Measuring Healing and Recovery After Gender-Based Violence: A Scoping Review

Abstract

Healing after gender-based violence (GBV) is multidimensional, with varying instruments used in the scientific literature to capture this phenomenon quantitively in survivor populations. The purpose of this scoping review was to (a) describe quantitative measures used to evaluate recovery after GBV, (b) compare these findings with domains uncovered in a qualitative metasynthesis about survivors’ perspectives about healing after GBV, and (c) summarize recovery relationships found. We searched Pubmed, PsycInfo, and Violence/Criminology/Family Studies Abstracts. Studies were included for review if they (a) used quantitative methods, (b) evaluated healing or recovery in survivors of GBV, (c) were available in English, and (d) were empirical articles in peer-reviewed journals. Two thousand nine hundred thirty-five articles were reviewed by title and abstract, and 92 articles were reviewed by full text. Twenty-six articles were included in this review. Eight studies used an alleviation of adverse symptomology as a proxy for recovery, eight used growth-related outcomes, and ten used a combination of both types of measures. While the quantitative instruments synthesized in this review seemed to map onto some of the recovery domains identified through qualitative metasynthesis, no study synthesized measured all domains simultaneously. Studies synthesized identified that recovery-related outcomes may be influenced by social support, symptom burden, disclosure, and various therapeutic intervention programs tested in the literature to date. Synthesizing research on recovery after GBV is an essential step to understand gaps in measurement and understanding. Streamlining and using holistic recovery outcome measurement can aid in the development of evidence-based interventions to promote healing in survivor populations.

Keywords

gender-based violence sexual assault intimate partner violence recovery healing measurement

Introduction

Gender-based violence (GBV) is a persistent and pervasive human rights concern and international public health issue (Heise et al., 2002). GBV is defined as acts of violence committed against an individual based on their gender identity and/or the unequal power dynamics related to gender, including but not limited to emotional, physical, financial, sexual, or psychological abuse (Peate, 2019). Although individuals of any gender can experience GBV, these acts disproportionately affect women. For example, in the United States, over 40% of women report experiencing some form of contact sexual violence in their lifetime, and 1 in 4 women report an experience of severe physical violence, contact sexual violence, and/or stalking by an intimate partner in their lives (National Center for Injury Prevention and Control, 2018; Truman & Morgan, 2014). When GBV is addressed with an intersectional lens, the numbers are even starker. In the United States, Black, Indigenous, and other women of color, as well as sexual minorities, women with disabilities, and undocumented residents, all face even higher rates of GBV (Erickson-Schroth et al., 2020). On a global scale, the prevalence of GBV among women is pervasive, with the World Health Organization estimating that worldwide, 1 in 3 women have experienced physical and/or sexual violence by a partner or non-partner in their lifetime (World Health Organization, 2021).

Significant literature exists exploring negative effects of GBV; however, research about recovery lacks a consensus on best practices to quantitatively measure healing after these experiences. The purpose of this scoping review is to summarize quantitative measures used to describe healing and recovery after GBV. Secondary aims include exploring relationships found using these measures and comparing the domains covered by these instruments to a qualitative metasynthesis of GBV healing to inform future theoretical development (Sinko et al., 2022). While many studies have discussed recovery and healing in qualitative capacities, there must be a deeper consideration as to how we measure individual recovery quantitatively to ensure it is aligned with survivors’ healing goals and desires.

Impact of GBV

GBV can include sexual assault, intimate partner violence, marital rape, sexual harassment, or child abuse (Heise et al., 2002). Like any traumatic or abusive experience, GBV can have long-term effects on survivors. Studies demonstrate heightened risk for substance use, mental health issues (such as depression, posttraumatic stress disorder (PTSD), and anxiety), chronic pain syndromes, gynecologic disorders, sexually transmitted infections, digestive system disorders, and suicide attempts for survivors in the aftermath of GBV (Bacchus et al., 2018; Bonomi et al., 2009; García-Moreno et al., 2013). These outcomes vary depending on the circumstances of the abuse and the history of the individual, with studies finding that greater severity, duration, and level of betrayal typically result in heightened mental health symptom burden for survivors (Campbell, 2002; Martin et al., 2013; Wills et al., 2022) and greater challenges for recovery. No matter what type of GBV experienced, due to the high prevalence of GBV against women, instances of GBV can be normalized and minimized by society, impacting whether individuals seek help for the health impacts of these experiences (Aghtaie et al., 2018; Rodelli et al., 2022; Thorvaldsdottir et al., 2021). Reintegration into environments that were harmful in the past without the support of others can further perpetuate adverse mental health symptoms (Sinko, Munro-Kramer et al., 2021), often making GBV recovery a uniquely isolating experience.

The present review includes study participants who identify with a variety and combination of GBV experiences. These range from someone who has experienced a single GBV event to people who have experienced years in an abusive relationship or experienced repeated, cumulative exposure to violence and abuse across the lifespan. In general, what determines whether GBV is traumatic is not only due to the event(s) that occur themselves but ultimately how these event(s) are experienced by the survivor and the long-term effect it has on them (Substance Abuse and Mental Health Services Association, n.d.). In this way, all GBV experiences are valuable to be studied, regardless of GBV type, frequency, and complexity, as traumatic impacts cannot be determined by the type(s) of events you have experienced alone. In addition, the healing needs across GBV types are quite similar, as demonstrated by a metasythesis of qualitative GBV healing studies (Sinko et al., 2022).

Because of the significant impact GBV can have on survivor mental health, a large body of literature primarily operationalizes recovery by the alleviation of adverse mental health symptom burden. For example, several studies have used improved depression (Hou et al., 2016), anxiety (Saint Arnault & O’Halloran, 2015), and PTSD (Ong et al., 2019) symptoms as a means to determine recovery progress. While these studies were able to uncover the importance of support groups, psychotherapy, and trauma-sensitive yoga in improving mental health symptom burden for survivors of GBV, survivors are often looking for more than symptom relief in their healing experiences (Sinko et al., 2022 for review). In the present review of GBV recovery measures, we anticipate prevalence of symptom-based measures but also want to highlight alternatives that focus on the multidimensional aspects of recovery.

