Sexual Assault Survivors’ Perceived Helpfulness of University-Affiliated Resources

Abstract

The goal of this study was to examine sexual assault survivors’ use and perceived helpfulness of university-affiliated resources. Data were collected in online anonymous surveys from women (n = 98) at two universities who experienced a sexual assault during college and used university resources. Participants who perceived university-affiliated survivor resources as helpful had significantly better mental health outcomes than women who perceived resources as unhelpful. The most often used resources were mental health counseling (60.6%) and university health centers (24%). The most helpful resources were survivor advocates, peer counseling, and peer support groups.

Keywords

university resources sexual assault help-seeking

Sexual assault is a major public health concern with many negative consequences. Women aged 18 through 24 are more likely to experience a sexual assault than any other age group of women (Sinozich & Langton, 2014). Approximately 21% of college women experience a sexual assault during their college years (Sinozich & Langton, 2014). The impact of sexual assault on a survivor’s mental health is well documented. Findings from a recent meta-analysis on psychopathology of sexual assault victimization suggest that people who have been sexually assaulted have an increased risk for psychopathology (depression, anxiety, posttraumatic distress syndrome [PTSD], substance use, suicidality, and disordered eating; Dworkin et al., 2017). In addition to affecting mental health, women who have been sexually assaulted during college report a negative impact on academic performance including a significant drop in grade point average and taking longer to complete degrees (Mengo & Black, 2016). Sexual assault during college does not just exhibit immediate consequences but also has implications for a multitude of long-term mental health, physical health, social, and financial consequences for the survivors that extend well beyond the college years (Black et al., 2011).

Most university campuses provide formal resources for survivors of sexual assault (e.g., student health services, mental health counseling, survivor advocates, peer counseling). However, studies consistently demonstrate that the overall rates of campus survivor resource utilization remain low (Sabina & Ho, 2014; Stoner & Cramer, 2019). In a 2016 study of campus resources and mental health of undergraduate students from 28 universities, campuses with more sexual violence resources had lower rates of anxiety, panic attacks, and PTSD reported by sexual assault survivors (Eisenberg et al., 2016). This study did not assess if participants had used any of the survivor resources available to them. Few studies have examined students’ perceptions of university-affiliated survivor resources. The current study aims to add to the extant research by examining sexual assault survivors’ use and perceived helpfulness of survivor resources provided by universities.

Resource Use and Mental Health

Because of the risk of mental health problems resulting after a sexual assault, it may be advantageous for women to seek help and utilize available resources. In a systematic review assessing the effectiveness of mental health interventions for adult female survivors of sexual assault, findings suggested that several treatments may improve mental health post assault: cognitive-behavioral interventions, exposure interventions, eye movement desensitization, or reprocessing interventions (Parcesepe et al., 2015). In the review, only nine articles were identified that met the search criteria (adult female survivors, comparison group, and evaluating effectiveness of intervention on mental health). Considering the severity and frequency of mental health problems following an assault, this suggests a relatively small body of evidence exists that evaluates mental health outcomes following interventions (Parcesepe et al., 2015). No studies have examined whether the use of a university’s survivor resources has an effect on mental health outcomes of college women who have been sexually assaulted (Sabina & Ho, 2014).

Barriers and Facilitators of University-AffiliatedResource Use

Women cite multiple reasons for not disclosing a sexual assault to formal and informal sources after a sexual assault. Among the top reasons are feelings of shame, self-blame, guilt and embarrassment; not wanting friends and family to find out; and thinking the victimization was not serious enough to report (Allen et al., 2015; Stoner & Cramer, 2019; Walsh et al., 2010). Women who experienced unwanted sexual contact were less likely to seek services than women who experienced completed rape (48% vs. 70%; Walsh et al., 2010). Victims who were intoxicated at the time of the rape were less likely to seek health services than women who were victims of rapes involving force or a weapon (Wolitzky-Taylor et al., 2011). College women have reported barriers to seeking services from an on-campus facility, including having only daytime hours of operation, requiring scheduled appointments, having limited emergency services, and having previous negative experiences with providers (Halstead et al., 2018).

