EFTA00156808.pdf

ESC\ EUROPEAN JOURNAL OF vt,•• PSYCHOTRAUMATOLOGY 88fLop CUNICAL RESEARCH ARTICLE Predictors of delayed disclosure of rape in female adolescents and young adults Iva A. E. Bicanic", Lieve M. Hehenkampl , Elise M. van de Puttee, Arjen J. van Wijk3 and Ad de Jongh3/1 'National Psychotraumacenter for Children and Youth, University Medical Corner Utrecht. Utrecht The Netherlands; 2Department of Paediatrics. University Medical Center Utrecht, Utrecht. The Netherlands: 3Department of Behavioral Sciences. ACTA. University of Amsterdam and VU University Amsterdam. The Netherlands: 'School of Health Sciences: Salford UnNersity Manchester. United Kingdom Background: Delayed disclosure ofrape has been associated withimpaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency The purpose of this study was to compare various demographics. post-rare characteristics. and psychological functioning of early and delayed disclosers (ix_ more than I -week post-rape) among rape victims. and to determine predictors for delayed disclosure. Methods: Data were collected using a structured interview and validated questionnaires in a sample of 321 help-seeking female adolescents and young adults (12-25 years), who were victimized by rape. but had no reported prior chronic child sexual abuse. Results: In 59"/Dof the cases, disclosure occurred within I week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12-17 years (odds ratio (OR) 2.05, confidence intervals (CI) 1.13-3.73). penetration (OR 2.36. CI 1.25-4.46). and closeness to assailant (OR 2.64. CI 1.52-4.60) contributed significantly to the prediction of delayed disclosure. Conclusion: The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services. Keywords: adolescents: stung auks: rape: sexual assauh: disclosure: limey to duck:tura posurounuttic stress disorder Responsible Editor: Rita Rosner. ICU Eichstaert-Ingolstadi. Germany. *Correspondence to: Iva A. E. Bicanic. National Psychotrauma Center for Children and Youth. University Medical Center Utrecht. P.O. Box 85090. N1.3508 AB Utrecht. The Netherlands. Email: i.a.e.bicanic@umadrecht.n1 For the abstract or full text in other languages. please see Supplementary files under Article Tool? Received: 31 August 2014: Revised: 30 March 2015: Accepted: 13 Apra 2015; Rblished: 11 May 2015 revious studies have shown that disclosure of rape groups (De Haas. Van Berl°. Bakker. & Vanwesenbeeck. P to formal agencies, such as police or mental health services, is uncommon (Fisher. Cullen, & Turner. 2000; Wolitzky-Taylor et al., 2011), especially when the 2012; Tjaden & Thoennes. 2006), may not receive targeted mental health care and may not report the crime to the police (Ruch. Coyne. & Perrone. 2000). rape has been committed on a date or by an acquaintance For reasons of mental health and public safety, it is and involves the victim's use of drugs and/or alcohol important to understand the potential factors that are (Resnick et al.. 2000: Wolitzky-Taylor et al., 2011). There is related to disclosure. Timing of disclosure may be a crucial evidence to suggest that victims believe that professionals factor. as early disclosers are more likely to utilize appro- will not be helpful to them because their rape experience priate medical care and report to the police than delayed does not match stereotypical conceptions of rape, such disclosers (Ahrens. Stansell. & Jennings, 2010; Ullman & as involving a stranger. a weapon. and severe injury Filipas. 2001). In contrast, adults who wait longer than (Patterson. Greeson, & Campbell, 2009; Resnick et al., I month to disclose the rape are more likely to suffer 2000). Accordingly, adolescents and young adults, who from posttraumatic stress disorder (PTSD) and depres- are more at risk to be victimized by rape than other age sion compared to early disclosers (Ruggiero et al., 2004). EuCted, J00010101 PSythOltasnalOICS. 