Recovery after GBV

“Recovery” broadly implies a return to baseline or normality, however, the recovery process itself can and should be described with greater nuance. Ranjbar and Speer (2013) note that focusing on recovery as simply the absence of symptoms may not “capture all relevant aspects of survivors” reactions and, as such, “may prevent an exploration of the full scope of what constitutes recovery” (Ranjbar & Speer, 2023, p. 275). Research into recovery after GBV, therefore, encompasses a broader conception of well-being and includes concepts such as adaptation, resiliency, posttraumatic growth (PTG), and healing (Bradley & Davino, 2007; Draucker et al., 2009; Heywood et al., 2019). Thus, for the purposes of this review, we aim to integrate discussions of these and other related topics as long as they are ultimately tied to the recovery process. This allows for the inclusion of a holistic body of research and ensures a more diverse set of lenses through which to assess elements of recovery.

Based on a qualitative metasynthesis on survivor perspectives of healing after GBV, healing is defined as a multidimensional, iterative, non-linear journey requiring courage, patience, and active recovery engagement (Sinko et al., 2022). Studies synthesized use terms such as “thriving” (Heywood et al., 2019; Taylor, 2004), “remaking the self” (Oke, 2008), “transformation of identity” (Glumbíková & Gojová, 2019), and “overcoming” (Flasch et al., 2017) to describe GBV recovery. Furthermore, survivor-desired healing outcomes surround processing and reexamining trauma, managing negative states, rebuilding the self, connecting with others, and regaining hope and power (Sinko et al., 2022). Though there is debate over the definition of recovery in general, quantifying progress in GBV survivor-relevant domains is critical to ensure we are tailoring our intervention and assessment approaches. While symptom burden is an important consideration, selfhood, social and future-oriented aspects may be missing when only symptoms are used (Sinko & Saint Arnault, 2020). To improve care and support for individuals who have experienced GBV, it is critical to measure healing after GBV in a holistic way that incorporates the multidimensional definition of healing.

Measuring Healing After GBV

Beyond qualitative and symptom-focused evaluation, a variety of instruments have been used in survivor populations to explore healing domains as described in Sinko et al. (2022) qualitative metasynthesis. The Positive Life Change Scale is an example of a study that asks questions related to self (e.g., “My ability to take care of myself”), relationships (e.g., “My relationships with family”), philosophy/spirituality (e.g., “My sense of purpose in life”), and empathy (e.g., “My concern for others in my similar situation”) on a five-point scale allowing individuals to rate the degree of change (Frazier, Tashiro et al., 2004). The Posttraumatic Growth Inventory (PTGI) is another measure that more closely aligns with survivor-voiced domains. In the PTGI, participants rate the degree to which change occurred in their life because of a traumatic experience within five factors: New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life (Cobb et al., 2006; Tedeschi & Calhoun, 1996). In general, quantitative literature lacks consistency about best practices and instruments used to measure recovery from GBV. In this way, it is difficult to prioritize outcome measures and compare findings across studies, preventing researchers and practitioners from full comprehension of interventions, approaches, and solutions to support recovery after GBV.

Within the literature, there is evidence suggesting that a more consistent and holistic instrument is needed. In fact, some literature discussed the idea that growth after GBV and clinical symptoms may be independent constructs (Cobb et al., 2006; Stermac et al., 2014). A variety of articles using symptom-based scales (Beck Depression Inventory, Posttraumatic Stress Symptom Scale, etc.) drew parallel between recovery and alleviation of symptoms. For example, one article identified recovery and resilience independently (Steenkamp et al., 2012), while another study included resilience as a recovery measure (Hou et al., 2016). Moreover, the relationship between growth outcomes and measures of depression and PTSD was found to be insignificant, suggesting that symptom burden and growth may not be directly related (Grubaugh & Resick, 2007). Moreover, environmental factors, such as childhood sexual abuse and previous rape, were found to impact depression and PTSD in different ways (Regehr et al., 1999). This finding potentiates inaccuracies within studies that use both depression and PTSD (Sigurvinsdottir & Ullman, 2015) as measures for recovery after GBV. In another study, symptom measures used to represent recovery, such as depression, improved from therapy, though effects of therapy on resilience were insignificant (Hou et al., 2016).

The Present Review

Synthesizing research on recovery after GBV is an essential step in the identification and development of appropriate, evidence-based interventions. The purpose of this scoping review is to (a) describe quantitative measures used to evaluate recovery after GBV, (b) compare instruments used to domains uncovered in a qualitative metasynthesis about healing after GBV, and (c) summarize recovery relationships. We chose to conduct a scoping review in order to synthesize, map key concepts, and address methodological gaps by systematically searching, selecting, and synthesizing existing knowledge (Colquhoun et al., 2014). Results can map out the state of the science on quantitative recovery literature to date, as well as key relationships found, while also addressing gaps and limitations of each measure as it relates to GBV healing. This is important because properly measuring recovery can help inform the ways we treat survivors. Those looking for help beyond symptom relief will be better supported if we measure recovery in a way that reflects what survivors are telling us about their recovery journey.

Methods

A scoping review was conducted to identify tools or instruments used to measure recovery and/or healing from GBV. Scoping reviews are useful for mapping the literature on a given topic, and they provide an opportunity to identify key concepts, gaps in the research, and sources of evidence to inform research, practice, and policymaking around that given topic (Pham et al., 2014). A scoping review can allow for a broader synthesis of information than a systematic review, which goes more in depth by assessing the quality of each study reviewed. We utilized Arksey and O’Malley’s (2005) five-stage approach to a scoping review to structure our study: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting results.

Identifying the Research Question

In order to capture the more elusive concepts of “healing” and “recovery” in our scoping search, we chose to pose a broad question with key terms that were evaluated by several researchers. Our search strategy was based upon the question, “How has healing or recovery after GBV been measured and quantified in the scientific literature?”

Identifying Relevant Studies

Consultation with a library scientist prompted us to use Pubmed, PsycInfo, and Violence/Criminology/Family Studies Abstracts for our research databases. An initial search in these databases was carried out to estimate the likely size and relevance of the key terms, and changes were made to the search strategy based on the results gathered (e.g., discovery of the term “trafficking” having multiple meanings cross disciplines led to the specification of “sex trafficking” to improve search relevance). Inclusion criteria included quantitative, empirical articles published in English in peer-reviewed journals. Articles synthesized focused on studies exploring a type of GBV (e.g., intimate partner violence, sexual assault) and the healing/recovery process, journey, or related outcomes. Studies were excluded if they focused on prevention only or evaluated interventions targeting specific aspects of recovery (e.g., self-compassion and self-efficacy) rather than recovery generally.

