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Epidemiology
Original research
Prevalence and associated factors with sexual violence victimisation youth before, during and after the COVID-19 lockdown: a cross-sectional study in Spain
  1. Belén Sanz-Barbero1,2,
  2. Carme Saurina1,3,
  3. Laura Serra1,3,
  4. Gemma Renart Vicens1,3,
  5. Laura Vall-Llosera Casanovas1,3,
  6. Laura Otero-García1,4,
  7. María José López1,5,6,
  8. Glòria Perez1,
  9. Carmen Vives-Cases1,7
  1. 1CIBERESP, Madrid, Spain
  2. 2National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
  3. 3Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
  4. 4Nursing Department. Falculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
  5. 5Agència de Salut Pública de Barcelona, Barcelona, Spain
  6. 6IIB Sant Pau, Barcelona, Spain
  7. 7Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain
  1. Correspondence to Dr Belén Sanz-Barbero; bsanz{at}isciii.es

Abstract

Objectives To analyse the prevalence of sexual violence (SV) and associated factors in Spanish young adults in the last year and before, during and after the COVID-19 lockdown.

Design Cross-sectional study based on the online ‘SV in Young People Survey’ (2020).

Setting Non-institutionalised population residing in Spain.

Participants 2515 men and women aged 18–35 years old. The participants were obtained from a probability based, online closed panel of adults aged 16 or older that is representative of the non-institutionalised population. The sample designed includes quotas by sex, age, region and country of origin.

Outcomes measures and analyses SV victimisation by sociodemographics, sexual attraction and couple-related characteristics during the past year and before, during and after the COVID-19 lockdown (March–June 2020). Prevalence ratios were calculated using robust Poisson regression models.

Results In Spain, 8.5% of young people experienced SV during the past year. The greatest prevalence was observed in women with bisexual attraction (17.5%) and in men with homosexual attraction (14.2%). During the COVID-19 lockdown, the prevalence of SV victimisation was lower (1.9%), but unwanted intercourses increased, affecting 64.4% of those exposed to SV during the period. People with homosexual or bisexual attraction were more likely to experience SV in all of the studied periods (PRbefore: 2.01; p<0.001; PRduring: 2.63 p=0.002; PRafter: 2.67; p<0.001). Women were more likely than men to experience SV prior to the lockdown, while no cohabitation increased the likelihood to experience SV after this period

Conclusions SV victimisation in Spanish youth is high. During COVID-19, there were changes in the magnitude of factors associated with SV. It seems that SV events decreased in people who did not live with their partners, but unwanted intercourses increased. The development of prevention strategies to address SV in youth should take into account social inequalities by sex, sexual orientation and origin.

  • COVID-19
  • epidemiology
  • public health

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-055227

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    Strengths and limitations of this study

    • This is the first study in Spanish youth that analysed sexual violence (SV) victimisation in young women and men during the last 12months, taking in account sociodemographics, sexual attraction and couple-related characteristics.

    • Data collection was carried out at the end of 2020, thus, it was possible to assess the impact of the COVID-19 lockdown on SV victimisation and its associated factors in young people.

    • The limited sample size and the low frequency of sexual minorities do not allow us to analyse the different sexual minorities independently.

    • The sample size of this study, the analysis of sort time periods and the low prevalence of SV during the time periods considered, mean that these results should be interpreted with caution.

    Introduction

    Sexual violence (SV) is defined as any sexual act or attempt, unwanted sexual comments or acts to traffic against a person’s sexuality using coercion by any person, regardless of their relationship with the victim, in any setting, including but not limited to home and work.1

    Sexual intimate partner violence (Sex-IPV) is one of the forms of SV that has been studied most. It is primarily perpetrated by men against women,2 but a high prevalence of Sex-IPV victimisation has been also reported by men.3 In the USA, an estimated 15.8% of women and 9.5% of men have experienced other forms of Sex-IPV during their lifetimes.2 In relation to non-partner SV, it has been estimated that 7.2% of women over age 15 worldwide have experienced any form of non-partner SV.4 In the European Union-28 context, a total of 11% of women have experienced Sex-IPV or non-partner SV.5

    There is an increasing awareness of the magnitude of non-partner SV/Sex-IPV, especially in relation to youth.1 Recent published meta-analysis shows that 9% of teenagers have experienced sexual dating violence. It has been reported that girls have higher rates of victimisation than boys (14% vs 8%).6 In Spain, according to the latest Macro-survey on Violence against Women, 8.4% of ever-partnered women have suffered Sex-IPV. In women aged 16–24, this percentage reaches 12.4%, compared with the 8.9% of women aged 25 and over. Non-partner SV is reported to be 1.8 times higher among women aged 16–24 as compared with women aged 25 years old and over (11% vs 6%).7

