prior sexual assault. The current study first sought to answer whether C-SA is associated with immediate changes in academic, interpersonal, and romantic functioning in college. Second, the current study examined whether C-SA is associated with mental health and relationship functioning approximately 9 years after college graduation and whether this association is moderated by race or ethnicity. Third, within the sample of women who were assaulted during college, the current study assessed whether assault severity predicts long-term mental health and relationship impairments and whether this association is moderated by race or ethnicity.

Method

Participants

To participate, women had to be between the ages of 28 and 30 years and have at least a Bachelor’s degree. Participants (N = 404) were recruited using a stratified framework such that the number of women with (n = 201) and without (n = 203) C-SA history who identified as Caucasian, Black, and Hispanic were even across categories. As a result, participants were 33.9% Caucasian, 32.7% Black, and 33.4% Hispanic; similarly, 48.9% of the Caucasian, 49.2% of the Black, and 51.1% of the Hispanic women experienced C-SA. Within the sexual assault sample, on average, women participated in this study 8.74 years (Median = 8.395 years) post C-SA. The majority of participants were currently employed full-time (67.3%) with fewer employed as part-time workers (17.8%), full-time homemakers (6.7%), or students (4.5%), and 3.7% unemployed. The majority of participants (57.2%) made less than US$50,000 per year with fewer making US$50 to US$75k per year (29.0%) or greater (13.9%). Finally, 94.1% of the sample held a Bachelor’s degree, while a minority of women had acquired a graduate degree (5.9%). There were no differences in employment, χ²(4) = 3.264, p = .515; income, χ²(6) = 9.225, p = .161; or education, χ²(2) = 2.088, p = .352, between woman with and without a C-SA history. Furthermore, there were no differences in employment, χ²(8) = 7.276, p = .507; income χ²(12) = 10.819, p = .544; or education, χ²(4) = 4.677, p = .322 by race or ethnicity.

Procedures

All procedures were approved by the (redacted) Institutional Review Board. Participants were recruited from throughout the United States through the Amazon Mechanical Turk subject pool from May through August of 2014 and were compensated for their participation. Specifically, six advertisements were created within Amazon Mechanical Turk, one for each combination of race/ethnicity (i.e., Black, White, Hispanic) crossed with experience of C-SA (i.e., presence, absence). Specifically, three advertisements recruited women who “first experienced an episode of sexual assault during college,” and the remaining half recruited women who had “NO history of sexual assault.” Only women who met the eligibility criteria were provided a link to the study survey. Each eligible participant was asked to answer an online survey administered through Qualtrics. As part of the informed consent form, participants were informed that they may experience anxiety, discomfort, and/or distress from some of the questionnaires. Participants were provided with laboratory contact information and provided a list of referrals to websites and appropriate clinical services (Rape, Abuse & Incest National Network [RAINN], suicide hotline, mental health hotline, therapy referrals) upon request.

Women in the C-SA group retrospectively reported on multiple domains of functioning in three time periods: (1) from the start of college through their first sexual assault in college, (2) following the assault through college graduation, and (3) current day. Women in the no-C-SA group reported on the same domains, but instead of answering questions relative to timing of assault history, they reported on each year of college (separately) as well as current functioning.

Following data collection, time periods were matched across groups. Control participants with no sexual assault history were randomly matched within racial/ethnic groups to C-SA participants, and their reports of each academic year were collapsed to correspond to the periods before/after the sexual assault of their matched C-SA participant. For example, for a control participant matched to a participant who experienced C-SA during her second year, the data from the control participant’s first year and first semester of second year were combined into the “before” period, and the remainder of her college career was combined into the “after” period.

Measures

Demographic information

Participants reported general demographics including age, ethnicity, highest educational level, current relationship status, employment, and income.