Researchers collaborated on a list of key search terms that were used to develop a search string. GBV is an intentionally broad term, and we decided to explicitly list and use concepts that fall under it in our search to be as thorough as possible. Using truncated words and wild cards (in this case*), we aimed for a broad search that would capture all terms with the same root word (Dickson-Swift et al., 2014). Recovery is similarly a broad term, and thus we used a previous qualitative metasynthesis on GBV healing (see Sinko et al., 2022) to identify key words survivors use to describe healing (e.g., healing, recovery, growth, thriving, overcoming, flourishing, and resilience). For some databases, we added a “NOT” term to eliminate qualitative approaches from our results (see Supplemental Appendix 1 for example search terms).

Study Selection

We used Rayyan Software (https://www.rayyan.ai/cite/) (Ouzzani et al., 2016) to manage our scoping review articles. Blinded screening was conducted of titles and abstracts based on our identified search criteria by two research assistants, with reconciliation meetings moderated by the first author. A total of 3,383 articles were found through our search, leading to 2,935 articles being reviewed by title and abstract after removing duplicates. Thirty-eight articles were agreed upon between reviewers for full-text review, with 112 articles either being marked as “maybe” by both reviewers, demonstrating a lack of consistency in reviewer decision-making (e.g., one chose to include while the other chose to exclude). Reconciliation meetings led to 20 of these articles being excluded, with the rest (N = 92) being included for full-text review. After full-text review, 26 articles were found to meet study criteria (See Figure 1). Results are summarized below via a Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) diagram.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram.

Results

Charting the Data

The 26 articles included in the final sample were published between 1994 and 2021. The research publications in this area have slowly increased over the years, accelerating in 2004, with 54% of the articles published after 2011. The articles synthesized appeared in 20 academic journals spanning multiple specialties, including clinical psychology, social psychology, counseling, psychiatry, nursing, and sociology. The studies presented in these articles were conducted in seven countries (Australia, Canada, England, Ireland, Taiwan, United States, and Wales), with the vast majority (77%) being conducted in the United States. Details of these studies as well as the primary recovery outcome measures used, can be viewed in Table 1.

Table 1.

Details of Studies Included in Review.

