Revictimisation of Women in Non-Urban Areas: A Scoping Review

Abstract

Literature widely acknowledges that women who experience Child Sex Abuse (CSA) have a higher risk of experiencing sexual revictimisation later in life, yet less is known about experiences of revictimisation in non-urban areas. The aim of this review is to examine what is known internationally regarding revictimisation of non-urban women, and to provide future research, practice and policy recommendations. A total of 2414 articles were identified through a comprehensive search across five broad health sciences and humanities databases; 11 articles met inclusion criteria and were included in this review. This review found a general lack of qualitative revictimisation studies, and limited research focusing on non-urban women. While existing studies included non-urban research samples, few articles (n = 3) explored how non-urban location contextualises revictimisation experiences. Most peer-reviewed articles identified within this paper (n = 7) examined intimate partner violence (IPV) revictimisation, highlighting a significant lack of research on sexual revictimisation within non-urban settings. Findings from the review indicate that experiences of violence in childhood and adulthood are frequent among non-urban women, and that experiencing child abuse is associated with a heightened likelihood of poor mental health and IPV in adulthood. The review also found that non-urban women faced significant structural disadvantage including low levels of employment and income, limited-service sector resources, unsafe family environments and exposure to community violence. Additional qualitative research is needed to better understand the experiences and needs of non-urban revictimised women, particularly within an Australian context.

Keywords

revictimization sexual assault child abuse domestic violence

Violence against women is a pervasive human rights violation and global public health issue (WHO, 2021). For the purposes of this article ‘violence’ encompasses sexual, physical, psychological and economic violations occurring within intimate, familial and stranger contexts. Within Australia 1 in 5 women have experienced sexual violence since the age of 15 (AIHW, 2019) and on a global scale, 27% of women have experienced either physical and/or sexual violence by an intimate partner in their lifetime (WHO, 2021). Research indicates within these statistics there is a subpopulation of women who face an even higher risk of sexual violence. Evidence suggests victim/survivors of Child Sex Abuse (CSA) are 2–3 times more likely than others to experience subsequent sexual victimisation, with women bearing the disproportionate burden of such abuse (Arata, 2002; Barnes et al., 2009). This increased risk is particularly alarming when considering the impact sexual revictimisation has on victim/survivors’ health and wellbeing.

Sexual Revictimisation

Sexual revictimisation has been the primary focus of revictimisation research (Classen et al., 2005), however a growing body of literature now acknowledges the ways different forms of violence co-occur throughout childhood and adulthood (Li et al., 2019; Ørke et al., 2018; Widom et al., 2014). For the purposes of this paper revictimisation may include any form of child abuse, and a subsequent experience of violence in adolescence or adulthood. Existing research highlights that sexual revictimisation has detrimental long-term impacts on women’s emotional and physical health. Sexual revictimisation is associated with anxiety and depressive disorders (Edwards & Banyard, 2020; Walsh et al., 2015), suicidal ideation and self-harm (Balsam et al., 2011; Edwards & Banyard, 2020), alcohol and substance abuse (Hannan et al., 2017; Ullman et al., 2009; Walsh et al., 2015), Post-Traumatic Stress Disorder (PTSD) symptoms (Jaffe et al., 2019; Ullman & Peter-Hagene, 2016), and a heightened risk of chronic physical illnesses such as endometriosis (Harris et al., 2018), and cardiovascular diseases (Friedman et al., 2015).

Despite this growing body of knowledge, revictimisation literature to date has overwhelmingly focused on quantitative data and general linear models (Macy, 2008), isolated predictor variables (Rich et al., 2004) and individual victim/survivor characteristics and behavioural factors (Grauerholz, 2000). Furthermore, existing studies largely focus on population samples within the United States of America (USA) with minimal geographical data to distinguish between urban and non-urban residency (Classen et al., 2005). Collectively, this suggests there is limited qualitative evidence that purposefully examines the experiences of non-urban women, including geographic-specific socio-cultural and ecological factors that may intersect and perpetuate the reoccurrence of violent experiences. Anecdotal information collected from our industry partner – an Australian regional/rural sexual assault response organisation – suggests revictimisation is common for clients in non-urban areas. However, limited research has been conducted in the Australian context.

Non-Urban Locations

Research indicates that prevalence rates of violence against women may be higher within non-urban locations. Findings from the 2016 Australian Bureau of Statistics (ABS) Personal Safety Survey have shown that 23% of women residing outside major cities have experienced partner violence since the age of 15, in comparison to 15% of women living in major cities (AIHW, 2019). A higher prevalence rate of violence within non-urban areas is also reflected internationally (Garcia-Moreno et al., 2006). Within rural Australia, other forms of violence such as sexual harassment are also more commonly experienced in traditionally defined masculine occupations, such as mining and agriculture (Saunders & Easteal, 2013). Yet a lack of reliable data distinguishing prevalence rates via geographical location, along with high levels of under reporting, complicate the ability to ascertain the precise prevalence of violence against women in non-urban areas (Coumarelos & Allen, 1999; Neame & Heenan, 2004, p. 8).

Research indicates gender inequality is the major factor driving violence against women (Michau et al., 2014; Wall, 2014; WHO, 2021). Researchers have drawn attention to factors that enhance gender inequality within non-urban areas, including traditional gender norms and patriarchal attitudes that normalise male violence and control (George & Harris, 2014; Wendt, 2009). Non-urban geographical and socio-cultural characteristics can also pose significant challenges for women when experiencing violence or seeking to leave violent relationships. This can include social and geographical isolation, a lack of transport options, limited local support services, and the ‘intimacy’ of small towns resulting in a lack of confidentiality (Campo & Tayton, 2015; George & Harris, 2014; Owen & Carrington, 2015, p. 5; Wendt et al., 2017). Gender inequality, local social norms, limited anonymity and fewer economic and social resources shape women’s experiences of violence in socially and geographically isolated places. As noted above, there is limited research in the Australian context that examines revictimisation experiences of non-urban women. As such, the aim of this review is to examine what is known internationally regarding revictimisation of non-urban women, and to provide future research, practice and policy recommendations.