Assault information

Participants in the C-SA group provided information about the timing of the C-SA relative to the academic year of college, the assault type (e.g., oral, anal, vaginal, nonpenetrative), the severity of the assault based on a one-item Likert-type scale assessment of experienced fear, helplessness, and/or horror; their relation to the perpetrator (e.g., stranger, acquaintance, etc.); whether physical injuries resulted from this assault; whether they reported this assault to authorities; and whether they sought medical treatment following the assault.

Among the women who had experienced C-SA (50.2%), the majority were assaulted vaginally (60.7%), while the remainder were assaulted orally (6.4%), anally (13.9%), or nonpenetratively (e.g., unwanted groping: 9.0%). About one quarter of women (26.3%) experienced more than one type of penetrative assault in a single event (e.g., both oral and vaginal assault versus oral assault only). The majority of women (63.7%) were assaulted by someone they knew (44.3% friend or acquaintance; 1.5% family member; 10.9% romantic partner at the time of assault; 7% former romantic partner at the time of assault), while 22.9% were assaulted by a stranger. Two-thirds of women (76.6%) sustained a physical injury during the assault, ranging from scrapes, scratches, or bruises to broken bone(s). Most women (65.2%) did not report the assault to campus police or local law enforcement. When asked how fearful, helpless, or horrified they felt during their assault(s) on a Likert-type-scale from 1 (not at all afraid) to 7 (extremely afraid), women endorsed being very afraid during the assault (M = 6 [very afraid], Range = 5 [mostly] to 7 [extremely]). Among the women who had experienced C-SA, 16.7% reported experiencing at least one subsequent penetrative sexual assault after college graduation, with 18.4% reporting at least one subsequent nonpenetrative sexual assault after graduation.

PTS symptoms

Current PTS symptoms were measured using the PTSD–eight items (PTSD-8; Hansen et al., 2010); this measure used Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria (Mollica et al., 1992) as data collection for the current study occurred prior to the release of Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). The PTSD is highly correlated with both the Harvard Trauma Questionnaire (HTQ) and the Trauma Symptom Checklist-23 (Hansen et al., 2010). Per Hansen et al. (2010), the PTSD-8 measure was originally validated in a sample of rape survivors at 3 months post-rape. In the current sample, Cronbach’s alpha was .934. The mean score was 4.49 (SD = 5.72) for individuals without C-SA and 8.97 (SD = 6.77) for individuals with C-SA, both of which are below the typical cutoff score of 18. Thus, the majority of participants likely do not meet diagnostic criteria for PTSD per DSM-IV criteria.

Depressive symptoms

Women reported on their current depressive symptoms on a Likert-type scale from 0 (rarely/none) to 3 (most of the time) using the 10-item Center for Epidemiologic Studies–Depression scale (CES-D; Cole, Rabin, Smith, & Kaufman, 2004). In this sample, reliability was good (Cronbach’s alpha = .836). Scores above 11 are indicative of clinical depression (Cole et al., 2004); the average depression score in this sample was 6.98 (SD = 6.10) for women without C-SA and 10.45 (SD = 6.75) for women with C-SA.

Anxiety symptoms

Anxiety symptoms were measured using a seven-item measure of Generalized Anxiety Disorder symptoms (GAD-7; Spitzer, Kroenke, Williams, & Löwe, 2006). The current sample had excellent reliability (Cronbach’s alpha = .929). The average score in this sample was 4.86 (SD = 4.93) for women without C-SA and 7.32 (SD = 5.66) with C-SA. Scores greater than or equal to 10 indicate the possible presence of Generalized Anxiety Disorder, though no diagnoses were confirmed via structured interview in the present study.

Relationship satisfaction

Participants currently in a romantic relationship rated their relationship satisfaction using the four-item Couples Satisfaction Index (CSI-4; Funk & Rogge, 2007). The CSI-4 scale is known to correlate highly with other longer measures of relationship distress. Reliability in this sample was good (Cronbach’s alpha = .702). In the current sample, the average relationship satisfaction was 15.07 (SD = 2.65) for women without C-SA and 14.59 (SD = 3.81), both of which fall within the satisfied range (above 13.5; Funk & Rogge, 2007).