    Non-partner SV and Sex-IPV have short-term and long-term health consequences, including a high risk of depression, suicide and femicide/homicide; sexually transmitted infections; induced abortion and alcohol consumption.4 5 7 The presence of this negative health effects is alarming.8 The silence and stigma that usually surround experiences of non-partner SV and Sex-IPV may influence not only the severity of these health consequences, but also the victim’s help-seeking behaviour.9 10

    Addressing SV and Sex-IPV is a priority. Further research about the associated factors in youth is needed to inform existing primary prevention strategies.11 12 Non-partner SV and Sex-IPV have been associated with individual, relational and social factors like sexism and traditional gender stereotypes,13 14 exposure to sexually explicit material,15 a large age gap between couples or lack of social support.14 Current knowledge about SV among youth in socially disadvantaged circumstances, due to their sexual orientation, migrant status or socioeconomic situation, is still rather scarce and the studies usually integrate SV with other forms of violence like physical-IPV.16

    This study is part of a larger project on SV, and the use of pornography in young adults in Spain, which occurs in the context of the proposal of a new national law to cope with SV and guarantee sexual freedom.17 In addition, our data collection was carried out at the end of 2020, thus, it was possible to describe, in young people, the prevalence of SV victimisation and its associated factors during the last 12 months and in different period related to the COVID-19 lockdown. Previous studies have already pointed to a possible increase in the prevalence of IPV and, above all, its severity, including more frequent SV in particular Sex-IPV.18–20 However, further research that distinguishes between the risk of Sex-IPV and non-partner SV in young adults during the period is needed.

    This study was based on the hypothesis that SV risk factors would remain in the different periods analysed. However, it is possible that the magnitude of the SV risk factors associated with SV in cohabiting couples increased during lockdown period. The aim of this paper was to analyse the prevalence of SV and its associated factors in Spanish young adults in the past year and before, during and after the COVID-19 lockdown period in Spain.

    Methods

    Population and sample

    Cross-sectional study of the SV in Young People Survey carried out online with young men and women age 18–35 residing in Spain. Calculation of the sample was carried out using the most recent data on the prevalence of SV against women in Spain7 corrected for sex. The minimum sample size needed was estimated at 2500 questionnaires with quotas by sex, age, autonomous community (region) and country of origin, in order to guarantee a sample error of ±5%, considering a 95% CI and prevalence estimates with a precision level of (±) 0.9. The sample was obtained from a voluntary panel that included 138 393 adults over age 16. This panel is designed to be fully representative of the non-institutionalised Spanish civilian population. The sample design included quotas by sex, age, region and country of origin, in order to represent the population between ages 18 and 35 residing in Spain. Panellists were invited by email to complete the survey. Those who accepted received (via email) an individual link to complete the online survey. Panellists received only non-survey-specific incentives through a point-based rewards programme, which they could use to purchase products from different stores. After conducting a first pilot study, a database of 2525 people was obtained. Once refined, it resulted in 2515 registrations. The response rate was 62.3%. Data collection was carried out from 15 October 2020 to 28 October 2020.

    Measurements

    The main outcome, prevalence of SV victimisation (sex-IPV and/or non-partner SV) during the past 12 months (SV12m), was measured using eight items following national7 and international survey guidelines (see online supplemental file 1).21 When one of the participants responded affirmatively to having experienced one of a number of sexual violence behaviours during last 12 months, we considered the person to have been exposed to SV12m. Then we asked: ‘Thinking back to how long we have lived through lockdown (March 14 through May 9, 2020), did this behavior happen … before lockdown? … during lockdown? or … after lockdown? (you may check all the applicable response options).

    Covariables were included that had been associated with SV12m victimisation in prior studies, such as sociodemographic variables, sexual attraction and relationship status.6 11

    Socioeconomic variables: sex (man, woman), age, country of birth (Spain, outside of Spain), highest completed studies (no studies, primary studies, secondary studies, higher education); work situation: ‘have you worked for pay in the last 12 months?’ (yes/no).

    Variables related to relationship status: ‘Do you currently have a partner?’ (yes/no). Those who had a partner were asked about their living situation. Response categories were: yes, we live together/yes, but we live together only intermittently (phases, weekends)/no, we live in different domiciles. The variable was categorised in terms of continuous cohabitation/non-cohabitation; the latter included intermittent cohabitation and non-cohabitation. Information was collected about whether participants had minor children from either one of the partners. The variable was categorised as: yes, minor children of one or both/no minor children.