Method

We adopted a scoping review methodology described by Arksey & O’Malley (2005), further refined by Levac et al. (2010). The scoping review method consists of five stages, with an optional sixth stage focused on consultation with stakeholders to inform the search and ensure the validation of findings (Arksey & O’Malley, 2005; Levac et al., 2010). Our approach embedded the sixth stage throughout the duration of the review by partnering with a regional/rural sexual assault response organisation. A service sector staff member participated in the review to assist with the interpretation of results. The organisation of this article will mirror the aforementioned five stages as outlined by Arksey & O’Malley, (2005), including identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarising and reporting the results.

Stage 1: Identify the Research Question

The research question for this review of the evidence was, ‘What is known from existing literature about the revictimisation of women in non-urban settings?’.

Non-urban settings

This paper focuses on women’s experiences of revictimisation in non-urban settings within Australia, New Zealand, the United Kingdom, the United States and Canada. Countries were selected due to their similar and interconnected feminist movements challenging gendered violence (Maddison & Sawer, 2013), as well as comparable socio-cultural/political colonial systems (Bell & Vucetic, 2019). Selected studies have used a variety of terms to capture geographical and cultural identity, raising important questions of how regional, rural and remote community identity is defined. However, for the purpose of this article, the term ‘non-urban’ will be used to depict regional, rural or remote areas. We acknowledge that women’s experiences of violence within non-urban areas are far from uniform, and that lived experiences within these areas are diverse and multi-faceted. However, rather than using multiple classification terms, the term ‘non-urban’ is used.

Stage 2: Identify Relevant Studies

Search terms were identified through an initial search and consensus discussion among the authors based on the aims of the review. The final search terms ‘revictimisation’, ‘repeat victimisation’ and ‘poly-victimisation’ were selected and searched across five broad health sciences and humanities databases including Medline, Pilots, PsychInfo, CINAHL and Scopus. This included searching for both published and noncommercially published grey literature work via Government and non-for-profit organisational websites. No grey literature was found (see Appendix A: Grey literature search). In recognising adolescence as a significant developmental period when revictimisation can occur (Humphrey & White, 2000), studies were included if participants were aged 10 years and above. This accords with The World Health Organization’s (WHO) definition of adolescents as 10–19 years of age (World Health Organization, 2020).

Stage 3: Study Selection

Two thousand four hundred and 14 articles were retrieved from the database search after duplicates were removed. Using Covidence (Covidence, 2020) as a research tool, all title, abstract and full text reviews were conducted using inclusion/exclusion criteria (see Table 1, and Appendix B: criteria rationale). Prior to the abstract and title screening process, five team members piloted the inclusion/exclusion criteria. The research team found it difficult to ascertain non-urban population from content in the article title or abstract. It was therefore decided that the inclusion criteria of non-urban population would be screened at the full text phase. Author 1 reviewed 2414 titles and abstracts, excluding those that clearly did not meet inclusion criteria (n = 1806). Author 1 independently reviewed 608 full text articles for inclusion. Authors 2–4 provided a second independent screening of full text articles with discrepancies in accept/reject ratings discussed by the full research team and resolved by consensus. Figure 1 demonstrates the article review process. Upon completion, there were 14 full text articles identified for charting. A further process of refinement took place to ensure studies were only included where non-urban data could be analysed. This resulted in the removal of a further three studies, leaving 11 studies for inclusion in this review. This is consistent with the scoping review methodology as an iterative process involving constant reflection and refinement of the inclusion criteria and study selection (Arksey & O’Malley, 2005; Levac et al., 2010).

Table 1.

Inclusion Criteria for Database Search.

Inclusion	Exclusion
• Women who have experienced revictimisation, aged 10 years and above.	• Men, children (aged 0–9 years).
• Studies that include men and women, if data analysis is separated by gender,and data on women can be extracted.	• One off incidences of violence.
• Studies where non-urban data can be analysed.	• Bullying – without the presence of some form ofinterpersonal abuse (e.g. CSA) preceding the bullying.
• Studies published between 1990 and Jan 2020.	• Poly-victimisation only existing in childhood.
• Studies published in English from the US, Australia, NZ, Canada and the UK.
• Peer-reviewed primary research.

Figure 1.

Flow diagram process.

Stage 4: Charting the Data

Following the method outlined by Arksey & O’Malley (2005), a data charting form was developed to support data extraction and analysis of the final 11 studies included in this scoping review (see Table 2). To help answer the research question the following data was charted: author/year, title/journal, country, aim/purpose, method, sample and type of violence examined.

Table 2.

Summary of Articles Included in Review.