Emotional and sexual intimacy

Women who indicated that they were currently in a romantic relationship reported on the quality of the emotional and sexual intimacy in their current romantic relationship using two subscales (six items each) of the Personal Assessment of Intimacy in Relationships (PAIR; Schaefer & Olson, 1981). Two items were added to the sexual intimacy subscale to assess anxiety and avoidance around sexual intimacy. Reliability was acceptable to good in this sample for emotional and sexual intimacy subscales (Cronbach’s alpha = .69 and .87, respectively).

Problematic alcohol and substance use

Women reported problematic alcohol or substance abuse using three items corresponding to DSM-IV-TR (text revision; American Psychiatric Association, 2000) substance abuse diagnostic criteria: “How many times did you miss work or school because you were intoxicated, high, or very hungover—or did a bad job at work or fail courses because of drinking or other substance use?” “How many times did you drink or use substances in situations in which it might have been dangerous to drink at all (e.g., driving)?” and “How often did you get into trouble with the law as a result of drinking or substance use?” Each item was analyzed individually.

Psychosocial domains

All women were asked to report the number of casual sexual encounters they engaged in, number of relationships that involved physical aggression, number of serious relationships, and grade-point average (GPA). C-SA women reported on these domains prior to the assault and between the time of the assault and college graduation, while women without C-SA reported on these domains during each academic year of college.

Results

Aim 1: Functioning During College

The study first sought to examine whether women experiencing C-SA, compared with women not experiencing C-SA, saw immediate change in academic, interpersonal, and romantic functioning. A series of repeated-measures 2 × 2 analyses of variance (ANOVAs) assessed the difference in college functioning between women with and without C-SA (“group”) before and after experiencing a sexual assault (“time”). Significant group-by-time interactions were probed for racial/ethnic differences using 3 × 2 × 2 repeated-measures ANOVAs.

Results indicated that there was a significant group-by-time interaction for GPA, F(1) = 27.134, p < .001; days of missed school due to substance use, F(1) = 6.594, p = .011; and number of romantic relationships, F(1) = 24.149, p < .001 (see Table 1 for full results). In all cases, women who experienced C-SA experienced significantly poorer functioning following the assault than did the control group. There were no significant group-by-time interactions for sexual encounters, the number of relationships that involved intimate partner violence, the number of times substances were used in dangerous situations (e.g., driving), or the number of times substance use caused legal trouble (see Table 1). Subsequent group-by-time-by-race repeated-measures ANOVAs revealed no significant differences (see Table 1).

Table 1.

Aim 1—Descriptive Statistics and Repeated-Measures ANOVAs.

	C-SA Group				Non C-SA Group				Time × C-SA Interaction
	Pre ^a		Post ^b		Pre ^c		Post ^d		F	p
	M	SD	M	SD	M	SD	M	SD	F	p
Number of sexual encounters	1.31	2.02	0.76	1.68	1.45	8.13	2.21	16.10	3.65	.06
College GPA	2.89	2.13	1.74	2.13	2.95	1.46	3.23	1.46	27.13	<.001
Number of serious romantic relationships	0.79	1.09	0.37	0.57	0.44	0.43	0.53	0.47	24.15	<.001
Number of relationships with intimate partner violence	0.42	0.94	0.35	0.59	0.07	0.22	0.12	0.64	24.52	<.001
Number of missed college classes due to substance use	0.60	2.18	1.11	2.76	0.53	1.45	0.40	1.15	6.59	.01
Number of instances of substance use in dangerous situations (e.g., driving)	0.65	2.04	1.00	2.74	0.55	2.35	0.65	4.07	0.69	.41
Number of substance-related arrests or legal issues	0.08	0.41	0.06	0.26	0.04	0.19	0.01	0.09	0.25	.61

Note. See text for additional information. ANOVAs = analyses of variance; C-SA = college sexual assault; GPA = grade-point average.