Article	(Country) Participants	Demographic Breakdown of Participants (as recorded in the study)	Methodology	Primary Recovery Outcome Measures Used
Ahrens et al. (2010)	(U.S.) Female (age 18–66) sexual assault (in childhood and/or adulthood) survivors recruited from the community (n = 103)	Race/ethnicity/nationality • African American (37%) • Asian (7%) • Latina (11%) • White (38%) Sexual orientation • Data not gathered/reported Education/employment • High school education or higher (80.2%) • Unemployed (55.9%)	Community-based quantitative interview study	• Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) • Posttraumatic Diagnostic Scale (PDS; Foa et al., 1997) • Cohen Hoberman Inventory of Physical Symptoms (Eby et al., 1995)
Cobb et al. (2006)	(U.S.) Women (average age 33) utilizing shelter services who had a history of a violent intimate relationship (n = 60)	Race/ethnicity/nationality • White (48.3%) • African American (38.3%) • Hispanic (1.7%) • Other (11.7%) Sexual orientation • Data not gathered/reported Education/employment • Averaged 12 years of education	Cross-sectional study	• Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996)
Donde and Ragsdale (2021)	(U.S.) College women (average age 20) who had experienced sexual victimization (n = 347)	Race/ethnicity/nationality • Black/African American (4.3%) • Asian (7.5%) • Hispanic/Latina (2.9%) • White/Caucasian (74.9%) • Other (10.4%) Sexual orientation • Heterosexual (92.2%) • Other (7.8%) Education/employment • In college (100%)	Cross-sectional retrospective study	• Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1965) • Rape Attribution Questionnaire, Perceived Future Control Over Sexual Victimization and Perceived Future Likelihood of Assault Recurrence Subscales; Frazier, 2003)
Ferrari et al. (2018)	(England and Wales) Women (age 18–66) who had experienced domestic violence and were recruited from shelters, refuge, and in the community (n = 260)	Race/ethnicity/nationality • White British or other white background (84.2%) Sexual orientation • Data not gathered/reported Education/employment • Completed secondary education (74.2%) • Not in formal employment (70.4%)	Two parallel groups, individually randomized controlled trial	• Patient Health Questionnaire-9 (Kroenke & Spitzer, 2002) • Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al., 2002)
Fraizer and Schauben (1994)	(U.S.) Female (age 17–56) rape survivors (assault occurred on average of eight years prior), recruited at university (n = 282)	Race/ethnicity/nationality • Caucasian (80%) Sexual orientation • Data not gathered/reported Education/employment • Data not gathered/reported	Cross-sectional study	• The Brief Symptom Inventory (BSI; Derogatis, 1982) • The McPearl Belief Scale (McCann & Pearlman, 1990)
Frazier, Steward et al. (2004)	(U.S.) Women (average age 39) sexual assault survivors (assault occurred on average of 16 years prior), recruited from the community (n = 135)	Race/ethnicity/nationality • Caucasian (79%) Sexual orientation • Data not gathered/reported Education/employment • Modal education level was completed in some college • Worked full time (53%)	Cross-sectional study	• The BSI (Derogatis, 1982) • Stress Related Growth Scale (Park et al., 1996) • 9-Item Life Satisfaction Measure (developed by authors) • 17-item Checklist for PTSD based on DSM-IV (Frazier et al., 2001)
Frazier et al. (2004)	(U.S.) Female (age 16–52) sexual assault survivors recruited at emergency rooms (n = 171)	Race/ethnicity/nationality • White (77%) • African American (15%) • Other (8%) Sexual orientation • Data not gathered/reported Education/employment • Data not gathered/reported	Longitudinal study	• Positive Life Change Scale (Frazier et. al., 2001)
Grubaugh and Resick (2007)	(U.S.) Treatment-seeking female (average age 32) physical and sexual assault victims (n = 100)	Race/ethnicity/nationality • Caucasian (56.0%) • African American (36.0%) • Native Hawaiian, Asian, or Other (8.0%) • Hispanic (6.3%) Sexual orientation • Data not gathered/reported Education/employment • Data not gathered/reported	Part of a longitudinal treatment study	• PTGI (Tedeschi & Calhoun, 1996)
Hassija and Turchik (2016)	(U.S.) Women (average age 21) with prior exposure to sexual assault, recruited at college (n = 85)	Race/ethnicity/nationality • Caucasian/White and non-Latino (78.8%) Sexual orientation • Data not gathered/reported Education/employment • Averaged 13.4 years of completed education	Cross-sectional study	• PTGI (Tedeschi & Calhoun, 1996)
Hou et al. (2016)	(Taiwan) Female (age 30–47) intimate partner violence survivors, recruited from services for abused women (n = 29)	Race/ethnicity/nationality • Taiwanese (100%) Sexual orientation • Data not gathered/reported Education/employment • College or above degrees (50%) Full-time job (50%)	A two-group, quasi-experimental design	• State Hope Scale-Chinese Version (Snyder et al. 1996) • 25-item Resilience Scale-Chinese Version (Wagnild & Young 1990) • Taiwanese Depression Questionnaire (Lee et al., 2000)
Ikonomopoulos et al. (2017)	(U.S.) Women (age 19–46) survivors of domestic violence, recruited at a counseling clinic (n = 3)	Race/ethnicity/nationality • Hispanic ethnic identities (100%) Sexual orientation • Heterosexual (100%) Education/employment • Data not gathered/reported	A-B single case research	• Outcome Questionaire-45.2 (Lambert et al., 1996) • Brief Resilience Scale (Smith et al., 2008)
Kirkner and Ullman (2020)	(U.S.) Women (age 18–71) sexual assault survivors, recruited from the community, services, and universities (n = 1,863*)	Race/ethnicity/nationality • African American (47%) • White (35%) • Asian (2%) • Other (10%) • Multiracial (6%) • Hispanic origin (14%) Sexual orientation • Data not gathered/reported Education/employment • College degree or higher (33%) • Employed (43%)	Exploratory longitudinal study	• Post Traumatic Growth Inventory-Short Form (PTGI-SF; Cann et al., 2010)
Koss and Figueredo (2004)	(U.S.) Female (age 18–57) recent (within three months) rape survivors, recruited from sexual assault service centers (n = 59)	Race/ethnicity/nationality • White (81%) • Hispanic (7%) • African American (7%) • Asian American or Pacific Islander (5%) Sexual orientation • Data not gathered/reported Education/employment • College degree or higher (29%)	Longitudinal study	• Social Adjustment Scale (SAS; Weissman & Bothwell, 1976) • BSI (Derogatis & Melisaratos, 1983) • PDS (Foa, 1995)
Lambert et al. (2013)	(U.S.) Women (age 18–58) who had recently experienced intimate partner violence, recruited from shelters (n = 55)	Race/ethnicity/nationality • White (67.2%) • Latina (11.5%) • African American (9.8%) • Native American (1.6%) • Asian American (1.6%) • Other (8.2%) Sexual orientation • Data not gathered/reported Education/employment • College degree or higher (8.2%)	Cross-sectional study	• Beck Depression Inventory-II (Beck et al., 1996) • PDS (Foa et al., 1997)
Najdowski and Ullman (2009)	(U.S.) Women (average age 32) who reported having experienced adult sexual assault, recruited on college campuses, mental health agencies, and rape crisis centers (n = 969)	Race/ethnicity/nationality • Caucasian (40%) • African American (43%) • Hispanic (6%) • Asian (3%) • Other (1%) • Mixed ethnic background (7%) Sexual orientation • Heterosexual (77%) • Lesbian (6%) • Bisexual (12%) Education/employment • College degree or higher (33%) • Employed (50%)	Cross-sectional study	• Self-Rated Recovery (Ullman, 1996) • PDS (Foa, 1995)
Neville et al. (2004)	(U.S.) Women (age 18–59) sexual assault survivors, recruited at university (n = 97)	Race/ethnicity/nationality • Black (46.4%) • White (53.6%) Sexual orientation • Data not gathered/reported Education/employment • Currently university student (100%)	Cross-sectional study	• RSES (Rosenberg, 1965)
Ong et al. (2019)	(U.S.) Women (age 26–52) that had experienced intimate partner violence, recruited from treatments sites for violence survivors (n = 5)	Race/ethnicity/nationality • Black, White, and Latino ethnicities (% not reported) Sexual orientation • Data not gathered/reported Education/employment • Data not gathered/reported	Case study	• Clinician-Administered PTSD Scale for DSM-5 (Weathers et al., 2018) • Subjective Units of Distress Scale (Wolpe, 1969)
Regehr et al. (1999)	(Canada) Women (age 17–47) adult rape survivors, recruited from universities, sexual assault centers and health centers (n = 71)	Race/ethnicity/nationality • Canadian-born (83%) • Had parents who immigrated (28%) Sexual orientation • Data not gathered/reported Education/employment • Completed college or university (42%) • Employed fulltime (39%)	Cross-sectional study	• Posttraumatic Stress Symptom Scale (Foa et al., 1993) • Beck Depression Inventory (Beck et al., 1961)
Saint Arnault and O’Halloran (2015)	(Ireland) Women (average age 44) receiving domestic violence support services who were in the recovery phase of their survivorship (n = 8)	Race/ethnicity/nationality • Irish (100%) Sexual orientation • Data not gathered/reported Education/employment • Graduate degree (12.5%)	Longitudinal pilot study	• CES-D; Radloff, 1977) • Zung Anxiety Self Report (SAS; Zung, 1971) • Composite Symptom Checklist (Saint Arnault & Fetters, 2011) • 36-Item Short Form Survey (SF-36, Bodily Pain, Vitality, Social Functioning, and Role Emotional Subscales; Ware et al., 1998) • Social Support Questionnaire for Transactions (Suurmeijer et al., 1995) • Quality of Relationship Inventory (Social Conflict Subscale; Pierce et al., 1991)
Shakespeare-Finch and Armstrong (2010)	(Australia) Male and female (average age 28) survivors of serious sexual assault, recruited from the community and universities (n = 32)	Race/ethnicity/nationality • Data not gathered/reported Sexual orientation • Data not gathered/reported Education/employment • Data not gathered/reported	Cross-sectional study	• PTGI (Tedeschi & Calhoun, 1996) • Impact of Events Scale-Revised (Weiss & Marmar, 1997)
Sigurvinsdottir and Ullman (2015)	(U.S.) Women (age 18–71) sexual assault survivors, recruited from the community, services, and universities (n = 1,863*)	Race/ethnicity/nationality • African American (45%) • White (35%) • Asian (2%) • Other (8%) • Hispanic (14%) Sexual orientation • Heterosexual (83%) • Bisexual (11%) • Lesbian (6%) Education/employment • College degree or higher (34.6%) • Employed (46.8%)	Cross-sectional retrospective study	• PDS (Foa, 1995) • Center of Epidemiologic Studies Depression Scale-7 (CES-D-7; Mirowsky & Ross, 1990) • Michigan Alcoholism Screening Test (Selzer, 1971) • Drug Abuse Screening Test-Shortened Version (McCabe et al., 2006)
Sigurvinsdottir and Ullman (2016)	(U.S.) Female (age 18–71) sexual assault survivors, recruited from the community (n = 905*)	Race/ethnicity/nationality • African American (47%) • White (35%) • Asian (2%) • Other (10%) • Multiracial (6%) • Hispanic (13%) Sexual orientation • Heterosexual (90%) • Bisexual (10%) Education/employment • College degree or higher (33%) • Employed (43%)	Longitudinal study	• PDS (Foa, 1995) • CES-D-7 (Mirowsky & Ross, 1990)
Steenkamp et al. (2012)	(U.S.) Women (age 18–65) who experienced a sexual assault within the previous month, recruited through online advertisements and medical advocates (n = 119)	Race/ethnicity/nationality • White (63%) • Black (20%) • Hispanic (8%) • Asian American (6%) Sexual orientation • Heterosexual (85%) • Bisexual (10%) • Homosexual (5%) Education/employment • Currently, student (11%) • Working full-time or part-time (68%)	Longitudinal study	• PTSD Checklist-Civilian Version (Weathers et al., 1993) • Depression Anxiety Stress Scale-21 (Lovibond & Lovibond, 1995) • Peritraumatic Dissociative Experiences Questionnaire (Marmar et al., 1994)
Stermac et al. (2014)	(Canada) Female and male (age 18–52) survivors who experienced sexual assault within the past three years recruited through online advertisements and in community services centers (n = 73)	Race/ethnicity/nationality • White (71.6%) • Asian (7.5%) • Black (6.0%) • Hispanic/Latino (4.5%) • Multiple race/other (10.5%) Sexual orientation • Data not gathered/reported Education/employment • Some university experience (77.9%) • Working (53.5%)	An exploratory retrospective study	• Trauma Symptom Checklist-40 (Elliott & Briere, 1992) • PTGI (Tedeschi & Calhoun, 1996) • Changes in Outlook Questionnaire-Short Form (CiOQ-S; Joseph et al., 2006)
Ullman (1997)	(U.S.) Women (average age 29) who experienced adult sexual assault over a year ago, recruited from universities, rape crisis centers, and community agencies (n = 155)	Race/ethnicity/nationality • Non-Hispanic White (81%) • African American (4%) • Hispanic (5%) • Asian (5%) Sexual orientation • Data not gathered/reported Education/employment • College graduates (44%) • Employed (71%)	Cross-sectional study	• Self-Rated Recovery • Psychological Reactions to Assault Questionnaire (Siegel et al., 1990)
Ullman (2014)	(U.S.) Women (age 18–71) sexual assault survivors recruited from the community and universities (n = 1,863*)	Race/ethnicity/nationality • African American (45%) • White (35%) • Asian (2%) • Other (8%) • Hispanic (14%) Sexual orientation • Data not gathered/reported Education/employment • College degree or higher (34.6%) • Employed (46.8%)	Cross-sectional study	• Posttraumatic Growth Inventory-Short Form (Cann et al., 2010)