Author/Year	Title and Journal	Country	Aim/purpose	Method	Sample	Type of violence
Breitenbecher, K. H. (1999)	The association between the perception of threat in a dating situation and sexual victimisation, Violence and Victims	United States of America	• Assess relation between threat perception in a dating situation and sexual victimisation.• Examine qualitative information about dating situation characteristics that cause women to feel threatened.	• Quantitative• Survey at two time points.	• N=224 women, 81% aged 18–21.	• Sexual violence
Kershner, M., Long, D., and Anderson, J. E. (1998)	Abuse against women in rural Minnesota, Public Health Nursing	United States of America	• Examine prevalence of physical, emotional and sexual abuse and health-related characteristics in women seeking support in rural medical clinics and Women, Infants and Children (WIC) food programme sites.	• Quantitative• Cross-sectional surveys.	• N=1693 women, mean age 34.95.	• IPV, FV, interpersonal violence
Kong, J., Roh, S., Easton, S. D., Lee, Y. S., and Lawler, M. J. (2018)	A history of childhood maltreatment and intimate partner violence victimisation among Native American adults, Journal of interpersonal violence	United States of America	• Examine association between childhood maltreatment and Intimate Partner Violence (IPV) among Native American adults.• Examine the roles of insecure attachment patterns and depressive symptoms in mediating the association between childhood maltreatment and IPV.	• Quantitative self-administered survey	• N=479, 60% women, mean age 44.6.	• IPV
Lilly, M. M., London, M. J., and Bridgett, D. J. (2014)	Using SEM to examine emotion regulation and revictimization in predicting PTSD symptoms among childhood abuse survivors, Psychological Trauma: Theory, Research, Practice, and Policy	United States of America	• Examine direct effects of childhood maltreatment, adult IPV, and emotion regulation difficulties on Posttraumatic Stress Symptoms (PTSS).	• Quantitative self-report surveys	• N=99 women, mean age 29.72.	• IPV
Logan, T. K., Walker, R., Cole, J., Ratliff, S., and Leukefeld, C. (2003)	Qualitative differences among rural and urban intimate violence victimisation experiences and consequences: A pilot study, Journal of Family Violence	United States of America	• Examine differences between urban and rural experiences of intimate violence and associated social support, health, mental health, and substance use sequelae.	• Mixed methods• Interviews and survey.	• N=23 women, mean age 33.	• IPV
Mitchell, K. J., Moschella, E. A., Hamby, S., and Banyard, V. (2020)	Developmental Stage of Onset, Poly-Victimisation, and Persistence of Childhood Victimisation: Impact on Adult Wellbeing in a Rural Community–Based Study, Child maltreatment	United States of America	• Examine the persistence of victimisation and poly-victimisation across various stages of development and the related impact on adult-wellbeing.	• Quantitative• Self-administered survey.	• N=2098, 65% women.	• Interpersonal violence
Pro, G., Camplain, R., de Heer, B., Chief, C., and Teufel-Shone, N. (2020)	A national epidemiologic profile of physical intimate partner violence, adverse childhood experiences, and supportive childhood relationships: group differences in predicted trends and associations, Journal of racial and ethnic health disparities	United States of America	• Examine racial/ethnic and gender differences in predicted probability of adult physical IPV across multiple Adverse Childhood Experiences (ACES), and Safe, Supportive, and Nurturing Childhood Family Relationships (SSNR) scores.	• Quantitative• Survey.	• N= 35,614, 56.2% women.	• IPV
Stockdale, M. S., Logan, T. K., Sliter, K. A., and Berry, S. A. (2014)	Interpersonal violence victimisation and sexual harassment: A prospective study of revictimization, Sex roles	United States of America	• Examine associations between past interpersonal victimisation (child and adult) and sexual harassment (SH).• Examine intervening/moderating variables of past victimisation with SH, including PTSS and job-gender context.• Examine alternate hypothesis for revictimisation that abuse survivors are ‘hyper-sensitive’ to perceptions of sexual harassment.	• Quantitative• Prospective interview survey at two time points.	• N=445 women, mean age 31.98.	• Sexual violence, IPV
Sutherland, M. A. (2011)	Examining mediators of child sexual abuse and sexually transmitted infections, Nursing research	United States of America	• Examine dissociative symptoms, alcohol use, intimate partner physical violence, and intimate partner sexual coercion as mediators of CSA and lifetime STI diagnosis in women.	• Quantitative• Cross-sectional study.	• N=189 women, mean age 29.	• IPV
Valdez, C. E., and Lilly, M. M. (2015)	Posttraumatic growth in survivors of intimate partner violence: An assumptive world process, Journal of interpersonal violence	United States of America	• Examine whether world assumption change predicts Posttraumatic Growth in IPV survivors.	• Quantitative, self-report survey at two time points.	• N=23 women, mean age 30.91.	• IPV
Valdez, C. E., Lim, B. H. P., and Lilly, M. M. (2013)	‘It’s going to make the whole tower crooked’: Victimisation trajectories in IPV, Journal of Family Violence	United States of America	• Examine childhood histories of IPV victim/survivors.• Determine unique trajectories of childhood maltreatment to IPV through perspectives of victim/survivors.• Further understand how childhood environments serve to increase risk for victimisation.	• Qualitative• Semi-structured interviews.	• N=23 women, mean age 32.	• IPV

Stage 5: Collating, Summarising and Reporting results

The final stage of the scoping review provides a descriptive summary, and qualitative thematic analysis of results (Levac et al., 2010) as set out below. Qualitative data analysis software NVivo (QSR International Pty Ltd, 2020) was used to sort, code and categorise main themes. A thematic analysis led to the categorisation of findings in alignment with an ecological model (Belsky, 1980; Bronfenbrenner, 1979; Heise, 1998).

Descriptive Summary

Study Type and Measurement

Year of publication for the final 11 studies ranged from 1998 to 2020. All articles were peer-reviewed papers from a range of disciplines including public health, nursing, psychology studies, race and ethnic health studies and social work. The majority (n = 9) used quantitative methods and cohort or cross-sectional samples. Most of these quantitative studies used standardised scales to measure a range of factors pertaining to revictimisation including childhood abuse, history of sexual victimisation, perceptions of threat, attachment styles, mental health symptoms, intimate partner violence (IPV) victimisation history, trauma exposure, emotion regulation, substance abuse, social support, physical health, world assumptions and post-traumatic growth. Of the remaining two studies, one used qualitative interviewing and the other use mixed methods.