Refers to the period of college pre-assault.

Refers to the period of college post-assault.

Refers to the period of college matched to the pre-assault sample.

Refers to the period of college matched to the post-assault sample.

Aim 2: Long-Term Functioning

Simple linear and logistic regressions examined whether long-term individual and relationship functioning was moderated by history of C-SA. If any variable yielded a significant main effect of C-SA, race and ethnicity and their interactions were added in a multiple regression. Results revealed women who experienced C-SA, compared to those that did not, had significantly greater PTS symptoms (b = 4.482, SE = 0.631, t = 7.710, p < .001), depression (b = 3.464, SE = 0.647, t = 5.353, p < .001), and anxiety symptoms (b = 2.461, SE = .553, t = 4.617, p < .001) about 9 years post-assault. Follow-up analyses revealed that the significant between-group differences did not significantly vary by race or ethnicity.

Women with a history of C-SA who endorsed being in a current relationship, compared to those in a current relationship without a C-SA history, reported significantly lower levels of emotional intimacy (b = −5.261, SE = 0.453, t = −11.610, p < .001) and sexual intimacy (b = −2.978, SE = 0.755, t = −3.945, p < .001) with their current romantic partner (approximately 9 years post-assault). Furthermore, the group difference varied by race, such that Black women’s emotional intimacy was significantly less impacted by a C-SA history than was White women’s emotional intimacy (b = 2.392, SE = 1.126, t = 2.124, p = .035) and Hispanic women’s emotional intimacy (b = 2.355, SE = 1.135, t = 2.074, p = .039). Neither race nor ethnicity moderated the group differences in sexual intimacy. Finally, C-SA was not significantly associated with overall relationship satisfaction (b = −0.737, SE = 0.390, t = −1.887, p = .060).

Aim 3: Assault Severity

Within the subsample of women who experienced C-SA, a series of linear and logistic regressions examined whether assault severity moderated the long-term impact of C-SA on mental health, psychosocial, and romantic functioning. Similar to Aim 2, if any variable yielded a significant main effect of C-SA, race and ethnic differences were subsequently tested.

PTS symptoms 9 years post-assault were significantly higher when the assault resulted in physical injury (b = 3.421, SE = 1.577, t = 2.169, p = .031), women experienced more fear at the time of the assault (b = 1.557, SE = .451, t = 3.452, p = .001), and the assault consisted of more than one type of penetrative assault (any combination of anal, vaginal, and/or oral compared with a single assault type; b = 3.963, SE = 1.204, t = 3.292, p = .001). None of these effects significantly differed by race or ethnicity. Similarly, anxiety symptoms 9 years post-assault were significantly higher when women reported more fear at the time of their assault (b = .968, SE = .386, t = 2.509, p = .013) or experienced more than one type of penetrative assault in a single incident (b = 2.794, SE = 1.020, t = 2.741, p = .007); these results did not significantly vary across race and ethnicity. In addition, women reported significantly higher depressive symptoms 9 years after the assault when the assault consisted of more than one type of penetrative assault (b = 2.986, SE = 1.207, t = 2.475, p = .014); this difference did not significantly vary across race and ethnicity. Finally, among those who reported being in a current committed relationship, women whose sexual assault resulted in physical injury reported significantly lower emotional intimacy with their current partner at the time of the study (b = −2.743, SE = 0.861, t = −3.188, p = .002); again, this difference did not vary across race and ethnicity. No severity moderator yielded significant differences in sexual intimacy with one’s current partner at the time of the present study. A summary of all results can be found in Table 2.

Table 2.

Aim 3—C-SA Severity as a Predictor of Long-Term Individual and Relationship Functioning.

