The medical community has largely agreed that racism and poverty take a toll on people's physical and mental health — from studies showing racism puts black Americans at greater risk for depression and even the common cold, to research showing poverty is a risk factor for heart disease. Now sexual assault and harassment may be added to that list of life experiences that impact long-term health.
A study published Wednesday in JAMA Internal Medicine found women who experience sexual harassment in the workplace often suffer lasting physical consequences, like elevated blood pressure, while women who have been sexually assaulted are more likely to suffer mental consequences, like persistent symptoms of anxiety and depression. Both groups contend with poor sleep at the level of clinical insomnia.
"The exposures and experiences that can happen to us as young girls and women can have a persistent impact throughout our lives," said Rebecca Thurston, one of the study authors and a professor of psychiatry at the University of Pittsburgh School of Medicine.
The study doesn't prove these incidents cause the health effects, she cautioned, but there is a strong association between experiences of sexual violence and poor health outcomes.
Researchers analyzed data from 304 women between the ages of 40 and 60 — 19 percent of whom had a history of sexual harassment and 22 percent a history of sexual assault. The researchers found women who had been sexually assaulted were almost three times more likely to have symptoms of major depression and two times more likely to have elevated anxiety. Women who experienced sexual harassment were twice as likely to have hypertension and three times more likely to have high triglyceride levels. All of these are risk factors for cardiovascular disease, Thurston said, which is the leading cause of death for women.
The findings were consistent even when controlling for factors like age, race, education, and medication use. Researchers did not ask when the incidents took place, but national data show the majority of sexual-violence victims were under age 30 when they were attacked.
"This shows we need to not only consider the social and ethical questions of sexual assault and harassment, but also the potential implications for women's health," Thurston said.
The results come at a time when sexual violence is in the national spotlight, with Supreme Court nominee Brett Kavanaugh's confirmation on hold while the FBI investigates allegations of sexual assault. Testifying before the Senate Judiciary Committee last week, Christine Blasey Ford said a sexual assault from decades ago has continued to define her life. She said Kavanaugh held her down and groped her at a high school gathering more than 30 years ago — allegations Kavanaugh has denied. Decades later, she said she continues to cope with anxiety, post-traumatic stress disorder, claustrophobia, and a fear of flying.
An estimated 40 percent to 75 percent of women in the United States have experienced workplace sexual harassment, and more than one in three women have experienced sexual violence.
The conversation about Kavanaugh in recent weeks has brought those memories to the forefront for many survivors. The National Sexual Assault Hotline reported a 338 percent increase in traffic on the day of Ford's hearing. The day after was the busiest day in the hotline's 24-year history.
Crisis centers around Pennsylvania and New Jersey have said many people calling in are recognizing for the first time how symptoms they have been experiencing for years are manifestations of trauma.
Previous research has shown that many survivors of sexual violence endure flashbacks, sleeping problems, and emotional detachment. Post-traumatic stress disorder is common, as are depression, substance-use disorder, and thoughts of suicide.
The newly published study looked at physical effects of sexual violence as well, which are less frequently studied.
Nancy Krieger, a professor of social epidemiology at Harvard University, coauthored a study in 2008 showing that workplace sexual harassment was associated with elevated systolic blood pressure (the top number in a reading) among low-income women. "When I published our study 10 years ago, there was virtually no work on the topic," Krieger said. "And that hasn't changed much."
The new study focuses on a more affluent, mostly white group of women. That might have led the authors to underestimate the prevalence of the issue, Krieger said, since low-income women and women of color report higher rates of sexual harassment.
The findings suggest doctors should be thinking and asking about a variety of factors when it comes to women's health. "It's not all about diet and exercise," Thurston said. "We need to ask about women's lived experiences. These are critical."
While it's clear sexual violence affects women's health, more research is needed to understand how, said Carol Jordan, executive director of the University of Kentucky's Office for Policy Studies on Violence Against Women."There is tremendous complexity in looking at that impact," she said.
A study she coauthored in 2006 found women who experienced intimate-partner violence were more likely to die from breast cancer than other women. The abuse didn't cause cancer, but abusive partners often restricted women from doctors' visits. As a result, they were often diagnosed at later stages of cancer, when treatment is less successful.
Understanding that can help doctors and policymakers create better interventions, Jordan said.
For people who have experienced sexual assault or harassment, the findings are even more reason to seek help, Thurston said. "Oftentimes women will dismiss the importance of their experiences and think they're not severe enough to matter," she said. "But they really do matter."