Community Services for Rape Survivors: Enhancing Psychological Well-Being or Increasing Trauma?

Reviewed by
Priscilla Schulz, LCSW

from an article of the same title by:
Rebecca Campbell, Tracy Sefl, Holly E. Barnes, Courtney E. Ahrens, Sharon M. Wasco, and Yolanda Zaragoza-Diesfeld, University of Illinois at Chicago

Journal of Consulting and Clinical, V. 67, 847-858, 1999

What is the scope of this study?
This study examined how contact with the legal, medical and mental health service systems affects the psychological well being of female rape survivors. It questioned if interactions with such services are retraumatizing to rape survivors (termed secondary victimization). The study also looked at what effect, if any, the type of rape, stranger vs. non-stranger, had on the experiences of victims who interacted with these service systems. Finally, the study explored whether or not the mental health system moderated or undid the harmful effects of the medical or legal systems on victims' psychological well being.

How were female rape survivors recruited for the study?
Researchers primarily used adaptive sampling to recruit participants from the city of Chicago and its two closest suburbs. In adaptive sampling researchers look for subjects in places where the targeted population may congregate. Female rape survivors are most likely to be found where high concentrations of women pass or gather.

In this study researchers initially identified zip codes in the city of Chicago with high representation of diverse (e.g., by race and socioeconomic status) groups of women. Subjects for the study were then recruited in these zip codes by advertising where women would most likely congregate, or pass by, en route to home, work or school (e.g., grocery stores, laundromats, coffee shops, public transportation, gyms, beauty salons). This method of sampling allowed rape survivors to choose in private whether or not to participate in the study. Researchers chose this method of sampling because it respected the needs of survivors to restore a sense of control and reestablish personal boundaries.

Fifty-one percent of study participants were African American, 37% White, 6% Latina, 5% multi-racial and 1% Asian American. In other characteristics study participants were representative of women living in the Chicago zip codes from which they were recruited.

How was this study conducted?
Each of the 102 participants completed the Crime-Related PTS (post-trauma symptoms) Scale and the Saunders et al. (1990) version of the Symptom Checklist-90-Revised to assess psychological well being. Researchers also assessed participants' interactions with social service systems after being raped and the effect of those interactions on participants through structured interviews. Numbers of contacts, if any, with medical, legal and mental health service systems, kinds of services received, possible negative experiences and the levels of distress caused by these experiences were compiled and statistically evaluated along with participants' responses on measures of psychological well being.

What were the study's findings?

Overall impact of social service contact on rape survivors

Participants who reported negative experiences with legal and medical systems post-rape were significantly worse psychologically. They had higher post-trauma symptom (PTS) scores, controlling for time since rape, individual variables (e.g., victims' age) and rape-related variables (e.g., stranger vs. non-stranger rape).

Most rape survivors who had contact with legal and/or medical systems reported at least two secondary victimization behaviors.

The type of rape significantly affected how providers responded to victims.

Relationship to the rapist significantly interacted with negative social service experiences. Women who were raped by people they knew, who received very little help from medical and legal systems, and who reported distressing experiences from their brief contact with these systems reported significantly increased distress than other study participants.

Moderators of secondary victimization by social services

Mental health services buffered the negative effects of secondary victimization by medical and legal systems. Victims raped by persons they knew, who received little help by medical and legal systems, and who were subjected to secondary victimization were significantly helped by mental health services.

What are the study's implications?

1. Mental health services may play an important role in assisting high-risk victims (i.e., victims of non-stranger rape receiving minimal and victim-blaming legal and medical services) recover from the trauma resulting from negative experiences that sometimes occur when victims seek help from their communities.

2. Efforts should be made not only to alleviate the effects of secondary victimization of rape survivors but also to prevent its occurrence. Medical, legal and other service providers who come in contact with rape victims should be educated about how their behaviors can affect rape survivors both negatively and positively.

What were the study's limitations?

1. There were no objective measures of service providers' behaviors to verify Participants' reports of secondary victimization.

2. Using self-report measures in a cross-sectional, retrospective study (on average, participants were 8.5 years post-rape), researchers could not rule out that PTS might have predisposed rape survivors to report more secondary victimization.

3. Because participants self-selected to become involved in the study, results might not be generalizable to all rape victims.

Reviewed by Priscilla Schulz, January 2000
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