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Sexual Assault and Physical Health: Findings From a Population-Based Study of Older Adults

From the Departments of Psychiatry (M.B.S.) and Family and Preventive Medicine (E.B.-C.), School of Medicine, University of California, San Diego, La Jolla; and the VA San Diego Healthcare System (M.B.S.), San Diego, California.

Address reprint requests to: Murray B. Stein, MD, Anxiety and Traumatic Stress Disorders Research Program, Department of Psychiatry (0985), University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0985. Email: mstein{at}ucsd.edu

OBJECTIVE: Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women.

METHODS: We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records.

RESULTS: Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13–2.76) and breast cancer (OR = 2.21, 95% CI = 1.12–4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08–20.3).

CONCLUSIONS: These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.

Key Words: sexual assault • sexual abuse • chronic medical illness, • health • women.

Abbreviations: CI = confidence interval; OR = odds ratio.

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