Study Purpose, Study Location and Sample Description

The type of violence identified in the 11 studies included IPV (n = 7), sexual violence (n = 1), interpersonal violence (n = 1) and mixed presentations of violence (n = 2). All studies (n = 11) were conducted in the United States. Only one article included both a rural and urban comparative sample. The included articles used non-urban samples, or a mix of both urban and non-urban for demographic reference. Two studies did not provide data distinguishing different racial/ethnic groups. Three studies were part of larger national studies conducted with both men and women.

Results

Factors associated with revictimisation identified in the peer-reviewed literature will be categorised according to the ecological model as set out below. An ecological model conceptualises an individual as embedded in and influenced by multiple environmental contexts (Bronfenbrenner, 1979). Ecological system levels include ontogenic factors (individual characteristics such as developmental experiences) (Heise, 1998); microsystems (activities, roles and interpersonal relations experienced by the individual in their immediate environment such as family or work) and exosystems (one or more settings where the individual may not actively interact, but where events occur that indirectly influence the microsystem of an individual) (Bronfenbrenner, 1979). Figure 2 provides a summary of the key ecological factors identified within the peer-reviewed literature.

Figure 2.

Ecological model of factors associated with non-urban women’s experiences of revictimisation.

Ontogeny

Ontogenic factors identified within the peer-reviewed literature included mental health, racial identity and initial child abuse experiences. Most studies examining factors at the ontogenic level focused on how variables are associated with risk of revictimisation.

Mental health

Studies noted that non-urban revictimised women reported poor mental health and high levels of stress (Logan et al., 2003). Mitchell et al. (2020) examined the impact that persistent victimisation and poly-victimisation had on adult wellbeing in a sample of low-income rural residents. A linear decline in subjective wellbeing, mental health and number of healthy days was observed as victimisation increased and became more diverse in type across developmental stages. The most commonly explored mental health conditions included depression (n = 2) and Posttraumatic Stress Symptoms (PTSS) (n = 1).

Rural women were significantly more likely to experience depression when compared with urban victim/survivors, and to attribute their experiences to IPV (Logan et al., 2003). Extending analysis to experiences of violence across the lifespan, Kong et al. (2018) found depression to be a significant mediator in the association of childhood maltreatment and IPV victimisation. PTSS was also highlighted as a mediator between child and adult experiences of violence. Lilly et al. (2014) highlighted the association between child maltreatment, adult victimisation and PTSS in a community sample of rural women. Their findings suggest a dual pathway whereby childhood maltreatment indirectly affected PTSS in adulthood through emotional regulation difficulties and an increased risk for IPV victimisation.

Racial identity

Prevalence of revictimisation and predicted probability of future revictimisation differed across racial identity in two studies, with American Indian/Alaska Native women significantly overrepresented (Pro et al., 2020). American Indian/Alaska Native women constituted the highest percentage of rural residents across Pro et al. (2020) study sample, and collectively rural and urban American Indian/Alaska Native women experienced the highest prevalence rate of physical IPV (21%) when compared to African American women (10.4%), and Latina and white women (9.5%), despite American Indian/Alaska Native women representing only 1.8% (n = 294) of the population sample. A similar trend was evident in Mitchell et al.,'s (2020) rural community sample, where those identifying as multiracial had the highest prevalence rate of victimisation across two or more developmental periods (40%) despite constituting only 3% (n = 65) of the total study sample.

Initial abuse experiences

Initial experiences of childhood abuse reported across studies were severe and diverse in type. Commonly cited forms of child abuse included sexual, emotional and physical abuse, and witnessing Family Violence (FV). While the following section will examine each form of abuse separately to enable comparative analysis, different forms of child abuse often co-occurred.

Child sexual abuse

Studies reported a prevalence of CSA ranging from 21–75% (Breitenbecher, 1999; Logan et al., 2003; Sutherland, 2011; Valdez et al., 2013). Sutherland (2011) noted a stark difference in prevalence when considering geographical residency; 61.3% of rural women had experienced CSA in comparison to 38.7% of urban women. Another key difference between rural and urban experiences highlighted that 50% of rural women reported being forced to have sex at the age of 5, compared with 7% of urban women (Logan et al., 2003). Perpetrators of CSA were often family members or relatives (Valdez et al., 2013) and force or threat of force was commonly involved (Logan et al., 2003; Valdez et al., 2013).

Emotional and physical child abuse

Valdez et al., (2013) reported a prevalence rate of 30% for childhood emotional abuse, while Logan et al., (2003) noted significant differences in prevalence reported between rural women (75%) and urban women (33%). Prevalence of child physical abuse ranged from 75–80% (Logan et al., 2003; Valdez et al., 2013). The physical abuse reported by women was severe and frequent; commonly the abuse involved being hit and beaten with an object (Valdez et al., 2013) including being threatened with knives (Logan et al., 2003; Valdez et al., 2013). Rural women were significantly more likely to be threatened with a weapon by a parent or caregiver as a child (27%), when compared with urban women (0%) (Logan et al., 2003).

Witnessing FV

Witnessing FV as a child was reported across three studies with prevalence ranging from 53 to 88% (Valdez et al., 2013; Mitchell et al., 2020; Logan et al., 2003). Exposure to FV and witnessing violence between the ages of 0–5 was significantly related to poorer wellbeing in adulthood (Mitchell et al., 2020). Witnessing FV as a child was found to normalise violence within women’s adult relationships, where they learned to expect and accept violence perpetrated by intimate partners (Valdez et al., 2013).

Ontogenic factors detailed in this review highlight that non-urban women reported poor mental health, and that mental health symptoms such as PTSS play a mediating role between child abuse and adult revictimisation. Demographic factors such as racial identity were also shown to be significantly correlated to violent experiences in adulthood. Studies highlighted that non-urban women’s experiences of initial child abuse are severe and diverse in type.

