Sexual Assault, Harassment Linked to Long-term Health Issues

Tara Haelle

October 09, 2018

SAN DIEGO — Sexual assault and harassment have a negative impact on the long-term cardiometabolic and mental health of women, according to a study of hot flashes in which more than 20% of women reported having experienced sexual assault.

"Practitioners may be accustomed to considering biomedical or even behavioral risk factors — such as obesity, diabetes, and smoking — as important to women's health; however, psychosocial risk factors are relatively overlooked," said lead researcher Rebecca Thurston, PhD, from the Women's Biobehavioral Health Laboratory at the University of Pittsburgh School for Public Health.

"Sexual harassment and assault are more than issues that impair a woman's quality of life and functioning. They also have implications for a woman's mental and physical health," she said here at the North American Menopause Society (NAMS) 2018 Annual Meeting.

"Preventing these traumatic experiences can be conceptualized as health-promotion and disease-prevention activities," she told Medscape Medical News.

For their study of menopausal hot flashes, Thurston and her colleagues recruited 304 nonsmoking women 40 to 60 years of age who lived in the Pittsburgh area using online and outdoor advertising. The study was published online October 3 in advance of the presentation.

The researchers collected demographic and anthropomorphic data from the women, along with medical histories, physical activity levels, current medications, and snoring symptoms.

In addition, the women were asked two questions about sexual harassment and assault: Have you ever experienced sexual harassment at work that was either physical or verbal? And have you ever been made or felt pressured into having some type of unwanted sexual contact?

One in five of the women (19%) reported having experienced workplace sexual harassment and 22% reported having been sexually assaulted. One in ten women had experienced both.

Women who reported harassment were more likely than those who did not to have a higher education and be under financial strain. There were no differences between the women who reported assault and those who did not.

"Why more highly educated women were more likely to be harassed is unclear," Thurston and her colleagues write. However, they posit that "these women may more often be employed in male-dominated settings, be more knowledgeable about what constitutes sexual harassment, or be perceived as threatening." They make the point that "sexual harassment is an assertion of hierarchical power relations."

Hypertension, Sleep Symptoms, Depression

Women who had been sexually harassed were more than twice as likely as those who had not to have stage 1 or 2 hypertension, defined as systolic blood pressure of at least 130 mm Hg and diastolic blood pressure of at least 80 mm Hg diastolic (odds ratio [OR], 2.36; P = .03). They were also nearly twice as likely to experience sleep symptoms that reached the clinical threshold of insomnia (OR, 1.89; P = .03).

And women who had been sexually assaulted were more likely to experience depressive symptoms (OR, 2.86; P = .003) and anxiety (OR, 2.26; P = .006).

Analyses were adjusted for age, race and ethnicity, education, body mass index, nightshift work, and the use of blood-pressure-lowering medication, antidepressants, anxiolytics, and sleep medications.

These findings make it clear just how important it is for practitioners to ask women about their history of sexual harassment, Thurston emphasized.

"If women are in a situation characterized by harassment and/or assault," healthcare practitioners need to connect them "to key resources and local agencies," she said.

Women living in an abusive situation are unlikely to engage in positive health behaviors, such as medication adherence, smoking cessation, and greater physical activity, she pointed out.

If a woman's trauma is in the past, "a clinician should be aware that this experience may continue to have implications for her health. Mental health support may be warranted, particularly with a therapist trained in caring for traumatized individuals," Thurston told Medscape Medical News.

"The provider should also be aware that women with these trauma histories may require close monitoring of their mental health, sleep, and cardiovascular risk factors," and risk factors should be treated in accordance with current guidelines, she explained.

"Societal Help" Needed

"Clinicians need to recognize that past traumatic events affect health as women age," said JoAnn Pinkerton, MD, from the University of Virginia Health System in Charlottesville, who is executive director of NAMS.

But "societal help" is needed "to get women to bring their past events to their doctors," particularly given the link between a history of assault and chronic heart and mental health conditions, she added.

The long-term effects of sexual harassment and assault have a negative impact on public health, cost tax dollars, and can become a vicious cycle, Pinkerton told Medscape Medical News.

"Poor-quality sleep leads to accidents and injuries on the job and impairs attention, alertness, concentration, reasoning, and problem solving," she explained. "Sleep loss can aggravate the symptoms of depression, and depression can make it more difficult to fall asleep."

This study is small and without a very diverse population, Pinkerton acknowledged, but other research suggests that "these health risks are likely to be greater in more racially diverse and economically stressed women."

The research was funded by the National Institutes of Health and the University of Pittsburgh Clinical and Translational Science Institute. Thurston has consulted for MAS Innovations, Procter & Gamble, and Pfizer. Pinkerton has disclosed no relevant financial relationships.

North American Menopause Society (NAMS) 2018 Annual Meeting. Presented October 5, 2018.

Follow Medscape OBGYN on Twitter @MedscapeObGyn and Tara Haelle @TaraHaelle

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