Several factors increased the likelihood of formal resource use after sexual victimization. The most common reason that female college students used health services is because they felt they experienced a crime or defined the experience as a rape (Guerette & Caron, 2007; Stoner & Cramer, 2019). Survivors were more likely to seek formal services if they received positive reactions or encouragement from informal support persons, such as friends or family (Guerette & Caron, 2007; Littleton, 2010). Women who experienced greater distress symptoms after an assault were also more likely to seek formal services (Stoner & Cramer, 2019). No studies examined factors such as quality of or perceived helpfulness of services, which may have an effect on facilitators and barriers of service utilization.

Types of Resources Used by Survivors

Representatives from 45 universities in 21 states were interviewed to assess which services were provided for students who experienced dating violence and sexual assault (Sabina et al., 2017). These university representatives reported offering on-campus counseling (80%), on-campus police services (69%), crisis centers (57%), survivor advocacy (53%), and on-campus medical assistance (51%). Services that were provided at less than 40% of universities included legal assistance, academic assistance, referral to community services, off-campus police services, on-campus housing service, and a crisis hotline (Sabina et al., 2017). A systematic review of 22 research articles on college health service utilization by sexual violence victims reported rates of campus resource use between 5 and 48% (Stoner & Cramer, 2019). The most common services used were campus health centers, mental health counseling, and campus rape crisis centers (Nasta et al., 2005; Stoner & Cramer, 2019; Walsh et al., 2010).

Students’ Perceptions of Helpfulness of Resources

Few studies have examined students’ perceptions of campus resources for sexual assault survivors. In a sample of undergraduate women (N = 37), participants recommended universities could improve the helpfulness of on-campus sexual assault survivor resources if they increased visibility of survivor resources, took measures to inform students of resources available, promoted a campus community of sexual violence prevention, and collaborated with survivor resources outside of the campus (Halstead et al., 2018). In another study examining perceived helpfulness of campus resources, participants (N = 475) rated the student health women’s center as most helpful (M = 4.45, 1-5 Likert-type scale, 5 = most helpful; Allen et al., 2015). Other campus resources assessed in this study that were also rated favorably included the university counseling center (M = 4.31), office for violence prevention (M = 4.35), student health center’s medical clinic (M = 4.17), and campus police (M = 4.07). The resource that received the lowest rating of perceived helpfulness was residential life staff (M = 3.80). Neither of the above studies assessed whether participants had ever experienced a sexual assault, nor whether they had ever used any of the campus survivor resources (Allen et al., 2015; Halstead et al., 2018).

Two qualitative studies have evaluated survivors’ perceptions of campus resources (Guerette & Caron, 2007; Sabri et al., 2019). Participants (n = 12) reported that it would have been helpful to have contacted rape response services sooner, refrained from self-blame, acknowledged the assault as a rape, and had a greater understanding of both the legal process following an assault and the services available to them (Guerette & Caron, 2007). Survivors (n = 27) also reported the need for more staff education on trauma-informed care, increased hours of availability for access to care, and diversifying the format for communication to include texting and chatting forums that allowed for anonymity (Sabri et al., 2019). No assessment of perceived helpfulness of the university-affiliated resources that were used by the survivors was completed in these studies. In a quantitative study of female undergraduate students (N = 247), participants were asked how confident they felt their university was at providing crisis resources to students who experienced a sexual assault (Burgess-Proctor et al., 2016). Victims reported significantly less confidence in university resources than non-victims (p < .05). This study did not assess if any of the victims had used any of the survivor resources available on the campus.

In the 2007 Campus Sexual Assault Study, of the undergraduate women (n = 657) who reported forced or incapacitated completed rape, only 11 contacted the crisis center or victim services program affiliated with the university; 15 victims sought medical services from the campus medical facility, and 14 saw a therapist affiliated with the university (Krebs et al., 2007). The majority of survivors who contacted a campus or community victim services program, crisis center, or health care center were overall satisfied with the way their reporting of the rape was managed; and only a few participants regretted reporting the incident to these types of services. In this study, the overall satisfaction of services was reported on the combined scores of both on- and off-campus services (Krebs et al., 2007).

Relatively few studies have examined the use of university-affiliated health services by college students following a sexual assault. Much of the existing research has focused on students’ awareness of resources or the facilitators and barriers to seeking help from university-affiliated resources (Sabina & Ho, 2014). College women report awareness of resources and presume to use these resources in hypothetical scenarios of sexual victimization (Nasta et al., 2005). However, in reality, resource use by survivors remains low on college campuses. Possible reasons for lack of resource use may be that the university-affiliated resources offered are perceived as not appropriate, unhelpful, or not effective in the recovery from a sexual assault (Sabina & Ho, 2014). Few studies have examined perceived helpfulness or satisfaction with resources and not all of the researchers asked if participants had, in fact, used the resources offered by the university.