Articles using the same dataset.

Summarizing and Reporting Results

Article Characteristics

The 26 articles reviewed reported on studies using cross-sectional, longitudinal, or experimental designs. A total of 5,081 GBV survivors were surveyed through the studies. These participants either experienced sexual or physical assault, domestic violence, or intimate partner violence, depending on how the authors framed their study (see Table 2 for the types of GBV experienced by participants across studies). The majority of participants were from the United States, with two studies describing Canadian survivors and one study each describing the experiences of survivors from Ireland, Australia, Taiwan, and England/Wales. Some studies only used an alleviation of adverse or distressing symptomology as a proxy for recovery (n = 8), while others only used growth and functioning-related outcomes (n = 8), and others used a combination of both types of measures (n = 10).

Table 2.

Type of GBV Experienced by Participants.

Type of GBV	n	No. of Studies
Sexual assault	4,625	18
Physical assault	36	1*
Domestic violence	271	3
Intimate partner violence	149	4
Total	5,081	26

Grubaugh & Resick looked at survivors of physical assault (n = 36) and sexual assault (n = 64).

Note. GBV = gender-based violence.

Instruments Used to Measure Recovery

We primarily uncovered two recovery paradigms as it relates to outcome measurement for survivors of GBV. As predicted, some studies used an alleviation of adverse or distressing symptomology as a proxy for recovery (n = 18). Thematic categories captured via adverse symptomology included depression symptoms (n = 8), anxiety symptoms (n = 2), traumatic stress symptoms (n = 13), substance use (n = 2), physical/somatic symptoms (n = 1), and other more comprehensive assessment of adverse mental health symptomology (n = 8). See Table 3 for a summary of specific instruments used to describe these domains in studies reviewed.

Table 3.

Critical Findings-Symptom-Based Recovery Outcomes Used by Studies.

Symptom Domain	Instrument Used	No. of Studies
Depression	Center for Epidemiologic Studies Depression Scale	4
	Patient Health Questionnaire-9	1
	Taiwanese Depression Questionnaire	1
	Beck Depression Inventory	2
	Total	8
Anxiety	Subjective Units of Distress Scale	1
	Zung Self-Rating Anxiety Scale	1
	Total	2
Traumatic stress	Posttraumatic Diagnostic Scale	6
	Posttraumatic Stress Symptom Scale	1
	17-item Checklist for PTSD based on DSM-IV	1
	Clinician-Administered PTSD Scale for DSM-5	1
	Impact of Events Scale-Revised	1
	PTSD Checklist-Civilian Version	1
	Trauma Symptom Checklist-40	1
	Peritraumatic Dissociative Experiences Questionnaire	1
	Total	13
Substance use	Michigan Alcoholism Screening Test	1
	Drug Abuse Screening Test-Shortened Version	1
	Total	2
Somatic symptoms	Cohen-Hoberman Inventory of Physical Symptoms	1
Somatic symptoms	Total	1
Comprehensive mental health	Clinical Outcomes in Routine Evaluation-Outcome Measure	1
	Brief Symptom Inventory	3
	Outcome Questionaire-45.2	1
	Depression Anxiety Stress Scale-21	1
	Composite Symptoms Checklist	1
	Psychological Reactions to Assault Questionnaire	1
	Total	8

Other studies used instruments to measure positive change individuals experienced beyond symptom reduction (n = 18). This included concepts of growth/positive change (n = 9), belief/outlook changes (n = 3), quality of life (n = 2), resilience (n = 2), social functioning (n = 3), and more specific healing domains such as self-esteem (n = 1) and hope (n = 1). See Table 4 for specific measures used to capture each of these recovery concepts.