Outcome	Predictor	B	SE	T	p
PTS symptoms	Medical care sought	−1.138	1.024	−1.112	.268
	Reported to police	−0.678	1.047	−0.648	.518
	Physical injury sustained	3.421	1.577	2.169	.031
	Assault type	2.173	1.666	1.305	.194
	Multiple penetration	3.963	1.204	3.292	.001
	Relation to perpetrator	−0.671	1.155	−0.581	.562
	Amount of fear	1.557	0.451	3.452	.001
Anxiety symptoms	Medical care sought	0.601	0.851	0.707	.481
	Reported to police	1.092	0.861	1.268	.206
	Physical injury sustained	1.116	1.343	0.831	.407
	Assault type	1.269	1.406	0.902	.368
	Multiple penetration	2.794	1.020	2.741	.007
	Relation to perpetrator	−0.926	0.971	−0.954	.341
	Amount of fear	0.968	0.386	2.509	.013
Depressive symptoms	Medical care sought	0.769	1.021	0.754	.452
	Reported to police	1.512	1.034	1.462	.146
	Physical injury sustained	1.744	1.589	1.097	.274
	Assault type	2.205	1.662	1.327	.186
	Multiple penetrations	2.986	1.207	2.475	.014
	Relation to perpetrator	−1.111	1.150	−0.996	.335
	Amount of fear	0.679	0.462	1.469	.144
Emotional Intimacy	Medical care sought	−0.132	0.584	−0.226	.821
	Reported to police	−0.783	0.596	−1.313	.192
	Physical injury sustained	–2.743	0.861	–3.188	.002
	Assault type	−1.376	0.990	−1.389	.167
	Multiple penetrations	0.854	0.614	1.392	.167
	Relation to perpetrator	0.005	0.648	0.008	.993
	Amount of fear	0.193	0.258	0.749	.455
Sexual Intimacy	Medical care sought	−1.815	1.208	−1.503	.136
	Reported to police	−1.856	1.238	−1.499	.137
	Physical injury sustained	−2.213	1.862	−1.189	.237
	Assault type	−0.280	2.083	−0.134	.893
	Multiple penetrations	−1.785	1.434	−1.245	.216
	Relation to perpetrator	1.915	1.339	1.430	.155
	Amount of fear	0.644	0.537	1.201	.232

Note. C-SA = college sexual assault; PTS = posttraumatic stress.

Statistically significant findings highlighted in bolded text.

Notably, results indicated that those who were assaulted by a stranger reported no differential mental health or relationship functioning on any outcomes compared with those who were assaulted by a friend, family member, or current/past romantic partner. Furthermore, women who sought and received medical care (i.e., from a doctor, clinic, or hospital) after their assault did not differ on any main outcome compared with women who did not seek or receive medical care. Similarly, women who reported their assault to campus police or local law enforcement did not differ significantly on any outcomes compared with those who chose not to report their assault.

Discussion

The current study offers insight into the unique associations between C-SA and short- and long-term impairments in post-assault functioning—separate from the potentially confounding effects of childhood and/or previous sexual abuse. Furthermore, the current study aimed to further disentangle whether these associations differed by race or ethnicity. Overall, results revealed that experiencing a college C-SA is associated with short-term declines in college academic achievement and serious romantic relationships. In addition, experiencing C-SA was associated with poorer long-term mental health and romantic relationship functioning. Furthermore, only one of these differences significantly varied by race or ethnicity, suggesting that these findings are generalizable important demographic groups.

Short-Term Consequences of C-SA

Women with a college assault history, compared to those without a history of C-SA, have fewer serious romantic relationships after their assault than in the period of college prior to their assault. This result is consistent with previous findings that sexual assault is associated with increased negative communication and hostility between romantic partners (Marshall & Kuijer, 2017), increased substance use, and hypervigilance about emotional or physical closeness (De Silva, 2001), which subsequently lessens relationship quality. Therefore, it is possible that women who experience a C-SA might be less motivated to pursue, or able to maintain, serious romantic relationships.