Purpose

The purpose of this study was to (a) examine the use of university-affiliated resources used by sexual assault survivors; (b) examine survivors’ perceived helpfulness of the resources used; (c) assess for relationships between perceived helpfulness and other study variables (demographics, sexual assault characteristics, mental health, self-blame, perceived control over recovery, and perceived helpfulness among female survivors of sexual assault who used resources); and (d) examine for differences in mental health, self-blame, and perceived control between women who perceived resources as helpful and those who perceived resources as not helpful.

Method

Participants

The eligible participants for this study were 18- to 24-year-old undergraduate women who had been sexually assaulted during their time at college and had used university-affiliated survivor resources. The sample for this study was a subset of participants from a larger study (n = 362) examining the mental health of women who experienced a sexual assault during college. The respondents who indicated they had used university-affiliated survivor resources (n = 98) were young women (mean age = 20.37, SD = 1.40) from two public 4-year universities in a mid-Atlantic state. The majority of the respondents (90.9%) came from one of the universities.

Procedures

The sample was recruited from two public universities with similar university-affiliated sexual assault survivor resources. For the first university, an invitation to participate was sent to all female students through the university’s student email listserv. For the second university, an email invitation was sent through departmental and student organization listservs. The email contained a link to the informed consent and a Qualtrics survey that remained open for 30 days. The survey data were downloaded from the Qualtrics server into a Statistical Package for the Social Sciences (SPSS v.25) compatible file for analysis. The Institutional Review Boards of both universities approved all procedures.

Measures

Demographics

Demographic data were collected, including current age, ethnicity, year in school, gender identity, and sexual orientation. For statistical analyses, ethnicity (1 = White, 0 = all other ethnicities) and sexual orientation (1 = heterosexual, 0 = all other orientations) were coded as dichotomous variables. See Table 1 for the demographic characteristics of the sample.

Table 1.

Demographic Data.

Characteristic (n = 98)	n (%)
Ethnicity
White	78 (79.6)
Black	2 (2.0)
Hispanic or Latino	5 (5.1)
Other or multiethnic	13 (13.2)
Sexual orientation
Heterosexual	78 (79.6)
Bisexual	16 (16.3)
Gay or lesbian	2 (2.0)
Other or prefer not to say	2 (2.0)
Sexual assault prior to entering college	56 (57.1)
Most severe sexual assault since entering college
Sexual contact	5 (5.1)
Attempted coercion	2 (2.0)
Coercion	3 (3.1)
Attempted rape	12 (12.2)
Rape	76 (77.6)
Intoxication level at time of sexual assault
Not at all intoxicated	22 (22.4)
A little	15 (15.3)
Somewhat	14 (14.3)
Quite a bit	26 (26.5)
Very intoxicated	21 (21.4)
Length of time since college sexual assault occurred
Past 6 months	31 (31.6)
6–12 months ago	20 (20.4)
1–2 years ago	29 (29.6)
2 or more years ago	18 (18.4)
Off-campus resource use	42 (42.9)
Perceived university-affiliated resources as helpful (n = 94)	42 (44.6)

Sexual assault

Sexual assault severity was measured using the Sexual Experiences Survey—Short Form Victimization (SES-SFV; Koss et al., 2007). The SES-SFV assesses victimization of unwanted sexual experiences. For this study, the participant’s highest level of severity of assault was recorded for correlational and group comparison analyses (0 = non-victim, 1= sexual contact, 2 = attempted coercion, 3 = coercion, 4 = attempted rape, and 5 = rape; Davis et al., 2014). For chi-square statistical analyses, sexual assault during college was recoded to two categories: “rape” and “all other forms of sexual assault.” Rape is defined as penetration obtained by force or incapacitation and non-consent (Koss et al., 2007). To assess for sexual assault experiences since entering college, the wording on the SES-SFV was changed from “How many times in the past 12 months . . . ?” to “since entering college have you experienced . . . ?”

Additional questions were asked about the amount of time passed since the assault, intoxication level at the time of the assault, and history of sexual victimization prior to entering college. For chi-square statistical analyses, intoxication level was recoded as dichotomous variable: “not at all” and “any intoxication.”

