Sexual Assault Recovery Among Sexual Minority Women: A Longitudinal, Multi-Level Study

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Project Summary/Abstract Sexual minority women (SMW) experience disproportionately high risk of sexual assault (SA) and resulting mental health sequelae (e.g., depression, PTSD), and these sequelae appear to be especially pronounced among Black SMW. The main theoretical model of sexual minority mental health disparities (i.e., the minority stress model) attributes this elevated risk to climate-level factors (e.g., laws, policies, and other conditions that afford risk or protection to minoritized groups) that vary across municipalities and states. Indeed, evidence suggests that climate-level factors are associated with risk for PTSD and other disorders in sexual minorities. However, nearly all studies to date have relied exclusively on assessments of individual-level perceptions of climate-level factors, and no studies have directly tested these climate-level factors in relation to SMW’s mental health following SA. This proposal therefore aims to test the minority stress model in relation to SMW’s SA recovery, including the first-ever direct test of the role of climate-level factors, to inform novel interventions and policy change efforts. We will recruit a geographically-stratified sample of 2400 SMW aged 18-35 (oversampling Black SMW) to complete self-report surveys every 6 months for 2.5 years, and use publicly- available population-level data on SMW and Black-relevant policies/laws and community presence to characterize the climates of participants’ municipalities and states. Aim 1 will involve testing cross-sectional baseline differences in mental health as a function of history of adolescent/adult SA and climate-level variables. Because the mental health effects of SA are most evident in the first 6 months following SA, Aims 2 & 3 will focus on the subsample of SMW (approximately 33%) who experience a prospective SA during the study. Aim 2 will test mediated relationships between climate-level variables, individual-level SMW minority stress, and rates of mental health symptom change in prospectively-assaulted SMW. Aim 3 will apply a critically-needed intersectional lens to these questions by testing the relationship of anti-Black climates to rates of recovery in prospectively-assaulted Black SMW. Combining these self-report and population-level datasets over multiple years provides an unprecedented opportunity to evaluate how sociopolitical environments influence health disparities while the disparities are emerging. Given persistent health disparities among SMW, identifying contributing factors across varying levels of causation is important for public health, both for SMW, and also for other minoritized groups. We will draw upon our team’s extensive expertise in SMW research and practice and utilize SMW advisory to carry out this study. Results of this study will immediately inform clinical interventions to improve recovery from SA among this highly vulnerable group and help to prioritize and justify public policy changes to reduce this mental health disparity.