    Sexual attraction data were collected using the following question: ‘With which of the following affirmations do you feel most identified?’: I’m only attracted to women/I’m normally attracted to women but sometimes I’m attracted to men/I’m attracted to both women and men/I’m normally attracted to men, but sometimes I’m attracted to women/I’m only attracted to men/I’m not attracted to men nor women—no response. Those who reported being exclusively attracted to people of the same sex were included in the homosexual category (gay/lesbian, according to sex). Those who reported only being attracted to people of the opposite sex were classified as heterosexual. Those who responded not being attracted to any sex (n=6) were considered missing values.

    Statistical analysis

    First, we described the prevalence of SV12m victimisation in the total sample and stratified by sex, according to the covariables described above. Later, we described the prevalence of SV victimisation before, during and after the COVID-19 lockdown period. The differences of the frequency distribution in the covariates were estimated using Pearson’s χ2 test. When the expected values in any of the cells were below 5 we used Fisher’s exact test. We also described the frequency of each SV12m behaviours, in the whole sample and stratified by sex, in addition to the frequency of each SV behaviour before, during and after lockdown.

    Finally, Poisson models with robust variance were estimated to analyse the association between the covariables and SV prevalence victimisation in the different periods. Unadjusted and later adjusted, prevalence ratios (PR) were calculated. In order to obtain model adjustment, variables were included sequentially when they resulted in statistical significance in the unadjusted model. Interactions were explored between sex and the covariables included in the models. No statistically significant interaction was identified.

    Patient and public involvement

    Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

    Results

    Table 1 shows the prevalence of SV12m victimisation in the whole sample and stratified by sex. In Spain, 8.5% of youth experienced SV12m. The prevalence was greater in women (10.5%) than in men (6.8%), and in those born outside of Spain (12% vs 8.1%). Among men, the prevalence was greater in those who reported homosexual (14.2%) and bisexual attraction (10.6%). In women, the prevalence increased among those with bisexual attraction (17.5%). In women, SV12m decreased as age increased (p<0.001). It was also lower in those who were cohabitating with their partner (7.4%).

    View this table:
    Table 1

    Prevalence of sexual violence victimisation in the past 12 months in the total sample and stratified by sex, Sexual Violence in Young People Survey, 2020

    During the lockdown (table 2), the prevalence of SV victimisation was 1.8%, and there were no significant differences by sex. Among the heterosexual population the prevalence of SV victimisation was lower in all of the study periods (5%, 1.3% and 1.6% before, during and after, respectively) than the bisexual population (11.8%, 3.8% and 4.5% before, during and after, respectively) and homosexual men (8.4%, 2.5% and 5.0% before, during and after, respectively). During the COVID-19 lockdown, there were no statistically significant differences in the prevalence of SV victimisation by place of birth (born abroad: 2.3% vs born in Spain: 1.8%) but this difference became statistically significant after the lockdown (4.0% vs 2.1%). Those who cohabitate had a greater prevalence of SV victimisation before (5% vs 7.6%) and after the (1.4% vs 2.7%) than those who do not cohabitate, but this difference was not statistically significant during the lockdown (2.3% vs 1.5%).

    View this table:
    Table 2

    Prevalence of sexual violence (SV) victimisation by period related to the COVID-19 lockdown, SV in Young People Survey, 2020

    The most prevalent behaviours (table 3) among those who experienced SV12m victimisation were ‘unwanted touching of intimate body parts’, reported by 73.6% of women and 61.6% of men. Unwanted intercourses was present in 39.4% of people who experienced SV12m. During the lockdown these practices affected 64.4% of those exposed to SV during this period.

    View this table:
    Table 3

    Frequency of violent behaviours between people who experienced sexual violence in the past 12 months, by sex2

    Tables 4 and 5 show the variables associated with SV prevalence, in different study periods. There is an independent effect of sex on the probability of experiencing SV12m. In the last 12 months (table 5), the probability of SV victimisation was 54% greater in women than in men, although this difference was not observed neither during nor after the lockdown. The probability of SV12m was greater among the population born outside of Spain than in the Spanish-born population (PR: 1.54 (1.07; 2.19)). This difference lost statistical significance during and after the lockdown period (PR: 1.83 (0.94; 3.57)) approaching statistical significance (p<0.07). Those with homosexual or bisexual attraction had a greater probability of experiencing SV than those with heterosexual attraction in all of the studied periods, during last 12 months (PR:1.98 (1.52;2.59)), prior (PR: 2.01 (1.46;2.76)) during (PR: 2.63 (1.42; 4.88)) and after (PR: 2.67 (1.54; 4.61)) the lockdown.