Women in the present study reported a higher frequency of missed class due to alcohol or substance use after C-SA, consistent with previous research showing that sexual assault is associated with an increased likelihood of depression and substance abuse (Kirkner et al., 2018). In previous studies, when women report using alcohol as a means of managing their mental health symptoms, sexual assault was associated with greater number of missed classes or work days attributable to substance use (Hannan, Orcutt, Miron, & Thompson, 2017). However, the current study did not find that experiencing C-SA was associated with higher frequency of substance use in dangerous situations (e.g., drinking while driving) or higher frequency of legal trouble due to substance use (e.g., getting a DUI or disorderly charge), perhaps because women did not report high levels of problematic substance use.

In addition, and consistent with previous findings (Baker et al., 2016; Jordan et al., 2014), women who experienced C-SA saw significant decreases in their GPA in the period of college after the assault. While all participants in the current study graduated college (as an eligibility requirement), C-SA is associated with increased risk of college dropout in part because of a reduction in GPA (Baker et al., 2016).

Long-Term Consequences of C-SA

While many studies have established the immediate or short-term impacts of sexual assault, fewer have researched its associations with long-term functioning. The present study revealed that, several years after graduation (which was on average almost 9 years post-assault), C-SA was significantly associated with greater symptoms of PTS, depression, and anxiety and, for those in a current romantic relationship, poorer emotional and sexual intimacy. Although women in the current study generally fell below the clinical cutoffs on measures of PTSD and depressive symptoms, previous research has consistently demonstrated that experiencing a sexual trauma is significantly associated with an increased risk for developing depression and PTSD (Kilpatrick, 2000). It is likely that C-SA is significantly associated with long-term deficits in relationship functioning given that women who endure sexual trauma are less likely to communicate effectively with later romantic partners, report poorer self-esteem, have increased irritability toward romantic partners, and experience hypervigilance in the face of emotional and sexual intimacy (De Silva, 2001). Marshall and Kuijer (2017) suggest that possible mechanisms of this phenomenon may include low self-esteem resulting from the assault, substance use to cope with the aftermath of trauma, depression, fatigue, anhedonia, flashbacks, shame, guilt, avoidance, anger, and anxiety about one’s prognosis.

The negative associations with C-SA were generally consistent across race and ethnicity; however, in the current sample, Black women’s emotional intimacy was significantly less impacted by C-SA compared to both White and Hispanic women. It is possible that Black women who attend college may see greater resilience over time from assault-related trauma in their interpersonal or romantic relationships. Notably, this finding is inconsistent with previous research showing that Black women, compared to non-Black women, experience worse mental health outcomes in the years following sexual assault (Sigurvinsdottir & Ullman, 2015). However, this previous study was conducted among survivors of both childhood and adult sexual assault, potentially confounding the effects of the two types of sexual assault.

Associations Between Assault Severity and Long-Term Functioning

Overall, assault severity did not predict mental and relationship health 9 years after C-SA. Of the analyses run in Aim 3 to determine whether assault severity indicators were associated with post-assault outcomes, only a small minority (16%; 7 of 45) were significant. There were no associations between assault outcomes and whether the perpetrator was a stranger versus an acquaintance, friend, or current/past romantic partner. In contrast, previous research has indicated that assault by an acquaintance, friend, or intimate partner was associated with higher number of reported symptoms (Drakulich, 2015) and more lasting symptoms of both PTSD and depression even 20 years post-assault (Kilpatrick et al., 1987), perhaps because assaults perpetrated by people once trusted as friends or partners were perceived as more violating than an assault by a stranger. Because the majority of women in the current study were assaulted by someone they knew (73.6%), we were likely not powered to detect significant differences in associations between perpetrator relationship and long-term functional impairments; therefore, this lack of association should be interpreted with caution.