Table 4.

Critical Findings—Positive Change Recovery Outcomes Used by Studies.

Conceptual Domain	Instrument Used	No. of Studies
Growth/positive change	Posttraumatic Growth Inventory and its 10-item short form	7
	Stress-Related Growth Scale	1
	Positive Life Change Scale	1
	Total	9
Belief/outlook changes	McPearl Belief Scale	1
	Changes in Outlook Questionnaire-Short Form	1
	Rape Attribution Questionnaire	1
	Total	3
Quality of life	9-item Life Satisfaction Measure	1
	Medical Outcomes Study Short Form-36	1
	Total	2
Resilience	Resilience Scale	1
	Brief Resilience Scale	1
	Total	2
Social functioning	Social Adjustment Scale	1
	Quality of Relationship Inventory	1
	Social Support Questionnaire for Transactions	1
	Total	3
Self-esteem	Rosenberg Self-Esteem Scale	2
Self-esteem	Total	2
Hope	State Hope Scale	1
	Total	2

Comparing Recovery Instruments Used to How Survivors Describe their Healing Qualitatively

A recent, comprehensive qualitative metasynthesis of survivor recovery needs and goals identified five main recovery domains: (a) trauma processing and reexamination, (b) managing negative states, (c) rebuilding the self, (d) connecting with others, and (e) regaining hope and power (Sinko et al., 2022). While the quantitative instruments in this review seemed to map onto some of these recovery domains, no instruments synthesized measured all of these domains simultaneously. For example, studies that used a reduction of adverse symptomology as a proxy of recovery only covered one domain out of the five synthesized, “managing negative states,” as it was defined by the authors. Relatedly, PTG captures the domains of new possibilities, personal strength, spiritual change, and appreciation of life but does not ask about experiences processing or reexamining one’s trauma or managing negative symptom states (See Figure 2 below for more examples). Finally, many of the instruments synthesized were developed to describe trauma recovery generally, potentially missing some nuances of healing after GBV specifically.

Figure 2.

Instruments assessed mapped onto survivor-derived qualitative domains.

Relationships Found Using Recovery Outcomes Synthesized

While the recovery outcomes used may not have encapsulated all survivor-relevant domains of recovery, we can glean insights into recovery through the relationships found in these studies. Some of the findings were expected, such as those identifying that social support improved symptom burden (Saint Arnault & O’Halloran, 2015). Similarly, positive social reactions were related to greater PTG (Ullman, 1997). Disclosure of the GBV to others improved individuals’ PTG, increased use of mental health treatment, and led to decreased symptoms of depression and posttraumatic stress compared to nondisclosures (Ahrens et al., 2010; Hassija & Turchik, 2016). Additionally, four articles showed how a variety of interventions had positive effects on recovery. For example, creative journal arts therapy reduced mental health symptoms and improved resiliency, the Psychological Advocacy Toward Healing intervention also improved mental health symptom burden, a strengths-based perspective group intervention decreased depression scores and improved the pathway component of hope, and trauma-sensitive yoga improved participant PTSD scores (Ong et al., 2019; Ferrari et al., 2018; Hou et al., 2016; Ikonomopoulos et al., 2017). Social support, therapeutic interventions, and disclosure were all helpful in reducing symptoms and increasing PTG in survivors.

Two studies examining the relationships between distress symptoms and growth outcomes found depression unrelated to PTG (Cobb et al., 2006; Grubaugh & Resick, 2007). Additionally, three articles identified self-blame as a barrier to recovery. For example, attributions of self-blame were associated with poorer recovery, and reduction in behavioral self-blame improved recovery (Frazier & Schauben, 1994; Koss & Figueredo, 2004; Ullman, 1997). Finally, perceived present and future control was positively correlated to better overall adjustment (Frazier, Steward et al., 2004).

Discussion

This review synthesized quantitative instruments to date that have been used to evaluate healing and recovery after gender-based harm. We uncovered two main approaches to quantify recovery: (a) through measuring mental or physical health symptom burden and (b) through measuring growth-related outcomes or specific facets of recovery. While all of the instruments synthesized mapped onto at least one of the recovery domains GBV survivors share as important to them (Sinko et al., 2022), no study used an instrument or combination of instruments that operationalized all of these domains. Though each instrument measured slightly different concepts, in general, studies synthesized identified that recovery-related outcomes may be influenced by social support, symptom burden, self-blame, perceived control, and disclosure.

Healing Measured as the Alleviation of Adverse Symptoms

It is not surprising to see recovery measured as alleviation of adverse symptoms (n = 8), progress toward growth-producing outcomes (n = 8), or a mixture of both (n = 10). Interestingly, though, many of the more recent studies included in this review belonged to the “only examining alleviation of adverse symptoms” group. Further, the most common way of measuring GBV recovery across all the articles was by assessing posttraumatic stress or PTSD symptoms among survivors (13 studies, using various traumatic stress instruments). Historically, research on trauma generally has operationalized recovery as relieving posttraumatic stress or depression symptoms, which, while useful for focused clinical interventions, often fails to consider the pervasive lingering of shame, self-blame, and mistrust that can persist in the face of symptom relief (Harvey, 1996). This literature also fails to recognize the impact trauma can have on one’s life beyond symptomology, impacting the goals they have for their healing and functioning. By only focusing on symptom reduction and psychopathology, clinicians and researchers risk missing important recovery milestones and interventions that may further promote recovery for GBV survivors. Researchers and clinicians who view recovery in this way can also unintentionally reinforce the narrative that increased symptom burden indicates a lack of recovery progress, perpetuating feelings of hopelessness and self-blame for survivors rather than emphasizing the nonlinearity of the healing journey (Sinko et al., 2020).

Healing Measured as Positive Growth

Growth-related outcomes synthesized in this review included belief and outcome changes, positive life changes, growth, social functioning, quality of life, self-esteem, and hope. As indicated in Figure 2 above, while these instruments map onto some of the domains GBV survivors view as important to their healing, no study covered all domains. Some studies used instruments that covered one aspect of healing (e.g., hope, self-esteem, and social functioning), which, while important, only gives a unidimensional understanding of the participants healing during those studies. Other studies used instruments initially created to measure trauma recovery more generally (e.g., PTG, stress-related growth, resilience), which does not account for the nuances of healing from GBV specifically. Interpersonal traumas (i.e., trauma that occurs as a result of actions by another person), particularly GBV, may require additional healing considerations due to the fact that their experience of violence was an intentional violation of bodily autonomy perpetrated by another person. These nuances can be demonstrated by quantitative evaluations comparing these outcomes by trauma type. For instance, Shakespeare-Finch and Armstrong (2010) found that survivors of sexual assault had greater difficulty relating to others appreciating life and higher rates of PTSD compared to survivors of motor vehicle accidents and those in bereavement.