Mental health

The Mental Health Inventory 18 (MHI) assessed overall mental health in the past 4 weeks (Veit & Ware, 1983). The instrument consists of two subscales rated on a 6-point Likert-type scale (1 = none of the time, 6 = all of the time): psychological distress (13 items) and psychological well-being (five items). The possible range of scores for the full scale is 18 to 108 with the higher MHI score demonstrating more positive overall mental health. When calculating the score for the distress subscale, the items were reverse coded. Once recoded, a higher score endorsed greater distress within the possible range of scores from 13-78. For the subscale of well-being, the possible range of scores was 5-30 with higher scores endorsing greater well-being. In the current study (n = 98), the distress (Cronbach’s α = .91), well-being (Cronbach’s α = .81), and total mental health (Cronbach’s α = .92) scales demonstrated good levels of internal reliability.

Resource use

Use of any resources not affiliated with the college campus was assessed by asking participants, “Did you use any off-campus or community resources after any of the unwanted sexual experiences occurring during college?” (1 = yes, 0 = no). For the purposes of this study, university-affiliated survivor resources were defined as resources that provided mental and physical health support and services after a sexual assault and were affiliated with the university. These resources included campus counseling centers, rape crisis centers, university health centers, 24-hour hotlines, survivor/victim advocates, peer support groups, and peer counseling. Participants were also provided space to list “other” university-affiliated resources they may have used. The list of resources was developed by the researchers from the available resources listed on the websites of the universities included in the study. Participants were first asked if they had used any of the resources listed (yes/no). Participants who indicated they had used any of the listed resources were directed to a question to rate their perceived helpfulness of each of the resources used. Perceived helpfulness was measured on a 5-point Likert-type scale by asking to what extent the participant agreed (5 = strongly agree) with the statement, “This resource helped me after the unwanted sexual experience.” A second item assessed overall perceived helpfulness: “Overall, did you find the university’s resources/services helpful?” (1 = yes, 0 = no).

Rape Attributions Questionnaire (RAQ)

The RAQ is a self-report measure of attributions made by survivors of sexual assault about why the assault happened (Frazier, 2003; Frazier et al., 2011). Each item asks the participant about a feeling they may have had in the past month. Three subscales of the full scale were used in this study: behavioral self-blame (RAQ-BSB; e.g., “I should have resisted more.”), characterological self-blame (RAQ-CSB; e.g., “I am just the victim type.”), and perceived control over recovery (RAQ Control; e.g., “I am confident that I can get over this if I work at it.”). Each subscale has five items rated on a 5-point Likert-type scale resulting in a score ranging from 5-25. Higher scores on each subscale indicated greater endorsement of the concept. Mean scores of each subscale were used for analysis in this study. The subscales of the RAQ were found to be reliable measures of each concept in the current sample: behavioral self-blame (Cronbach’s α = .84), characterological self-blame (Cronbach’s α = .73), and perceived control over recovery (Cronbach’s α = .75).

Statistical Analysis

The data were examined for outliers, patterns in missing data, and violations of assumptions of statistical tests. Differences in demographics and outcome measures between universities were evaluated by examining a series of chi-square tests for categorical variables and t tests for continuous variables. Cases missing all items on the MHI (outcome variable) and SES-SFV (sexual assault experiences) were excluded from the study. The independent variables in this study were demographic data, sexual assault-related factors, community resource use, and perceived helpfulness of resources. The dependent variables in this study were mental health outcomes, self-blame, and perceived control over recovery.

Use of university-affiliated resources was summarized with frequencies and percentile estimates, and perceived helpfulness was summarized with means and standard deviations for each resource. Chi-square tests were performed to examine associations between perceived helpfulness and demographic characteristics and sexual assault experiences. A series of t tests was conducted to examine for differences between participants who perceived university-affiliated resources as helpful and those who perceived them as not helpful for age; MHI total score; MHI well-being subscale; MHI distress subscale; and RAQ subscales of characterological self-blame, behavioral self-blame, and perceived control over recovery. A significance level of 0.05 was set for all analyses.