As articulated by Bronfenbrenner (1979), an ecology of human development emphasises the mutual and progressive interaction between an individual and their changing environment. Moving beyond the ontogenic level, the microsystem details the immediate environmental surroundings and connections that a developing individual holds. The following section will consider factors associated with revictimisation at a microsystem level.

Microsystem

A microsystem involves immediate environmental settings that enable an individual to engage in patterns of activities and interpersonal relations (Bronfenbrenner, 1979). Factors identified within the peer-reviewed literature at the microsystem level included family environment, attachment patterns and world assumptions, relationship to perpetrator, helping professionals and housing and employment.

Family environment

Unsafe family environments experienced during childhood were highlighted as contributing to women’s experience of IPV and sexual violence in adulthood (Valdez et al., 2013). An increase in the number of adults and children within the home increased adult women’s risk for current abuse (Kershner et al., 1998).

Attachment patterns and world assumptions

Fearful attachment, described as a discomfort with emotional closeness and distrust of others, was significantly correlated with childhood maltreatment (Kong et al., 2018). While insecure attachment patterns did not mediate the relationship between childhood maltreatment and IPV victimisation, (Kong et al., 2018) found that all paths linking childhood maltreatment, fearful attachment, depressive symptoms and IPV victimisation were statistically significant, though an overall mediation effect was not significant. Conversely, Valdez et al. (2013) utilised attachment theory to examine victimisation trajectories of IPV. The study identified emotional childhood trauma, and physical childhood trauma, as two trajectories which resulted in women experiencing adulthood IPV revictimisation. While studies reported the finding that adverse experiences in childhood can distort world assumptions and beliefs (Kong et al., 2018; Valdez et al., 2013), models of posttraumatic growth suggest that traumatic experiences can promote cognitive processing and positive schema reconstruction. Valdez & Lilly (2015) found that world assumptions of IPV victim/survivors did become more positive 1 year after initial interviews, indicating that through schema reconstruction they were able to incorporate traumatic experience into a more balanced world view. However, this growth occurred only for those women that were not revictimised during the study period (12 months), highlighting the impact that repeated victimisation has on the reinforcement of negative internalised assumptions (Valdez & Lilly, 2015).

Perpetrators of revictimisation

Perpetrators of adult revictimisation were most commonly intimate partners. Stranger victimisation was the least common form of revictimisation (Logan et al., 2003; Valdez & Lilly, 2015), specifically 27% of urban women had experienced stranger victimisation in their lifetime in comparison to 0% of rural women (Logan et al., 2003). Rural women were more likely to report physical abuse (Kershner et al., 1998; Logan et al., 2003) and encounter abuse earlier in their adult intimate relationships (Logan et al., 2003). Specifically, 50% of rural women reported the first incident of abuse as occurring within 1 month of their relationship, compared to none of the urban women (Logan et al., 2003). For 100% of rural women, the incident that led to the current restraining order against their intimate partner was not the first incident of abuse (Logan et al., 2003). Rural women reported being in multiple (up to four) abusive relationships, and while a small minority (20%) reported leaving the relationship it was more common to remain with the abusive partner (Valdez et al., 2013). Kershner et al. (1998) found that type of relationship impacted women’s rate of risk, with single and divorced women being twice as likely to experience abuse compared to married women. This risk increased to more than six times for separated women.

Helping professionals

A lack of material and physical resources within rural communities can create challenges for health care workers providing consistent and comprehensive response services (Logan et al., 2003; Mitchell et al., 2020). Kershner et al. (1998) collected data on the prevalence of abuse for women attending rural medical clinics and Walk In Centre (WIC) food programmes, they highlighted that one in five women had experienced physical, emotional or sexual abuse in the past 12 months, and that 35.1% (N = 1693) had experienced abuse prior to the age of 18. Abused women attending healthcare settings did not have a demographic profile that enabled easy identification of violent experiences. A lack of healthcare consultation regarding abuse experiences was found by Logan et al. (2003), who noted only 27% of urban women, and 38% of rural women reported a health or mental health practitioner asking about experiences of abuse. The need for screening at medical visits and discussion of abuse and safety with clients was pertinent for women in rural areas, as specialised shelters and advocacy services may be located far away (Kershner et al., 1998).

Housing and employment

Study samples reported low rates of employment for revictimised women, while those who did work reported low levels of income. Unemployment rates reported across studies ranged from 65.2 to 72.7% (Lilly et al., 2014; Valdez & Lilly, 2015). Rural women were less likely to be employed (13%) when compared with urban women (80%) (Logan et al., 2003). Women’s income levels were characterised as poor or working class, with a mean monthly income ranging from US$1147.81 to $1419 (Logan et al., 2003; Valdez & Lilly, 2015). Rural women were also more likely to report they were homeless (90%) when compared with urban women (20%) (Logan et al., 2003).

Examination of factors at a microsystem level highlights that women’s experiences of unsafe family environments during childhood contributed to their experience of IPV and sexual violence in adulthood. Early experiences of child abuse contributed to women experiencing insecure attachment styles and were associated with women’s experience of IPV in adulthood. Perpetrators of violence were most commonly intimate partners, with non-urban women often reporting multiple abusive relationships, with frequent incidents of abuse occurring early within the partnership. The need for medical practitioners to discuss abuse and safety with clients was highlighted as pertinent, particularly for non-urban women who may have limited access to specialised sexual or FV services. Lastly, non-urban revictimised women reported low levels of income and experiences of unstable housing.

Exosystem

An exosystem refers to a setting that may indirectly impact a developing individual, such as a neighbourhood or community legal system. At a community level, one study described exposure to community violence as extreme and highlighted the normalising impact this had for women in creating opportunity for patterns of victimisation within their personal lives (Valdez et al., 2013). Conversely, in their study exploring sexual harassment revictimisation, Stockdale et al. (2014) found that rural geographical location was not significantly associated with sexual harassment and subsequently the control variable was dropped from further statistical analysis.