The most used instrument across studies synthesized was the PTGI (n = 7). Important subconcepts of PTG include relating to others, new possibilities, personal strength, and appreciation of life (Tedeschi & Calhoun, 1996), domains which directly coincide with many survivor healing goals synthesized. Domains missing from this instrument, however, include processing and reexamining trauma and managing negative states. In addition, important aspects are missing relating to specifically rebuilding one’s relationship with themselves and developing feelings of freedom and power (Sinko et al., 2022). It is also important to note that the wording of the PTGI may be problematic for the population of GBV survivors. Specifically, the stem of the questions on the instrument states each improved outcome “as a result of [the survivor’s] crisis.” This stem may not resonate with GBV survivors because it implies that one experiences such positive changes as a result of their crisis rather than as a result of personal efforts toward healing and recovery (Tedeschi & Calhoun, 1996). Attributing positive changes merely due to experiencing trauma itself may feel disempowering to GBV survivors. Moreover, this attribution may be difficult for them to relate to because it does not give justice to the work and effort survivors have put into their healing journeys. This impact of this wording is even more critical because of the trauma-informed practice guidelines, as well as the emphasis on empowerment that many survivors have in their healing, in which they try to feel strong and capable throughout their recovery experiences (Sinko & Saint Arnault, 2022; Sinko et al., 2020; Sinko, Schaitkin, et al., 2021).

Similarly, while resilience, another common recovery instrument used, has been measured in different ways throughout the scientific literature, it conceptually focuses more on evaluating one’s ability to bounce back from adversity rather than how one might do that. Resilience is defined as an individual’s ability to bounce back after adverse life events (Bonanno, 2004) or “the ability of individuals facing adversity to utilize resources within psychological, social, and cultural domains that sustain their well-being and promote adaptive outcomes” (Schaefer et al., 2018, p. 18). This is conceptually different than recovery, focusing more on protective traits individuals possess (e.g., personal competence, social competence, family coherence, social support, and personal structure (Friborg et al., 2003) rather than perceived progress from baseline. Indeed, resilience has been found in the scientific literature to be a potential mediator for the psychological impact of GBV (e.g., Catabay et al., 2019; Miller et al., 2023). However, critics of individual resilience instruments also recognize that not everyone has the same opportunity for resilience when the underlying social structures are unequal (e.g., Meyer, 2015). Hence, rather than focusing on individual resilience (which risks a “blame the victim” attitude) in reference to trauma recovery, moving toward a concept of community resilience, or “how communities further the capacities of individuals to develop and sustain wellbeing” (Zautra et al., 2010) may be important to understand how resilience is related to GBV recovery.

Healing Measured as Both an Outcome and a Process

When looking at the quantitative literature, recovery is explored both as an outcome and a process. Fifteen studies in our review measured recovery cross-sectionally, and eleven studies used longitudinal and/or experimental designs, measuring recovery at least twice over the study period. While recovery is certainly an outcome individuals may strive for, many survivors view healing and recovery as an ongoing journey with no real end date or “perfectly healed state” (Sinko et al., 2020). Additionally, recovery often implies progress from baseline.

Because individuals are impacted by traumatic events differently (e.g., Sinko et al., 2022), without quantifying survivor perceptions about how they were initially impacted by their GBV experiences, it is difficult to compare or understand changes from baseline to one’s current state. In this way, studies that assessed recovery cross-sectionally without a reference point risk drawing inaccurate conclusions about individuals who had heightened growth-producing outcome scores or reduced adverse outcome scores, equating them as having greater healing progress when perhaps they were less affected by the violence at baseline compared to others in their cohort. For this reason, future studies should consider measuring recovery-oriented outcome measures over time to understand survivor healing with greater nuance.

Because there are often limitations necessitating a cross-sectional design to understand healing states, our research team developed a new instrument after this review called the Healing after Gender-based Violence Scale (GBV-Heal; Sinko, Schaitkin et al., 2021; Sinko, Özaslan et al., 2021). This instrument is offered here as a free resource for those who would like to gather survivor perceptions of healing cross-sectionally. The GBV-Heal consists of 18 statements about one’s views of themselves, others, and the world using a five-point Likert scale (with 0 being “Not at all” and 4 being “To a great extent”) where survivors assess where they were at their “lowest point” as well as their “current feelings now.” Subscales include relating to others, regaining hope and power, self-connection, and trauma processing/self-advocacy. See psychometrics of this instrument here (Sinko, Özaslan et al., 2021). While self-recall is not always the most accurate way to measure progress, it does gather survivors’ perceptions of where they feel they are at based on how it felt to them at their lowest point. This provides greater options for researchers who want to move this science forward in a cross-sectional capacity.

Relationships with Recovery-Related Variables

Relationships found with recovery-related variables revealed the importance of one’s social context and support. In the aftermath of GBV, positive social reactions and disclosure experiences were found to support recovery outcomes. This reveals the importance of providing increased educational and programmatic opportunities to teach the public about how to appropriately respond to disclosures and support survivor decision-making after GBV. In addition, our review revealed interventions that supported various aspects of recovery for GBV survivors (e.g., creative journal arts therapy, trauma-sensitive yoga, strengths-based perspective groups). Future research should consider testing these interventions with larger sample sizes using recovery outcomes that incorporate all domains of survivor recovery to better understand the efficacy of these interventions for survivor healing.

Two studies found depression unrelated to PTG (Cobb et al., 2006; Grubaugh & Resick, 2007). Cobb et al. (2006) conclude that this might be because mental health symptom burden may not be representative of recovery, as PTG occurred alongside symptoms. Additionally, three studies (Frazier & Schauben, 1994; Koss & Figueredo, 2004; Ullman, 1997) identified self-blame as a barrier to recovery. This is extremely consistent across qualitative studies (e.g., Sinko, Munro-Kramer et al., 2021) and may be a key area for intervention to improve recovery outcomes in survivor populations.

