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Believe #metoo: sexual violence and interpersonal disclosure experiences among women attending a sexual assault service in Australia: a mixed-methods study
  1. Susan Rees1,
  2. Lisa Simpson2,
  3. Clare A McCormack1,
  4. Batool Moussa1,
  5. Sue Amanatidis2
  1. 1 School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Community Health, Sydney Local Area Health District, Sydney, New South Wales, Australia
  1. Correspondence to Dr Susan Rees; s.j.rees{at}


Objectives Sexual abuse is a strong predictor of future psychiatric problems. A more nuanced qualitative understanding of mental health outcomes, in the context of interpersonal responses from family members towards survivors after sexual abuse, may help to better inform prevention and interventions.

Design A mixed-methods approach included a qualitative timeline method to map and identify contextual factors and mediating emotional responses associated with mental disorder following sexual abuse.

Setting Participants were adult survivors of sexual abuse, seeking support from the Sexual Assault Counselling Service, Sydney Local Health District, Australia.

Participants Thirty women 18 years and older with current or past mental disorder or symptoms were interviewed between August 2015 and May 2016.

Outcome measures A qualitative timeline interview and the Mini-International Neuropsychiatric Interview (MINI, 5.5.0) were applied.

Results The MINI prevalence of current post-traumatic stress disorder was 96.6% (n=28) and of major depressive disorder was 82.8% (n=24). More than half (53%) reported suicidal ideation at some time in their lives. Women exposed to childhood sexual abuse reported being ignored, not believed, or threatened with retribution on disclosing the abuse to others, usually adult family members, at or close to the time of the violation(s). Participants described experiences of self-blame, betrayal, and psychosocial vulnerability as being the responses that connected negative disclosure experiences with mental disorder. Participant accounts suggest that these reactions created the foundations for both immediate and long-term adverse psychological outcomes.

Conclusion A more in-depth understanding of the type and emotional impact of negative responses to disclosure by parents and other family members, and the barriers to adequate support, validation and trust, may inform strategies to avert much of the longer-term emotional difficulties and risks that survivors encounter following childhood abuse experiences. These issues should receive closer attention in research, policy, and practice.

  • qualitative research
  • psychiatry
  • child & adolescent psychiatry
  • mental health

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  • @susanjrees1 Study reveals negative disclosure experiences of sexual abuse to family members, and how these are linked to mental disorder.

  • Contributors All authors meet the ICMJE criteria for authorship. SR had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SR, LS, SA. Acquisition of data: SR, LS, CM. Analysis and interpretation of the data: SR, LS, BM, CM. Drafting of the manuscript: SR. Critical revision of the manuscript for important intellectual content: SR, BM, SA, LS, CM. Obtaining funding: SR. Administrative, technical or material support: SA, BM.

  • Funding Australia’s National Research Organisation for Women’s Safety Ltd / ANROWS RG142667.

  • Disclaimer The lead author and guarantor SR affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was given for the study by Human Research Ethics Committee, Liverpool Hospital, NSW, Australia 2170. Approval number: HREC/15/LPOOL/72.

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

  • Data sharing statement Data are available upon reasonable request.

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