The psychological impact of rape trauma: a longitudinal

study of adult female survivors in the Western Cape

Anastasia Maw

Clinical Psychologist & Lecturer

Department of Psychology

University of Cape Town

Rape in South Africa

Comparative statistics suggest that South Africa has one of the highest incidences of rape in a war-free country.

Rape is highly pathogenic

Experience of rape trauma is not evenly distributed in society

The impact of rape

Psychiatric impact:

Acute Stress Disorder (ASD)

Depression

Anxiety – social and specific phobia, panic attacks, OCD

Substance Abuse/Dependence

Somatoform disorders – somatisation, conversion disorder

Sexual disorders

Post Traumatic Stress Disorder (PTSD)

Psycho-social impact:

Self-blame and self-guilt

Low self-esteem

A sense of contamination or of being worth less as a result of the rape

Social maladjustment

Increased fear

Pre-Assault

Demographics

Prior psychiatric history

Prior trauma history

Post-Assault

Social Support

Secondary traumatisation

Meaning making

Resilience &

Posttraumatic growth

Assault

Acquaintanceship status

Level of violence

Subjective distress

What Affects Recovery?

Research questions

What are the mental health consequences in the first six months post rape for a group of black women rape survivors living in a low socio-economic, urban context presenting for care post-rape at a public health care facility?

Do these mental health consequences compare to those reported in the international literature?

Research Design

Longitudinal quantitative study

Adult female rape survivors – raped within last 72 hours

Thuthuzela Care Centre

Main Entrance

Bullet-proof Doors

Research Design

Quantitative interviews with 64 participants

Interviews at: Baseline, 1, 4, 12 and 24 weeks post rape

Selection of assessment instruments informed by international research

Interview procedure – face to face interviews

Data collection period: October, 2006 to February, 2008

Research protocol

Baseline

Consent

Contact Details

Demographics

Assessment of Initial Reaction

Week 1, 4, 12 and 24

Details of rape

Assessment of Social Support

Impact on Self Esteem, Self Blame and Guilt

Full Psychiatric Assessment

Assessment of Social context

Interview Assessment

Ethical considerations

The problem of informed consent

Referral procedure for distressed participants

The struggles of the activist/feminist/clinician researcher

Demographics Majority aged btw 20 and 30

African (71%) and coloured (25%)

81% between Grade 8 and 12 education

78% income of less than R800.00 per month

18% raped before

35% HIV Positive

80% raped btw 18h00 and 06h00 on weekends or public holidays

60% raped by someone known to them

72% raped in private place (perpetrator or victim’s home)

30% raped by more than one perpetrator

60% of rapes involved use of weapons

72% reported additional acts of violence

79% perpetrators s under 30

48% of perpetrators believed to be under influence at time of rape

Comparability to international, national and regional data

Impact of rape across time

Social Support: 2/3rd receive positive support, 1/3 report negative or unsupportive responses

Self-esteem: 50% lowered self esteem with steady recovery over time

Self blame and guilt: complex relationship which waxes and wanes over time

Greatest psycho-social needs: counselling, safe housing, education, employment

ASD: Wk 1- 72%

PTSD: Wk 4 - 71%, Wk 12 – 54%, Wk 24 – 57%

Consistently:

Prior History of Mental Illness

Diagnosis of ASD at Week 1

Lowered Self Esteem at Week 1

Less Consistently:

Negative responses

Guilt and Worthlessness

Self Blame

Assault and Rape details (Injury, violence, type of rape)

Predictors of increased PTSD symptoms severity at Wk 4, 12 & 24

Mean symptom severity scores for Week 4, 12 and 24 (n =34)

Where notations changes difference is significant (p < .001)

a b b

Diagnosis of ASD at Week 1

Prior History of Mental Illness

Negative Responses

Lowered Self Esteem

Higher PTSD Symptom

Severity Score across Wks 4

and 12

Which variables predict change within individuals of PTSD

symptom severity over time?

What do these results suggest?

In very broad terms the findings are in keeping with international findings

Highly traumatised survivors in immediate aftermath of rape appear to be most vulnerable to higher PTSD symptomatology later

Cautionary notes in relation to findings

Sample is drawn from women who identify themselves as rape survivors and who chose to report the rape.

Interviews were experienced by many of the interviewees as a form of therapeutic intervention which may alter impact.

Sample is drawn from a flagship for best practice in a relatively well resourced urban context – implications for care in less resourced contexts?

Future research: Results suggest a complex set of

relationships amongst predictor variables informing both course and trajectory of PTSD.

Exploration of these mediating and/or moderating relationships requires more sophisticated statistical analysis of the data - not possible in this study because of sample size constraints – complemented by qualitative research.

Acknowledgements

Research Funding

ADDRF (African Doctoral Dissertation Research Fellowship)

National Research Foundation

University of Cape Town Research Committee Grant

URC-Carnegie Research Development Grant

Research Assistants

Nina du Plessis

Sadia Edross

Warren King

Jill Mosdell

Sharon Ndlela

Katherine Rix

Gail Womersely

Special thanks to G.F. Jooste Hospital, TCC & the women who agreed to take part in this research