Discussion

This scoping review sought to examine peer-reviewed articles specific to the revictimisation of women in non-urban settings. In general, there is limited evidence on women’s experience of sexual revictimisation in non-urban settings. Quantitative studies dominate the research, limiting our in depth understanding of women’s revictimisation lived experiences. Most studies explored the association between ontogenic factors and revictimisation, with particular emphasis on victim/survivor psycho-behavioural functioning. A precise prevalence of revictimisation was difficult to ascertain due to the varied definitions of revictimisation, including how child abuse, adolescent, and adult violence was measured and the time frames used. While all studies reported child abuse and adult experiences of violence, several studies defined revictimisation as repeat instances of adult IPV across specific time frames, while others examined violence exposure across the lifespan. There was significant heterogeneity in what forms of child abuse were recorded and what measures were used. Adult victimisation was most commonly measured via the Conflict Tactics Scale (CTS and CTS2) (M. Straus, 1995; M. A. Straus et al., 1996).

While studies highlighted non-urban research samples, very few (n = 3) explored why or how non-urban location contextualises revictimisation experiences. Only one study utilised both a rural and urban comparative sample, making geographical comparative analysis difficult.

Evidence highlighted in this review suggests that while non-urban women experience multiple forms of violence, IPV is the most researched form of violent revictimisation. Studies highlighted the co-occurrence of multiple types of violence, including emotional, physical and sexual. However, the relationship between geographical location and revictimisation was difficult to ascertain. Very few studies focused specifically on the relationship between child abuse, adult revictimisation and non-urban geographical context. Several studies utilised a mix of both urban and non-urban samples, or national samples of mixed gender, where geographical location was captured for demographic reference. Within these large national samples, findings specific to non-urban location were hidden within data sets and not specifically reported on.

At an ontogenic level multiple factors were highlighted as associated with experiences of revictimisation, including mental health conditions, initial child abuse experiences and racial identity. Of particular concern was the high prevalence rates of child abuse reported across multiple studies, and in particular CSA. Research within the United States estimates that the prevalence of sexual abuse and sexual assault for girls under 18 is 26.6% (Finkelhor et al., 2014). Studies included within this review reported significantly higher rates, with differing forms of child abuse often co-occurring across studies. American Indian/Alaska Native women constituted the highest percentage of rural residents within Pro et al.,’s (2020) study sample, and collectively rural and urban American Indian/Alaska Native women reported the highest prevalence rates of both child and adult violence. Yet a lack of intersectional analysis exploring why or how racial and gender identity are associated with prevalence and risk of revictimisation limited further conclusions. While racial identity is considered at the ontogenic level, the compounding impact of colonisation and structural racism should also be considered at a macrosystem level. It is necessary for research to contextualise revictimisation prevalence statistics with qualitative data that details the ongoing discrimination and trauma perpetrated towards American Indian/Alaska Native women which continues to disturb cultural and familial structures (Campbell & Evans-Campbell, 2011).

Within the peer-reviewed papers examined, non-urban revictimised women reported high levels of childhood physical abuse, which commonly involved being beaten with a weapon, and exposure to community violence. Research indicates weapon and firearms have a prominent presence within rural life in a way that is not reflected within urban settings (George & Harris, 2014). FV literature has highlighted the interaction between rurality, gun culture and violence, and the ways this impacts women and children’s feelings of safety (Wendt, 2009). Exposure to FV as a child was consistently reported across studies within this review and was associated with predicted probability of ever experiencing adult IPV. High levels of exposure to violence as a child, including the co-occurrence of diverse forms of child abuse, detrimentally impacted women’s interpersonal schemas regarding self-worth and resulted in the normalisation of violence within adult romantic relationships. The cumulative effect of violence impacted all facets of women’s wellbeing, including emotional, psychological and physical health.

The negative health effects stemming from revictimisation noted in this paper reflect findings within broader revictimisation literature that identify detrimental health outcomes of cumulative abuse/trauma and the burden of disease. Specifically, health outcomes associated with revictimisation indicate women experience anxiety and depressive disorders (Edwards & Banyard, 2020; Walsh et al., 2015) and PTSD symptoms (Jaffe et al., 2019; Ullman & Peter-Hagene, 2016).

Factors identified at both a micro and exosystem level highlight the significant and structural inequalities that non-urban women face. Samples reported low socioeconomic status, high unemployment rates, homelessness, exposure to severe family and community violence and difficulty in accessing continued and comprehensive support. In addition, non-urban women most commonly experienced revictimisation by an intimate partner. Within Australia, FV is a major driver of homelessness (AIHW, 2020a), yet there exists a lack of available housing and support services (Murray et al., 2021; State of Victoria, 2016, p. 116). This review found rural women’s intimate relationships were characterised by physical violence, multiple abusive relationships and a reluctance to leave abusive partners. Evidence suggests that living in geographically isolated areas, with limited financial security and accessible housing/support leaves women with few options beyond returning home to violent partners.

In examining risk for revictimisation, the majority of articles analysed within this scoping review focused on victim/survivor variables including women’s individual mental health, and behavioural functioning. While these factors are no doubt involved in experiences of revictimisation, we contend the narrow focus on women’s characteristics works to both individualise violence and pathologise women, and by extension implies that ‘since past victims are more likely than others to be future victims, they must be doing something to make this happen and that “something” is motivated’ (Wooley, 1993, p. 309). In other words, concern with individual psychopathology diverts focus away from societal pathology, decontextualising the experience of revictimisation from the gendered, colonial and capitalist politics inherently entangled within women’s experiences. For many women existing within a white heteropatriarchal society, ‘the apparent choice to act differently is more illusory than real’ (Wooley, 1993, p. 311). The inclusion of elements at both the micro and exosystem level within this review provided crucial information in contextualising women’s experiences of violence within a broader societal framework, however more research is needed at a mesosystem and macrosystem level.