Limitations, Implications, and Future Directions

When synthesizing the literature, some limitations and future directions were noted (see Table 5 for practice, policy, and research implications). For example, most survivors surveyed experienced either sexual harm or some sort of physical violence by a partner or non-partner. Future research should explore other types of GBV to compare and understand more in depth the recovery patterns of individuals across GBV types. Additionally, as we know that experiences of trauma and healing are influenced by the culture in which one lives (Bryant-Davis, 2019; (Sinko et al., 2022), additional research is needed to understand the unique healing experiences of individuals outside of Western nations. Related to this idea, trauma impact, available resources, and recovery are highly affected by intersectionality, and generally, the studies reviewed did not take this into consideration in their analyses. For example, recovery and resilience depend on other resources influenced by socioeconomic level, cultural background, immigration status, and other variables. Future research in this area needs to pay greater attention to intersectionality to recognize health disparities and unique community resilience factors in these populations. Finally, all studies synthesized surveyed either “women” or “female” survivors of GBV, with only two including “male” survivors as well, and none of the studies included gender-diverse individuals. As we know, non-binary individuals, trans men, and trans women are at even higher risk for GBV compared to their women-identifying peers (James et al., 2016), and future research should explore the recovery needs and experiences of these populations.

Table 5.

Practice, Policy, and Research Implications.

Practice implications	• Conceptualize and operationalize GBV recovery beyond the alleviation of adverse mental and physical health symptoms.• Consider which outcome measures are being used to track survivor recovery progress clinically and how this aligns with survivor healing goals.• Use holistic recovery outcome tracking and assessment to better meet survivor patients and clients where they are at within their healing journey.• Educate survivor service providers about how to talk about healing and recovery beyond symptom reduction with patients and clients.
Policy implications	• Equip more survivor-centered outcome instruments when trying to evaluate policy changes intended to improve recovery for gender-based violence survivors.• More comprehensive coverage for holistic recovery programs to provide equitable infrastructure and promote survivor healing beyond traditional medical models.
Research implications	• Conceptualize and operationalize GBV recovery beyond the alleviation of adverse mental and physical health symptoms.• Make a conscious effort to provide clarity on how recovery is defined and ensure operationalization is consistent with this definition.• Recognize intersectionality of survivors and better track survivor demographic data to understand cultural nuances related to recovery barriers, facilitators, and needs.• Critically review instruments used to measure recovery to ensure they are trauma-informed and resonate with the experiences of the intended population of interest.• Use caution when incorporating instruments created for traumatic experiences more generally within GBV research, as they may not capture the gender and power nuances of GBV.• Future research should:- Expand exploration of GBV recovery quantitatively to understand recovery-promoting variables and nuances based on GBV history and cultural background.- Capture more diverse quantitative samples to understand differences between cultural subgroups as they relate to healing needs and access to resources.- Conduct more studies to understand GBV recovery in specific cultural groups, including but not limited to nonbinary and trans people, survivors of color, survivors with whom English is not their first language, and survivors with disabilities.- Explore healing longitudinally to understand how recovery changes over time and if healing states can be further categorized to provide more tailored interventions.

Note. GBV = gender-based violence.

This scoping review has some limitations worth noting. Studies were only included that were published in English and samples were mostly from the United States or other western regions. Our review also did not include gray literature, which may have illuminated non-research ways healing is being captured. Because recovery was measured differently across studies, and because our review did not report on instrument psychometrics of outcome measures synthesized, relationships between recovery-relevant variables should be used with caution. Finally, for the qualitative domains of healing, we compared instrument conceptual domains to focus on survivor perspectives of healing. It is not clear how providers’ perspectives of healing may change the comparative domains.

Future research must make a more conscious effort to provide clarity on how recovery is defined for their study and that their operationalization of it is consistent with this definition. While some may consider using the GBV-Heal mentioned above for future work, they may also want to incorporate multiple instruments related to the various domains to get a more comprehensive picture of participants’ recovery. Additionally, more longitudinal research is needed to understand how recovery changes over time and if healing states can be characterized to provide more targeted intervention depending on where someone is at in their healing journey.

This review has many implications. Mainly, it substantiates a need for better articulation of what recovery means for GBV survivors and how it is measured in both the clinical and research settings. Additionally, it reveals that in order to create comprehensive healing interventions for GBV survivors, we need survivor-relevant instruments to be sure interventions are working as intended. In addition, this review aims to support the future development and implementation of survivor-centered quantitative instruments, demonstrating how to leverage qualitative metasynthesis to evaluate outcome measurement choices. By amplifying survivors’ perspectives through mixing quantitative and qualitative findings, we can advance science forward to better understand, promote, and measure recovery in these populations.

Supplemental Material

sj-docx-1-tva-10.1177_15248380241229745 – Supplemental material for Measuring Healing and Recovery After Gender-Based Violence: A Scoping Review

Supplemental material, sj-docx-1-tva-10.1177_15248380241229745 for Measuring Healing and Recovery After Gender-Based Violence: A Scoping Review by Laura Sinko, Claire Dubois and Karen Birna Thorvaldsdottir in Trauma, Violence, & Abuse

Footnotes

Acknowledgements

We would like to acknowledge the effort of Erin Finucane and Riley Hasche who supported article retrieval for this review.

Correction (March 2024):

Citations of references ‘Sinko, Schaitkin, et al., 2021’, ‘Sinko, Munro-Kramer et al., 2021’, and ‘Sinko et al., 2022’ were missing from pages 12, 14, and 15. These have been updated now.

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 iDs

Laura Sinko

Karen Birna Thorvaldsdottir

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Laura Sinko, PhD, MSHP, RN, is a practicing sexual assault nurse examiner, Director of the Phoenix Gender-based Violence Lab, and Assistant Professor of Nursing at Temple University College of Public Health. Her research focuses on promoting gender-based violence recovery across the life span, particularly understanding socio-structural influences of these processes. She is interested in leveraging creative research methodologies to bridge the gap between survivor lived experience, the scientific community, and policy makers.

Claire Dubois, RN is a recent graduate from the University of Pennsylvania School of Nursing with a minor in Gender, Sexuality and Women’s Studies. During this time, she was a research assistant in the Phoenix Gender-based Violence lab at Temple University. She is passionate about creating a more supportive infrastructure for survivors of trauma and violence. She is currently working at Memorial Sloan Kettering Cancer Center as a registered nurse.

Karen Birna Thorvaldsdottir, PhD, is a researcher in the Department of Psychology at Reykjavik University. Her work explores the help-seeking and healing processes after trauma and loss, with a specific focus on socio-cultural influencing factors. She uses mixed methods in her research and is passionate about trauma-informed and survivor-centered approaches. She is interested in developing interventions targeted toward breaking down barriers and helping survivors find their way to trauma recovery.

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