Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up

Abstract

Objective To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided.

Methods A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%.

Results The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups.

Conclusion The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Resumo

Objetivo Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado.

Métodos Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%.

Resultados O grupo precoce (n = 242) continha maior número de estudantes (p < 0,001), que sofreram mais agressões diurnas (p = 0,031), em suas residências (p < 0,001), por agressor conhecido (p < 0,001), tiveram maior necessidade de proteção legal (p = 0,001), e demoraram mais a procurar atendimento (p = 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n = 279) houve maior consumo de álcool durante a agressão (p = 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p = 0,033), distúrbios do sono (p = 0,003), sintomas de ansiedade (p = 0,045), e sentimentos de angústia (p = 0,011); e receberam mais prescrições de psicotrópicos (p = 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos.

Conclusão Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Keywords

adolescence - women - sexual violence - sexual assault - mental health - emergency care - retrospective study

Palavras-chave

adolescência - mulher - violência sexual - agressão sexual - saúde mental - atendimento de emergência - estudo retrospectivo

Contributors

All authors participated in: the concept and design of the present study; analysis and interpretation of data; draft or revision of the manuscript; and they have approved the manuscript as submitted. All authors are responsible for the reported research.

Publication History

Received: 19 May 2021

Accepted: 18 November 2021

Article published online:
11 March 2022

• References

• 1 Johnson SB, Blum RW, Giedd JN. Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy. J Adolesc Health 2009; 45 (03) 216-221 DOI: 10.1016/j.jadohealth.2009.05.016.
• 2 Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC. et al. Adolescence: a foundation for future health. Lancet 2012; 379 (9826): 1630-1640 DOI: 10.1016/S0140-6736(12)60072-5.
• 3 Hagemann CT, Helland A, Spigset O, Espnes KA, Ormstad K, Schei B. Ethanol and drug findings in women consulting a Sexual Assault Center–associations with clinical characteristics and suspicions of drug-facilitated sexual assault. J Forensic Leg Med 2013; 20 (06) 777-784 DOI: 10.1016/j.jflm.2013.05.005.
• 4 Larsen ML, Hilden M, Lidegaard Ø. Sexual assault: a descriptive study of 2500 female victims over a 10-year period. BJOG 2015; 122 (04) 577-584 DOI: 10.1111/1471-0528.13093.
• 5 Guedes A, Bott S, Garcia-Moreno C, Colombini M. Bridging the gaps: a global review of intersections of violence against women and violence against children. Glob Health Action 2016; 9: 31516 DOI: 10.3402/gha.v9.31516.
• 6 Scoglio AAJ, Kraus SW, Saczynski J, Jooma S, Molnar BE. Systematic review of risk and protective factors for revictimization after child sexual abuse. Trauma Violence Abuse 2021; 22 (01) 41-53 DOI: 10.1177/1524838018823274.
• 7 World Health Organization. Violence against women. WHO Descriptive Notes [Internet]. 2021 [2021 May 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/violence-against-women
• 8 Lehtimaki S, Schwalbe N. Adolescent health: the missing population in universal health coverage [Internet]. Geneva: World Health Organization, UNICEF, Plan International, International Association for Adolescent Health (IAAH), The Partnership for Maternal, Newborn & Child Health, and Child Health Initiative; 2018 [cited 2021 May 14]. Available from: https://www.who.int/pmnch/media/events/Adolescent-Health-Missing-Population-in-UHC.pdf?ua=1
• 9 United Nations International Children's Emergency Fund. Hidden in plain sight: a statistical analysis of violence against children [Internet]. 2014 [cited 2021 May 6]. Available from: https://www.unicef.org/publications/index_74865.html
• 10 Fergusson DM, McLeod GF, Horwood LJ. Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse Negl 2013; 37 (09) 664-674 DOI: 10.1016/j.chiabu.2013.03.013.