There is a need for qualitative research that explores non-urban women’s experiences pertaining to the interconnection of different ecological system levels, including how environments influence and shape revictimisation. There is also a need to examine protective factors in relation to sexual revictimisation, as research indicates early intervention in childhood, including strengthening supportive relationships for family/caregiver environments and addressing social inequities may reduce prevalence of CSA (Hooker et al., 2021). From an ecological theoretical perspective, the importance of qualitative data lies in the ability to capture what victim/survivors believe to be important to their experience, including the meaning they attribute to this. As articulated by Bronfenbrenner (1979, p. 22), ‘Very few of the external influences significantly affecting human behavior and development can be described solely in terms of objective physical conditions and events’. In other words, aspects of one’s environment that are most powerful in shaping experiences of, or heightening risk for revictimisation, are those that are meaningful to an individual in their given situation.

Limitations

Limitations of this scoping review include constraints evident in searching for English only studies from high income countries. There are also practical restrictions that impact searching across electronic databases and grey literature websites. As a result, we may have missed evidence important to non-urban revictimisation. However, the scoping review methodology is a comprehensive method of searching for evidence and was strengthened using multiple reviewers, including a service sector staff member from a sexual assault response organisation, and group consultation at each stage of the process.

Data limitations on measuring the prevalence of revictimisation have been cited. Our definition of revictimisation was purposefully broad to capture the already limited data available on non-urban experiences of violence. However, this resulted in considerable differences in revictimisation definitions across studies, including variation in age range and violence experiences.

Review findings are not generalisable outside of the USA. The review aimed to provide an overview of what is known about the revictimisation of non-urban women within Australia, New Zealand, the UK, the USA, and Canada to date. This has enabled an identification of gaps within the evidence, and the need for further research.

Implications for Research, Practice and Policy Research.

• There is very limited research on the revictimisation of women in non-urban populations, particularly sexual revictimisation, despite literature indicating non-urban women face high rates of gendered violence. More research is needed that use urban and non-urban comparative samples.

• Majority of evidence available on this topic is quantitative in nature, however methodological issues such as differing definitions of revictimisation and measures used complicate ascertaining exact prevalence rates.

• Intimate partner violence was the most common form of revictimisation reported by non-urban women in this review.

• Further qualitative research is needed to better understand non-urban women’s lived experiences that can inform policy and practice. A greater understanding of the social-ecological context of non-urban revictimisation may support improved response and prevention of revictimisation within non-urban communities. Research should consider the impact that revictimisation has on delayed disclosure, and how this is compounded by limited-service access in non-urban locations.

Practice and policy.

• Resilience/protective factors need to be identified to build an evidence base and effective interventions to stop violence against women. Evidence from Australia suggests intervening early and supporting healthy relationships/family environments can protect against sexual violence, particularly CSA (Hooker et al., 2021).

• Social policies need to consider how service provision can better accommodate revictimised women within non-urban settings.

• More funding is needed to support structural interventions for revictimised clients including employment and housing support.

• Further training and capacity building for generalist healthcare providers is needed to adequately recognise and respond to revictimisation (Kalra et al., 2021)

There is a significant lack of research available on the revictimisation of women in non-urban areas. This is particularly the case for sexual revictimisation. For example in Australia, research exploring women’s experience of sexual violence in rural areas is often subsumed within studies that examine domestic and FV more broadly (Lievore, 2003; Wendt et al., 2017). While sexual violence towards women exists within domestic and familial settings, it also exists as a phenomenon outside of these contexts, and therefore requires specific attention to better understand its existence outside of the home, and within non-urban settings (Hooker et al., 2019; Neame & Heenan, 2004; Wendt et al., 2017).

Most studies included in this review were quantitative in nature, and therefore did not capture the rich detail of non-urban women’s experiences of revictimisation. This review also found that research studies included in this paper had limited engagement with support service providers to ascertain current response practices and prevention initiatives. Non-urban communities may not have access to specialised FV or sexual violence support services, and therefore generalist healthcare services may be the only point of contact for socially and geographically isolated women. The 2016 ABS Personal Safety Survey found that four out of 10 women who sought support for sexual violence did so via their General Practitioner or other health professional (AIHW, 2020b). In addition to limited-service access, research suggests that sexually revictimised women may be more likely to delay disclosure due to self-blame, and a desire to protect themselves and others, when compared with those who experience one incident of victimisation (Kellogg & Hoffman, 1997). Further healthcare provider training and skill development is needed to ensure evidence based care, enhanced identification and response to revictimised clients (Kalra et al., 2021).

Conclusion

Revictimisation is a human rights and public health issue that has negative long-term impacts on victim/survivors’ lives. The relationship between repeat gendered violence and non-urban geographical location is complex and multi-faceted, yet very little research has explored non-urban women’s experience of revictimisation both within Australia, and internationally. Almost all of the evidence available is quantitative in nature, from the USA and limited in its capacity to capture the complexities of what victim/survivors consider to be important to their own experience of revictimisation. Our limited findings indicate there are several factors associated with non-urban women’s experience of revictimisation. At an ontogenic level, non-urban women experienced frequent and co-occurring forms of child abuse, which is associated with a heightened likelihood of experiencing IPV in adulthood. Experiences of violence have negative impacts on women’s mental health within this review, particularly for Native American/Alaskan Native women. Microsystem level factors influencing revictimisation include unsafe family environments, insecure attachment and significant experiences of IPV. Non-urban women also faced significant structural inequities such as low income, housing and limited response service resources. At the exosystem level exposure to community violence served to normalise violence within women’s lives. Factors at all system levels point to the detrimental impact revictimisation has on non-urban women’s health and wellbeing, highlighting the need for additional qualitative research to better understand the experiences and needs of non-urban revictimised women.

