Journal Article Annotations
2018, 4th Quarter

Women’s Mental Health

Annotations by Olusola Segun, MD
January 2019

Association of sexual harassment and sexual assault with midlife women’s mental and physical health

PUBLICATION #1 — Women’s Mental Health

Association of sexual harassment and sexual assault with midlife women’s mental and physical health

Thurston RC, Chang Y, Matthews KA, von Känel R, Koenen K

Abstract: JAMA Intern Med 2019; 179(1):48-53

Importance: Sexual harassment and sexual assault are prevalent experiences among women. However, their association with health indices is less well understood.

Objective: To investigate the association of history of sexual harassment and sexual assault with blood pressure, mood, anxiety, and sleep among midlife women.

Design, Setting, and Participants: Non-smoking women without cardiovascular disease were recruited from the community to undergo physical measurements (blood pressure, height, and weight), medical history, and questionnaire psychosocial assessments (workplace sexual harassment, sexual assault, depression, anxiety, and sleep).

Exposures: Sexual harassment and sexual assault.

Main Outcomes and Measures: Blood pressure, depressive symptoms, anxiety, and sleep characteristics.

Results: Among the 304 non-smoking women aged 40 to 60 years who participated in the study, all were free of clinical cardiovascular disease, and the mean (SD) age was 54.05 (3.99) years. A total of 19% reported a history of workplace sexual harassment (n = 58), and 22% reported a history of sexual assault (n = 67). Sexual harassment was related to significantly greater odds of stage 1 or 2 hypertension among women not taking antihypertensive (odds ratio [OR], 2.36; 95% CI, 1.10-5.06; P = .03) as well as clinically poor sleep (OR, 1.89; 95% CI, 1.05-3.42; P = .03), after adjusting for covariates. Sexual assault was associated with significantly greater odds of clinically elevated depressive symptoms (OR, 2.86; 95% CI, 1.42-5.77; multivariable P = .003), clinically relevant anxiety (OR, 2.26; 95% CI, 1.26-4.06; P = .006), and clinically poor sleep (OR, 2.15; 95% CI, 1.23-3.77; multivariable P = .007), after adjusting for covariates.

Conclusions and Relevance: Sexual harassment and sexual assault are prevalent experiences among midlife women. Sexual harassment was associated with higher blood pressure and poorer sleep. Sexual assault was associated with poorer mental health and sleep. Efforts to improve women’s health should target sexual harassment and assault prevention.

On PubMed: JAMA Intern Med 2019; 179(1):48-53

Annotation

Type of study: Prospective cohort study to investigate the association of history of sexual harassment and sexual assault with blood pressure, mood, anxiety, and sleep among midlife women.

The finding: Sexual harassment and sexual assault have implications for women’s health.

Strength and weaknesses: This article brings to light the prevalence of sexual harassment and/or assault in the work place as this is a topic that is not only understudied but also under reported. It also attempts to show correlation of sexual harassment and or assault with negative medical as well as psychological consequences that affect the quality of life of middle-aged women in the community.

Some of the limitations of the study include the lack of screening for PTSD, as this diagnosis would likely correlate with increased autonomic stimulation, which in turn would explain the physiological sequelae of hypertension, tachycardia and disturbance in sleep. There also appears to be a selection bias as 70 percent of all participants where “white” and 30 percent “not white.” Even with the breakdown it would be important to further categorize the “non-white” (e.g., African-American, Hispanic, Asian) to better represent the community. Recall bias may also be a factor to consider as participants were asked to remember incidents that happened some time ago. Also, all symptoms were measured by surveys and not by structured diagnostic interview by a healthcare professional. The data analysis for sexual harassment in relation to systolic and diastolic blood pressure, in addition to anxiety, all show P value of >0.5 making it statistically not relevant. The same seems to apply for sexual assault and SBP, DBP show P value of >0.5 making it statistically not relevant. The power of the study is very small.

Relevance: Future studies should include a larger cohort of women which is more representative of the society to foster initiatives that will effectively target the community in which we live. Furthermore, future efforts to improve women’s health should include structured diagnostic interviews with emphasis on sexual harassment and assault and the potential sequelae.