    View this table:
    Table 4

    Variables associated with sexual violence in the past 12 months, before, during and after the lockdown, unadjusted analysis, robust Poisson regression

    View this table:
    Table 5

    Variables associates with sexual violence in the last 12 months, before, during and after the lockdown, multivariate analysis, robust Poisson regression

    Discussion

    In Spain 9 of every 100 young people ages 18–34 have experienced SV12m victimisation. The overall prevalence was greater among women (10.5%) and in those born outside of Spain (12%). By sex, the prevalence was greater among men with non-heterosexual attraction (homosexual: 14.2% and bisexual: 10.6%) and in women with bisexual attraction (17.5%).

    The prevalence of SV12m identified in this study is greater than that shown in the last Macro Survey on Violence Against Women carried out in Spain.7 This greater prevalence, even though our study period included men and women and the lockdown period, in which there was a reduction in SV, could be related to the use of a different methodology for retrieving information. While both questionnaires used the same questions to collect exposure to SV, collection in the Macro Survey cited above took place through computer-assisted personal interviews. In our study, the people surveyed carried out the survey online through a link sent through email, thus, they had the opportunity to complete the questionnaire in complete privacy. Also, it is possible that the recognition and declaration of SV among young people in Spain has increased in recent times given the greater visibility of SV in recent years.22

    This work suggests for the first time using empirical data that the prevalence of SV victimisation could have decreased in Spain during the lockdown period, though its severity could have increased. This decrease, also observed in other countries through the decrease in the use of emergency services for sexual aggression,23 could reflect the decrease in SV during this period outside of cohabitation situations. In this sense, the study shows that the behaviours related to ‘unwanted touching of intimate parts’, which frequently occurs in public spaces, seem to have decreased during the COVID-19 lockdown period. However, unwanted sexual intercourses probably increased during the lockdown period. Along the same lines of argument, the probable greater severity of SV identified in this period could be due to the exposure to Sex-IPV between cohabiting partners. Even though studies using empirical data during this recent period are scared, the current evidence suggests that, during this period both in Spain24 as well as in other European countries, there was an increase in calls to helpline centres for victims of gender violence, while there was also a decrease in formal complaints.25 Studies published by Gosangi show greater severity of injuries in women attended at gender violence emergency service centres.26

    Our results allow us to partially accept the hypothesis raised in this work. Some risk factors, such as belonging to sexual minorities, remained associated with SV in all the periods studied. Other factors, such as sex, did not show significant associations with SV during and after the confinement period.

    The greatest SV risk was observed among women before the lockdown, but not during the lockdown. This could be explained by the decrease in the high level of SV experienced by women beyond the SV experienced in the family environment.5 7

    Related to sexual attraction, our results highlight how people with lesbian, gay or bisexual (LGB) attraction have a higher prevalence and probability of SV victimisation in all of the periods analysed; this association was independent of the rest of the variables. Given the social isolation that took place during the lockdown, it is possible that the prevalence of SV in the LGB population compared with the heterosexual population in this period, reflects Sex-IPV. According to the Minority Stress Model,27 people who belong to a minority group are exposed to excess psychosocial stress due to the fact that they belong to a socially stigmatised and marginalised group. This model distinguishes between external and internal stressors. In the specific case of sexual minorities, social homophobia is among the external types of stressors and results in experiences of violence, assault and discrimination. Internal stressors include internalised homophobia, defined as the level at which people who belong to a sexual minority group internalise and integrate into their own identities negative feelings, attitudes, beliefs and behaviours related to their homosexuality.28 Various studies have suggested that internalised homophobia could be related to greater risk of victimisation and perpetration of violence29 towards people of the same sexual orientation. Higher levels of internalised homophobia have been associated with higher levels of IPV in couples of the same sex.28

    Bisexual people have been described in the literature as a doubly stigmatised group, exposed to discrimination by homosexuals and by heterosexuals.30 In our study, the small sample size and low prevalence of non-heterosexual people did not allow us to analyse different sexual minorities independently. However, at the descriptive level, we did observed a higher prevalence of SV among bisexual people, primarily among bisexual women (17.5%). Although there is scarce literature that characterises perpertrators of sexual violence towards homosexual and bisexual people, the study carried out by Mellins31 shows that 97% of bisexual women and 75% of lesbian women who are sexually assaulted were assaulted by a man. It is possible that the greater SV victimisation by bisexual women is due to belonging to two discriminated groups, that is, to say, due to their being women and being a sexual minority.