Results

There were no significant differences between the universities for age, sexual orientation, ethnicity, MHI Total, MHI well-being subscale, MHI distress subscale, sexual assault severity, history of sexual assault prior to college, use of community resources, or overall perceived helpfulness of university-affiliated resources. A significant difference was noted for intoxication level at the time of the assault (X² = 17.43, df = 1, p < .001) with more participants from University 1 (n = 74, 83.1%) than University 2 (n = 2, 22.2%) being intoxicated at the time of the assault. Due to the small sample size, analyses to examine differences between universities may be underpowered to detect statistical significance.

Prevalence and Types of Campus Resources Use

The most often-used campus resource was mental health counseling (n = 66, 67.3%) followed by the university health center (n = 26, 26.5%) and the survivor/victim advocate (n = 14, 14.3%). The perceived helpfulness of the resources ranged from 2.89 to 4.50. The highest perceived helpfulness scores were for the campus survivor/victim advocate (M = 4.50, SD = 0.522), peer support groups (M = 4.44, SD = 0.527), peer counseling (M = 4.08, SD = 0.954), the student health center (M = 3.67, SD = 1.47), and mental health counseling (M = 3.67, SD = 1.34). The lowest score for perceived helpfulness was for the campus rape crisis team (M = 2.89, SD = 1.36). For the item measuring overall perceived helpfulness of resources, less than half of participants (44.6%, n = 42) reported that resources were overall helpful. For the item assessing additional “other” university resources that some participants (n = 4) used, two participants indicated contacting Title IX, one participant contacted campus police, and one participant did not indicate which resource was used.

Perceived Helpfulness

In the chi-square analyses, no significant relationships were found between perceived helpfulness of university-affiliated resources and sexual orientation, sexual assault severity, intoxication level, time passed since college assault occurred, and history of sexual assault prior to college. Women who identified with an ethnicity other than white were significantly more likely to perceive university resources as not helpful (n = 16, 30.8%) than helpful (n = 5, 11.9%; X² = 4.77, df = 1, p = .029). Women who used community or off-campus resources were more likely to perceive university-affiliated resources as not helpful (51.9%) than helpful (31.0%; X² = 4.18, df = 1, p = .041). See Table 2 for prevalence of resources used and ratings of helpfulness.

Table 2.

Resource Use and Perceived Helpfulness.

University-affiliated survivor resource (n = 98)	Used resource n (%)	Perceived helpfulness
University-affiliated survivor resource (n = 98)	Used resource n (%)	M (SD)
University Health Center	26 (26.5)	3.67 (1.47)
Mental Health Counseling	66 (67.3)	3.67 (1.34)
Sexual Assault Crisis Team	11 (11.2)	2.89 (1.36)
Sexual Assault Crisis Hotline	9 (9.2)	3.43 (1.13)
Survivor/victim advocate	14 (14.3)	4.50 (0.52)
Peer counseling	12 (12.2)	4.08 (0.95)
Peer support group	13 (13.3)	4.44 (0.53)

There was a statistically significant difference in MHI total scores between women who perceived university-affiliated resources as helpful (M = 66.07, SD = 13.78) and women who perceived them as unhelpful (M = 59.79, SD = 14.27; t = 2.16, p = .034). There was a statistically significant difference in MHI well-being subscale scores between women who perceived resources as helpful (M = 18.93, SD = 3.84) and women who perceived them as unhelpful (M = 17.23, SD = 3.95; t = 2.10, p = .039). Results suggest that women who perceived campus resources as helpful had better overall mental health and higher reported well-being. There was not a statistically significant difference in MHI distress subscale scores between women who perceived campus resources as helpful (M = 43.86, SD = 10.92) and women who perceived resources as unhelpful (M = 48.44, SD = 11.41, t = −1.97, p = .052). Table 3 illustrates means of mental health scales and t test results.

Table 3.

Results of t Test and Descriptive Statistics of Study Measures by Perceived Helpfulness.

	Helpful (n = 42)	Not helpful (n = 52)	t	p	95% CI formean difference
Measures	M (SD)	M (SD)	t	p	95% CI formean difference
MHI total	66.07 (13.78)	59.79 (14.27)	2.16	.034	[0.49, 12.07]
MHI well-being	18.93 (3.84)	17.23 (3.95)	2.10	.039	[0.09, 3.31]
MHI distress	43.86 (10.92)	48.44 (11.51)	−1.97	.052	[−9.22, 0.05]
RAQ CSB	11.93 (4.63)	12.37 (4.36)	−0.47	.640	[−2.28, 1.41]
RAQ BSB	16.17 (5.61)	15.40 (5.12)	0.69	.493	[−1.44, 2.97]
RAQ control	19.07 (3.72)	17.89 (4.16)	1.43	.156	[−0.46, 2.81]
Age	20.14 (1.49)	20.54 (1.34)	−1.36	.179	[−0.975, 0.192]

Note. CI = confidence interval; MHI = Mental Health Inventory; RAQ = Rape Attributions Questionnaire; CSB = characterological self-blame; BSB = behavioral self-blame.