Many studies suggest that young women are unlikely to disclose sexual assaults to law enforcement or medical and mental health providers, especially if their assault occurred during a period of substance use or was perpetrated by an acquaintance or romantic partner (Bicanic, Hehenkamp, van de Putte, van Wijk, & de Jongh, 2015). Consistent with previous research, the current study found no relation between whether women sought and received medical care for their assault or reported their sexual assault to law enforcement or campus police and their level of psychosocial, mental health, or academic functioning. These findings can be interpreted as further dispelling the stereotype that if women do not report their sexual assaults to law enforcement or seek immediate medical attention, they were less traumatic or significant (Wolitzky-Taylor et al., 2011). In fact, C-SA is significantly associated with long-term declines in mental health and romantic functioning regardless of whether women reported their assault to law enforcement or campus police.

However, results did reveal a partial pattern in the predictors of long-term outcomes. The most consistent predictor of subsequent functioning was whether women sustained more than one type of penetrative assault (any combination of anal, oral, or vaginal); these women reported greater PTS, depression, and anxiety symptoms about 9 years post-assault compared to women who reported being assaulted either anally, orally, or vaginally. These findings are consistent with previous research showing that penetration assaults are more highly associated with sustained injury (Testa, Vanzile-Tamsen, & Livingston, 2004), which in the current study was associated with greater PTS symptoms and lower emotional intimacy approximately 9 years post-assault. Thus, penetrative assaults may be internalized as more intrusive or distressing than nonpenetrative sexual groping. Finally, consistent with previous research (Ullman & Filipas, 2001), the amount of fear sustained during the assault was significantly associated with greater PTS and anxiety symptomatology 9 years post-assault.

Limitations and Future Directions

The current study is not without limitations. First, the study design poses risk of retrospective bias, given that women who experienced C-SA were asked to report specific details of their assault, their college GPA, number of missed classes, and number of sexual partners throughout college several years after college graduation, and approximately 9 years post C-SA. The trauma literature indicates that memory of traumatic events and their timing are often unreliable due to dissociation and increased stress reactivity, which prevents the event from being fully encoded and integrated (Hardy, Young, & Holmes, 2009). However, there is no consensus on whether memory of sexual trauma specifically may be less vulnerable to traumatic memory impairment compared to nonsexual trauma (Peace, Porter, & ten Brinke, 2008). In addition, it is not clear whether any retrospective bias would attenuate or strengthen the between-group differences or associations found in the present study. Relatedly, because we asked control participants without C-SA to report frequencies of each outcome per year of college, it is possible that women were not cued with sufficient temporal context to be able to report reliably, as some research has suggested that temporal cues serve to improve long-term memory recall of autobiographical details or events (Janssen, Chessa, & Murre, 2006). However, any error in reporting could make it more difficult to detect between-group differences and is thus an unlikely explanation for the significant differences found in the current study. Overall, given this potential recall bias, future research should include more immediate post-assault assessment.

Second, we assumed that by asking participants to report on a sexual assault during college, they would report on the assault that was most impactful to them (in the event they experienced more than one sexual assault). However, we did not explicitly ask participants to report on their most impactful assault. The current study also did not assess for other negative, stressful, or traumatic life events in the 9 years following C-SA which may have significantly impacted the present outcomes assessed. Indeed, if those who experienced C-SA subsequently experienced more traumatic or stressful events, the experience of those events may be a mechanism through which C-SA operates.

In addition, given the self-report nature of this study and the anonymity of MTurk survey participation, an additional limitation is the lack of corroborating evidence that participants’ responses related to sexual assault history, mental health symptoms, race, or ethnicity. Furthermore, by narrowing our sample to women who had obtained a Bachelor’s degree, we may have missed a group of women whose C-SA caused them to drop out of college prematurely. Thus, future research may consider including any woman who matriculated into college to detect even poorer academic outcomes than the current study was able to (e.g., college dropout as a direct or indirect result of C-SA).