• 11 Abrahams N, Devries K, Watts C, Pallitto C, Petzold M, Shamu S. et al. Worldwide prevalence of non-partner sexual violence: a systematic review. Lancet 2014; 383 (9929): 1648-1654 DOI: 10.1016/S0140-6736(13)62243-6.
• 12 Trotman GE, Young-Anderson C, Deye KP. Acute sexual assault in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2016; 29 (06) 518-526 DOI: 10.1016/j.jpag.2015.05.001.
• 13 Crawford-Jakubiak JE, Alderman EM, Leventhal JM. COMMITTEE ON CHILD ABUSE AND NEGLECT, COMMITTEE ON ADOLESCENCE. Committee on Adolescence. Care of the adolescent after an acute sexual assault. Pediatrics 2017; 139 (03) e20164243 DOI: 10.1542/peds.2016-4243.
• 14 Delziovo CR, Bolsoni CC, Nazário NO, Coelho EBS. Características dos casos de violência sexual contra mulheres adolescentes e adultas notificados pelos serviços públicos de saúde em Santa Catarina, Brasil. Cad Saude Publica 2017; 33 (06) e00002716 DOI: 10.1590/0102-311X00002716.
• 15 Sena CA, Silva MA, Falbo Neto GH. The incidence of sexual violence among children and adolescents in Recife, State of Pernambuco, Brazil, in 2012 and 2013. Ciênc Saúde Coletiva 2018; 23 (05) 1591-1599 DOI: 10.1590/1413-81232018235.18662016.
• 16 Pereira VO, Pinto IV, Mascarenhas MD, Shimizu HE, Ramalho WM, Fagg CW. Violence against adolescents: analysis of health sector notifications, Brazil, 2011–2017. . Rev Bras Epidemiol 2020; 23 Suppl 1: e200004.SUPL.1 DOI: 10.1590/1980-549720200004.supl.1.
• 17 United Nations International Children's Emergency Fund. The state of the world's children 2011: adolescence: an age of opportunity [Internet]. 2011 [cited 2021 May 6]. Available from: https://data.unicef.org/resources/the-state-of-the-worlds-children-2011-adolescents-an-age-of-opportunity/
• 18 Ke X, Liu J. Intellectual disability. In: Rey JM. ed. IACAPAP e-textbook of child and adolescent mental health. Geneva: IACAPAP; 2012. [2020 Nov 30]. p. 1–25. Available from: https://iacapap.org/content/uploads/C.1-Intellectual-Disability.pdf
• 19 Paiva V, Calazans G, Venturi G, Dias R. Grupo de Estudos em População, Sexualidade e Aids. [Age and condom use at first sexual intercourse of Brazilian adolescents]. Rev Saude Publica 2008; 42 (Suppl. 01) 45-53 DOI: 10.1590/s0034-89102008000800007. Portuguese.
• 20 Fergusson DM, Horwood LJ, Lynskey MT. Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization. Child Abuse Negl 1997; 21 (08) 789-803 DOI: 10.1016/s0145-2134(97)00039-2.
• 21 Krahé B, Scheinberger-Olwig R, Waizenhöfer E, Kolpin S. Childhood sexual abuse and revictimization in adolescence. Child Abuse Negl 1999; 23 (04) 383-394 DOI: 10.1016/s0145-2134(99)00002-2.
• 22 Miller E, McCaw B. Intimate partner violence. N Engl J Med 2019; 380 (09) 850-857 DOI: 10.1056/NEJMra1807166.
• 23 Basile KC, Clayton HB, Rostad WL, Leemis RW. Sexual violence victimization of youth and health risk behaviors. Am J Prev Med 2020; 58 (04) 570-579 DOI: 10.1016/j.amepre.2019.11.020.
• 24 Massaro LTDS, Adesse L, Laranjeira R, Caetano R, Madruga CS. Rape in Brazil and relationships with alcohol consumption: estimates based on confidential self-reports. Cad Saude Publica 2019; 35 (02) e00022118 DOI: 10.1590/0102-311X00022118.
• 25 Busardò FP, Varì MR, di Trana A, Malaca S, Carlier J, di Luca NM. Drug-facilitated sexual assaults (DFSA): a serious underestimated issue. Eur Rev Med Pharmacol Sci 2019; 23 (24) 10577-10587 DOI: 10.26355/eurrev_201912_19753.
• 26 Anderson LJ, Flynn A, Pilgrim JL. A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review. J Forensic Leg Med 2017; 47: 46-54 DOI: 10.1016/j.jflm.2017.02.005.
• 27 Fontes LF, Conceição OC, Machado S. Childhood and adolescent sexual abuse, victim profile and its impacts on mental health. Ciênc Saúde Coletiva 2017; 22 (09) 2919-2928 DOI: 10.1590/1413-81232017229.11042017.
• 28 Schaeffer P, Leventhal JM, Asnes AG. Children's disclosures of sexual abuse: learning from direct inquiry. Child Abuse Negl 2011; 35 (05) 343-352 DOI: 10.1016/j.chiabu.2011.01.014.
• 29 Platt VB, Back IC, Hauschild DB, Guedert JM. Sexual violence against children: authors, victims and consequences. . Ciênc Saúde Coletiva 2018; 23 (04) 1019-1031 DOI: 10.1590/1413-81232018234.11362016.