Discussion

The purpose of this study was to examine women’s experiences with campus sexual assault survivor resources and to identify what factors may be related to women perceiving the resources as helpful. Findings suggested that women who perceived university-affiliated survivor resources as helpful had better mental health outcomes than women who perceived the resources as unhelpful. The majority of survivors in this study sought mental health counseling. The higher use of mental health counseling may reflect the considerable number of women who experienced mental health consequences after the sexual assault (Dworkin et al., 2017). The perceived helpfulness of mental health counseling for sexual assault survivors was consistent with previous research (Allen et al., 2015; Artime & Buchholz, 2016; Starzynski & Ullman, 2014).

Many women in our study found university-affiliated resources to be overall not helpful. Although most universities offer survivor resources, a study of representatives from 45 public, 4-year universities, found that only 62% of universities indicated having specialized training for providers of sexual assault services including mental health counselors (47%) and medical staff (33%; Sabina et al., 2017). Health care providers, counselors, and staff in university health settings should be educated on trauma-informed care of individuals who experience a sexual assault. In addition to using campus resources, 42.9% of the survivors also sought off-campus or community-based resources. University staff should be encouraged to develop relationships with and referral systems for off-campus resources. In addition, campus facilities should implement screening questions to address risk factors. The majority of survivors in our study experienced a sexual assault prior to entering college and a majority were under the influence of alcohol at the time of the assault. Screening for sexual assault experiences, alcohol use, and psychological distress may help providers identify women who have experienced a sexual assault in college and better facilitate timely and appropriate referrals.

It is possible that evaluations of the resources were affected by the distress associated with the assault itself. The women who experienced more distress might have perceived the resources as less helpful than someone who had experienced less distress. A large percentage of women in our study experienced a rape (77.6%) compared with a campus climate study of nine universities where researchers found that 31.6% of the sexual assaults that occurred in college women were rape (Krebs et al., 2016). Sexual assault severity and use of force have demonstrated a deleterious effect on mental health in previous studies (Dworkin et al., 2017). In this study, sexual assault-related factors (severity, intoxication level, and amount of time passed) demonstrated no significant relationships with perceived helpfulness, overall mental health, distress, or well-being. These nonsignificant findings contribute to the research by suggesting that though sexual assault characteristics may cause distress, they may not influence women’s perceptions of campus survivor resources.

Participants in this study who found university-affiliated resources to be helpful had better overall mental health and a greater sense of well-being than women who found resources to be unhelpful. Alternatively, in a study by Starzynski and Ullman (2014), as sexual assault survivors’ PTSD symptom severity increased, women were 1.59 times more likely to find mental health professionals helpful. The participants in that study were older (median age = 30), more diverse (less than half were white), and of a lower socioeconomic status (more than half had an annual household income<$20,000) than typical college students. Starzynski and Ullman (2014) also found that perceived control over recovery was a significant predictor of sexual assault survivors rating mental health professionals as helpful. In our study, the relationship between perceived control over recovery and perceived helpfulness of resources was not statistically significant.

Survivor advocates were perceived as the most helpful resource; however, they were only used by a small number (n = 14, 14.3%) of participants in this study. Survivor advocates have demonstrated beneficial outcomes in previous research (Campbell, 2006). Women who had the assistance of a survivor advocate were more likely to report the assault to the police, receive comprehensive medical services, and experience less distress. They were also less likely to experience self-blame and less likely to be treated negatively by the police or medical personnel (Campbell, 2006). University health care providers and staff should promote awareness of and referral to this beneficial and underutilized resource.

Although only used by a few participants, peer counseling and peer support groups were both rated as helpful after a sexual assault experience. Research demonstrates that women were more likely to disclose a sexual assault to a female friend than a formal support provider (health care provider, counselor, police; Sabina & Ho, 2014). Female friends often responded with emotional support, and emotional support has been associated with increased coping in college women (Orchowski et al., 2013). It is possible that university resources that train peers to offer supportive responses through support groups and peer counseling would provide sexual assault survivors with a social network that facilitates the recovery process and has the potential to improve mental health outcomes.