Finally, because women were not randomized into the two groups, it is possible that a third variable caused both an increased risk for C-SA and poorer long-term functioning. However, we attempted to protect the results from this study in two ways. First, unlike previous research, the current study was able to provide a more accurate examination of the unique associations with C-SA by excluding women who endorsed a history of childhood sexual abuse or sexual assault prior to entering college. Second, by requiring that all participants have a Bachelor’s degree and by balancing race and ethnicity across the two groups, we controlled for important demographic factors.

Given the long-term associations between C-SA and several domains of functioning, future studies should seek to explore moderators and mechanisms of this effect. Future studies could examine utilization of mental health services and whether these services moderated the associations with poor subsequent functioning. To examine mechanisms of C-SA, future research could explore whether subsequent sexual assaults (either during or following college) or other negative, stressful, or traumatic life events mediate short- and long-term associations of C-SA with mental health and relationship functioning.

Implications

The significant associations between C-SA and negative academic, mental, and relationship health paired with the findings that these associations were generally not moderated by assault type and severity suggest that survivors with a variety of C-SA experiences need to be supported. Based on these results, efforts are essential to reduce the incidence of sexual assault throughout college campuses. One suggestion may be requiring incoming students to receive psychoeducation about the prevalence of C-SA perpetration, the definition and importance of sexual consent, and the short- and long-term impacts of C-SA. Beyond psychoeducation, clinicians are also beginning to explore the use of intervention to reduce the incidence of multiple offenders (e.g., Science-based Treatment and Risk Reduction for Sexual Assault [STARRSA]). Despite the fact that nationwide efforts have been taken toward increasing the number of campus sexual assault services, college supports continue to be significantly underutilized (Holland & Cortina, 2017). Efforts toward increasing awareness of on- and off-campus therapeutic services and widely accessible online resources (e.g., NotAlone.gov, EndRapeOnCampus.org) are therefore critical. Combined with the fact that previous research and the current study demonstrate that few women report their assaults, it may be important for future researchers to consider more anonymous web-based counseling services for processing sexual trauma. Finally, given the prevalence of sexual assault in college women and its long-term associations with mental health and relationship functioning, it is suggested that mental health service providers (both individual and couple therapists) regularly include assessments of sexual assault to better inform their case conceptualizations and treatment plans.

Footnotes

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the University of Miami College of Arts and Sciences Dean’s Summer Fellowship to the second author.

ORCID iD

Karen Rothman

Author Biographies

Karen Rothman, MS, is a doctoral candidate in the Adult Clinical Psychology Division of the University of Miami. Her research interests include romantic relationship functioning in underserved populations, the development and dissemination of couple therapy interventions, and the impacts of traumatic and environmental stress on romantic dyads, with a particular focus on sexual trauma.

Emily Georgia Salivar, PhD, is a faculty member within the Nova Southeastern University Department of Clinical and School Psychology, where she specializes in family and couple research and treatment. Her research interests include advancing the understanding of the impact of interpersonal trauma on romantic relationships, as well as the dissemination of flexible, online couple interventions.

McKenzie K. Roddy, MS, received her BS in psychology and minor in biology from the University of North Carolina at Chapel Hill and MS in Psychology from the University of Miami. She is currently pursuing her PhD in clinical psychology at the University of Miami. Her most recent research focuses on individual mental and physical health outcomes from an online relationship self-help program.

S. Gabe Hatch, BS, is a doctoral student in the Adult Clinical Psychology Division at the University of Miami. His research interests include the implementation of couple therapy interventions using a wide-reach, light-touch, and easy-to-use methodologies to find the minimum effective dose. His interests also include refining the measurement and investigating the etiology of pornography consumption.

Brian D. Doss, PhD, is an associate professor in the Psychology Department at the University of Miami. His research seeks to increase the reach of couple interventions to at-risk or distressed couples, often using technology to bridge barriers to dissemination. He has received multiple grants from the National Institutes of Health and Administration for Children and Families to fund his research.

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