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 work was supported by the La Trobe University (La Trobe Graduate Research Scholarship).

ORCID iDs

Emily Corbett

Paulina Billett

Leesa Hooker

Grey Literature Search

• Australian Institute of Family Studies http://www.aifs.gov.au/

• Australian Centre for the Study of Sexual Assault https://aifs.gov.au/projects/australian-centre-study-sexual-assault-acssa

• Australian Institute of Health and Welfare http://www.aihw.gov.au/

• Australia’s National Research Organisation for Women’s Safety http://www.anrows.org.au/

• Australian Government Department of Health https://www.health.gov.au/

• Australian Government Department of Social Services https://www.dss.gov.au/

• CASA https://www.casa.org.au/

• OurWatch https://www.ourwatch.org.au/

• VicHealth https://www.vichealth.vic.gov.au/

• Domestic Violence Resource Centre Victoria https://www.dvrcv.org.au/

• Domestic Violence Victoria https://dvvic.org.au/

• Women’s Health Victoria https://whv.org.au/

• Gender Equity Victoria https://www.genvic.org.au/

• Respect Victoria https://www.respectvictoria.vic.gov.au/

• SASS Sexual Assault Support Service https://www.sass.org.au/

Rape and Domestic Violence Services Australia https://www.rape-dvservices.org.au/

Appendix B

Inclusion Criteria	Rationale
Women who have experienced revictimisation, aged 10 years and above.	The focus of the paper is women’s experience of revictimisation. Revictimisation is stated in the paper as ‘any form of child abuse, and a subsequent experience of interpersonal violence in adolescence or adulthood’. The paper states, ‘The World Health Organization (WHO) defines adolescents as 10–19 years of age (World Health Organization, 2020). In recognising adolescence as a significant developmental period when revictimisation can occur (Humphrey & White, 2000) studies were included if participants were aged 10 years and above’.
Studies that include men and women, if data analysis is separated by gender, and data on women can be extracted.	Some of the selected studies included both men and women within the population sample. Studies were included if data could be extracted based on gender.
Studies where non-urban data can be analysed.	Some of the selected studies included urban and non-urban populations. Studies were included if non-urban population data could be extracted.
Studies published between 1990 and Jan 2020.	An initial database search highlighted there was limited non-urban revictimisation literature published within the past two decades; therefore, we extended the search to 1990 to ensure any non-urban literature was identified.
Studies published in English from the US, Australia, NZ, Canada and the UK.	As stated, ‘This paper focuses on women’s experiences of revictimisation in non-urban settings within Australia, New Zealand, the United Kingdom, the United States, and Canada. Countries were selected due to their similar and interconnected feminist movements challenging gendered violence (Maddison & Sawer, 2013), as well as comparable socio-cultural/political colonial systems (Bell & Vucetic, 2019)’.
Peer-reviewed primary research	Articles needed to be peer reviewed and primary research to ensure relevant and high quality information was included in the review.
Exclusion Criteria	Rationale
Men, children (aged 0–9 years)	Although men can experience revictimisation, they were not the focus of this paper.
One off incidences of violence.	Revictimisation is stated in the paper as ‘any form of child abuse, and a subsequent experience of interpersonal violence in adolescence or adulthood’.
Bullying – without the presence of some form of interpersonal abuse (e.g. CSA) preceding the bullying.	This paper is concerned with revictimisation, being child abuse and then a subsequent experience of violence later in life. Child abuse is defined as any form of physical, sexual or emotional maltreatment by someone in a position of responsibility or power that could harm the child’s health (World Health Organization, 2020). While peer to peer abuse could constitute revictimisation, it does not constitute an initial experience of child abuse as defined in this paper.
Poly-victimisation only existing in childhood.	Revictimisation traditionally occurs when ‘a survivor of sexual abuse or rape during childhood is victimized again (i.e. revictimized) during adulthood’ (Messman & long, 2003). In recognising adolescence as a significant developmental period when revictimisation can occur (Humphrey & White, 2000), studies were included if participants were aged 10 years and above. Multiple experiences of violence during childhood do not meet this study’s definition of revictimisation.

Author biographies

Emily Corbett is an industry PhD student with the Australian Research Centre in Sex, Health and Society (ARCSHS) La Trobe University, and the Centre Against Sexual Assault Central Victoria (CASA-CV). Her PhD research will focus on exploring women’s experiences of sexual revictimisation in non-urban spaces.

Jacqui Theobald is senior lecturer in social work at La Trobe University with expertise in qualitative research, particularly with marginalised groups. Her primary areas of research are women’s homelessness, gender-based violence, and women’s refuges.

Paulina Billett is a lecturer in Sociology at the Department of Social Inquiry, La Trobe University. Her research interest focuses on wellbeing, individuals lived experience and identity formation, with a particular focus on the lives of women and young people.

Leesa Hooker is a Senior Research Fellow at La Trobe University, leading research on Reducing Violence against Women. She has established expertise in the epidemiology of family violence, women’s mental and reproductive health and parenting. Her research includes intervention trials, observation studies and systematic reviews with a focus on improving maternal and child health outcomes.

Lee Edmonds is the Manager, Strategy and Development at the Centre Against Sexual Assault Central Victoria (CASA-CV).

Christopher M Fisher is the Academic Course Coordinator at Victoria University Online and an adjunct at the Australian Research Centre in Sex, Health and Society, La Trobe University. His research focuses on adolescent sexual health and wellbeing including consent and sex education, behaviours and knowledge.

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