    Some authors suggest that the scarcity of empirical data related to bisexuality has contributed to bisexuality being socially falsely stereotyped as a ‘phase’ or ‘fictitious’ sexual identity.30 In this sense, the studies carried out by Friedman et al32 found that 14.4% of undergraduate students affirmed that ‘bisexuality was not a valid sexual orientation’. Other studies show that bisexual people are perceived as confused about their sexual orientation.33 Even though research is still limited, there are authors who suggest that bisexual people experience internalised biphobia that could contribute to the risk of IPV in this sexual minority.34

    The greater probability of women born outside of Spain of experiencing SV is supported by a both national35 and international literature.36 Immigrant women in Spain have a greater risk of IPV,35 and being killed as a results of IPV.37 The greater gender inequality in countries of origin,38 economic dependence, lack of social support, presence of minor children in the home and/or barriers to accessing formal resources make it difficult to escape from IPV and aggravate situations in which immigrant women are exposed.10 Contrary to expectations, we have not identified significant associations between the place of origin and the victim in the different periods studied. It is possible that this lack of association could be explained by the lack of precision associated with the sample size. It is in this sense to point out that although the adjusted prevalence ratios of this variable are not significant, its value is above the value 1 in all the periods analysed.

    Even though our study shows novel results that advance the knowledge of SV, and that our sample includes quotas by sex, age, region and country of origin, in order to represent the population between 18 and 35 years old residing in Spain the study results should be interpreted considering its limitations. The sample size of this study, the analysis of concrete time periods, and the low prevalence of SV during the time periods considered mean that these results should be interpreted with caution. In this article, we analyse the prevalence of SV during the last 12 months, and in the 12 months prior, during and after the lockdown. These periods are not exclusive, so we cannot compare the periods to each other. Despite this limitation, the results obtained in this study are consistent with the results published in previous scientific literature. The cross-sectional study design did not allow us to establish a causal relationship, but it did provide the ability to estimate prevalences. In this sense, the sample design, as well as the wide range of the panel used, provided the opportunity to approach the exposure of young people in Spain to SV.

    The prevalence of SV observed in Spanish young people is alarming. While COVID-19 lockdown measures decreased SV events that occurred outside of cohabitation situations, the exposure to unwanted intercourses increased during the lockdown. The groups with greater exposure to SV included women, those born outside of Spain and those belonging to the LGB sexual minority. In terms of this last group, more studies are needed that use scales adapted to the different forms of communication and relation established in sexual encounters among different groups.39 The development of more effective strategies for prevention of SV in young people requires a consideration of the social inequalities in sex, in sexual orientation and in country of birth that were observed in this study.

    Data availability statement

    Data are available on reasonable request.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study was approved by the Ethics Committee of Alicante University (ref. UA-2020-07-07).

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    Footnotes

    • Contributors BS-B: Guarantor of the study. Initiated the collaborative project, designed data collection tools, monitored data collection, designed statistical analysis plan, cleaned and analysed the data, wrote the manuscript draft and edited the manuscript. CS: Participated in the design project, participated in the statistical analysis design and in the interpretation of data, revised the paper and approved the final version of the manuscript. LS: Participated in the design project, participated in the discussion of the results, revised the paper and approved the final version of the manuscript. GR: Participated in the design project, designed data collection tools, revised and discuss the results, revised the paper and approved the final version of the manuscript. LV-LC Participated in the design project, participated in the statistical analysis design, revised and discuss the results, revised the paper and approved the final version of the manuscript. LO-G Participated in the design project, revised and discuss the results, revised the paper based on intellectual contribution and approved the final version of the manuscript. MJL: Participated in the design project, designed data collection tools, participated in the statistical analysis design, revised and discuss the results, revised the manuscript and approved the final version of the manuscript. GP: Participated in the design project, participated in the statistical analysis design, revised and discuss the results, participated in reviewing, editing and revising the manuscript and approved the final version of the manuscript. CV-C: Initiated the collaborative project, designed data collection tools, participated in the discussion of the results and revised the paper based on intellectual contribution and approved the final version of the manuscript.

    • Funding This research was supported by the CIBER of Epidemiology and Public Health of Spain; Grant ESP20PI02.

    • Disclaimer This article presents independent results and research. The views expressed are those of the authors and not necessarily those of the Instituto de Salud Carlos III.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.