Limitations

This study had several limitations. Consistent with previous research, only a small number of women reported using campus resources; therefore, the sample size in this study was small. Accordingly, the results of this study should be interpreted with caution, and similar analyses should be replicated in future studies with larger samples. The cross-sectional nature of this study design precluded making causal inferences between victimization, perceived helpfulness of university-affiliated resources, and mental health outcomes. No conclusions could be drawn about a relationship between the concepts of helpfulness and effectiveness of university-affiliated resources in the recovery process.

In our study, we asked only one question about overall helpfulness. The psychometric properties of this question are unknown. Due to the small sample of women who used campus resources, we had limited power and could not adequately examine relationships between perceived helpfulness of specific resources, mental health outcomes, self-blame, and perceived control over recovery. While this study addressed an existing gap in the literature of women’s experiences with university-affiliated resources, it did not address which characteristics of each resource were perceived as helpful or unhelpful.

Future research might include longitudinal studies to identify factors that may have a lasting effect on mental health after the college years. Qualitative studies might focus on how women characterize their encounters with university-affiliated resources to determine what factors contribute to differing levels of perceived helpfulness. The ways in which a sexual assault affects a woman’s recovery, mental health, and perceived helpfulness of support services are complex. Future studies could examine personal characteristics of the survivor (e.g., personality traits, history of mental health diagnoses prior to the assault), events leading up to formal help-seeking, or perceptions of the university climate toward sexual assault. Obtaining clear timelines of help-seeking may also better inform university resources: How long after the assault did participants seek resources? Was resource use a one-time occurrence or ongoing? Were off-campus resources used before or after university-affiliated resources? Finally, the small sample size in the current study did not allow for statistical analyses that examined relationships between the perceived helpfulness of the individual types of resources used and the mental health outcomes for survivors.

Conclusion

Sexual assault has become a topic of increasing interest in the popular media in recent years and federal mandates to address sexual violence on college campuses are under debate. Currently, Title IX requires colleges and universities that receive federal funding to provide sexual assault survivor resources (Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving Federal Financial Assistance, 2018). The adverse, long-term mental and physical health consequences of experiencing a sexual assault are well demonstrated in the literature (Dworkin et al., 2017). It is imperative that universities strive to provide resources that are helpful to optimize mental health outcomes for the survivors who use these resources. Examining sexual assault survivors’ perceptions of helpfulness of university-affiliated resources is crucial in improving the quality of care delivered by these resources. Overall, the data indicate that perceived helpfulness of university-affiliated resources had a positive association with better psychological well-being. Developing a clearer understanding of perceived helpfulness is important in informing future research on the recovery process for sexual assault survivors. Identifying factors related to perceived helpfulness can improve the efforts of campus resources for women seeking help after a sexual assault. There has been very little research done on this subject, and an understanding of survivors’ help-seeking experiences with university resources plays an essential role in improving the recovery process.

Footnotes

Acknowledgements

We would like to acknowledge all of the students who completed our survey.

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.

ORCID iD

Amy C. Graham

Author Biographies

Amy C. Graham, PhD, FNP-BC, is an Associate Professor in the School of Nursing at James Madison University. She is also a family nurse practitioner practicing in a free clinic. Her research interests include experiences of sexual assault survivors and the role of formal support in recovery.

R. Kevin Mallinson, PhD, RN, is an Associate Professor in the School of Nursing at George Mason University. His research has focused on persons with—or at risk of—HIV disease in the United States and Sub-Saharan Africa. Using qualitative and mixed-methods approaches with at risk, vulnerable, or marginalized populations, he seeks to strengthen the capacity of individuals to manage the grief, trauma, and other adversities associated with HIV disease.

Jenna R. Krall, PhD, is an Assistant Professor in the Department of Global and Community Health at George Mason University. She is a biostatistician with research interests in air pollution and environmental epidemiology. She is also interested in collaborative work related to chemical mixtures, spatial statistics, and missing data.

Sandra L. Annan, PhD, RN, is an Associate Professor at James Madison University. Her research interests focus on intimate partner violence, sexual assault, forensic nursing, and rural health.

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