To our knowledge, this is the first study to examine determinants of different forms of service utilization in a large national sample of rape victims. In our sample Caucasians were more likely than minority women to report help seeking; specifically Caucasian status was the only consistent predictor of help seeking among rape victims. These results are consistent with previous studies finding that minorities are less likely to seek services (24
). While community level factors have been shown in previous studies to make some contribution, research suggests that individual factors, such as ethnicity, remain central in addressing health disparities (25
PTSD was related to ever seeking treatment, number of services accessed, and seeking mental health counseling. One potential explanation is that PTSD is a complex constellation of symptoms that may be more likely diagnosed by a mental health professional versus medical professional. Interestingly, lifetime depression was only a significant predictor of seeking medical help and was not a predictor of mental health service utilization. While Lewis and colleagues (19
) previously found that depression was predictive of formal help seeking among women, unlike the current study, they did not differentiate between medical professionals and mental health professionals. Depression is frequently associated with worse global health ratings, the number and severity of reported health concerns, likelihood of seeking medical treatment for unexplained physical symptoms, emergency room visits, and some evidence suggests that depression mediates the relation between PTSD diagnosis and physical health complaints (26
). This strong relation between depression and physical health may serve to partially explain its prediction of medical service utilization in this study. Further research could better elucidate factors influencing rape victims' decision to seek medical vs.
mental health services for their depressive symptoms.
The women in our sample endorsed relatively high rates of past year substance abuse underscoring the importance of standard assessment for substance use disorders in this population. The elevated rate of substance abuse among rape victims is consistent with previous research (12
), and lack of a strong relation between substance use and help seeking also is consistent with prior studies (6
). It is possible, given the wording of our question (i.e., “Have you ever contacted a professional for help with emotional problems?”), that we underdetected receipt of services for substance use disorders. Further, several service modalities often used to treat substance abuse (e.g., group therapy, inpatient hospitalization, residential treatment, day treatment), were not specifically referenced in the prompts for type of service provider.
Neither type of rape nor history of multiple rapes was found to be important with respect to help seeking. One possible explanation for this finding is that this study assessed general help seeking, not assault related help seeking. Given that forcible rape has been found in previous studies to be associated with greater life disruption compared to other forms of rape (30
), it was hypothesized that forcible rape would be associated with higher rates of help seeking than drug- or alcohol-facilitated rape and incapacitated rape. This hypothesis was not supported. However, the majority of our sample had experienced a forcible rape (nearly 80%), thereby limiting our power to detect possible differences among rape types. Additionally, no incident characteristics were predictive of help seeking in this sample.
This was one of the first studies to examine social and psychological correlates of multiple forms of help seeking using a large, representative sample of adult rape victims. This study also had several limitations. First, findings are based strictly on retrospective self-report data which introduces potential recall biases. Second, our interview was necessarily brief because a lengthy interview would have been cost-prohibitive. Use of a brief interview prevented comprehensive assessment of help seeking (e.g., amount of help seeking, informal help seeking, forensic medical examination post-rape) as well as the temporal directionality of rape, mental health outcomes, substance abuse, and help-seeking. Additionally, other forms of potentially traumatic events that impact help seeking (8
), such as physical assault and child sexual abuse, were not assessed. It should also be noted that this paper is on general help seeking for emotional problems among rape victims, and this is therefore not restricted to rape-specific help seeking. Last, future research should include analysis of possible interactions between incident characteristics and rape type.
In addition to addressing the aforementioned limitations, future research in this area should continue to explore variables associated with women's choice of provider. Our data suggest that those who seek help do so from approximately two modalities, yielding a potentially high societal cost. This suggests the need for more organized service delivery for victims of rape that would both be effective at amelioration of the emotional sequelae, and also more cost effective. Also, that two-fifths of women never sought formal help of any kind underscores the need for further research on barriers to care, particularly within populations who are traditionally underserved (e.g., ethnic minorities). Such information could inform public health campaigns that are aimed at both treatment seekers and treatment providers.