2015. e 2015 Neaten:sac same le en Open AOGOSS RIO) 081,1tanea under 'heKorea II. OMU9ccntnale Airyomn orniernalbnalUcensefloAtereedvecommonaxnaloonaaatlyyl4,04.010.vhg thrOPSOBV00:43venOnK181,1bUt. Monate:NI hEnYrAPOORMIOIMPL RAO lonarroc. irracem.rdbuld °whoa rasa brat/prose. ovanurnrnercoN under tocceclimnlhal accraprtve crod I gnvrt. Ms a Otto thatonsom powleol and tnai micas themes *ea owip.YEums, do scuttle I!cauustle mealy. VA not hely way that NiEuests 71.3 Swear faCIC4E46 yOu USI). Citalicre Euxpean Journal of Psycholraurnalolcgy 2015. it 25653 ItfirEctcclar orgrallOakiPeARISEIRS Wapowenor rot INMAMA WPOral 3502-016 Page 1 of 9 EFIA_00001467 EFTA00156808 Iva A. E. Scenic et al. In addition. adolescents who disclose their rape experience interventions that increase victims' opportunities to at least I month after the incident took platy arc found receive timely post-rape services. to be at higher risk for major depressive disorder and delinquency (Broman-Fulks et al., 2007) compared to those Methods who disclosed within I month. Victim-assailant relationship is crucial in disclosure Subjects and data collection latency, with victims being at higher risk for delayed dis- Rape was defined as "an event that occurred without the closure if there is a close relation with the assailant (Kogan. victim's consent that involved the use or threat of force in 2004: Koss 1988: Rickert, Wiemann, & Vaughan, 2005). vaginal, anal, or oral intercourse" (Tjaden & Thoennes. In contrast, delayed disclosure is less common in victims 2006). The definition includes both attempted and com- of a stereotypical rape. i.e., rape by a stranger including a pleted rape: the term "completed" referring to vaginal. weapon and injury (Smith et al.. 2000). Victims of prior oral, anal. or multiple penetrations. Victims who disclosed sexual trauma are more likely to postpone disclosure of a within I week were defined as "early disclosers." whereas subsequent assault than those without prior victimization those who disclosed at least after d week were defined as (Smith et al., 2000: Ullman, 1996). This is in contrast with "delayed disclosers." This dichotomization of the variable the findings of Ahrens et al. (2010), who report no dif- "disclosure latency" was based on the study of Ahrens ference in rates of prior sexual trauma between early and et al. (2010) and the national standard criteria for admis- delayed disclosers. In addition, the victim's age appears sion to a Rape Centre in the Netherlands. i.e., a maximum to be an important variable in predicting disclosure. of 7 days post-rape. Evidence suggests that young children are at higher risk The study was conducted in the Dutch National for delayed disclosure than adolescents (Kogan. 2004: Psychotrauma Centre, which provides psychological ser- SchOnbucher, Maier, Mohler-Kuo. Schnyder. & Landoll. vices for rape victims aged 12-25 years and their parents. 2012). Thus, various rape and victim-related character- Between May 2005 and December 2011. the centre re- istics have been found to be associated with timing of ceived 621 phone calls concerning alleged rape victims disclosure. from police authorities, mental health services, and self- The majority of the aforementioned studies included referrals. In 178 cases, the phone call did not result in college and adult female rape victims. It is important to admission at the centre because of age limitations, or examine rape disclosure latency in an age and sex group motivational reasons. In 108 cases. referrals were made to that is most at risk for rape victimization. There is only other institutions because the index trauma was chronic one prior quantitative study in adolescents (those aged childhood sexual abuse rather than rape in adolescence/ 12-17 years) that identified factors that might influence young adulthood. Of the 335 cases admitted to the centre. disclosure latency (Kogan. 2004). lie found that identity 12 were not included in this study because of male gender. of the assailant, a familial relationship with the assailant. resulting in a final sample of 323 females with the index and a history of drug abuse in the household were related trauma being single rape. Referral sources for this final to the timing of disclosure. The results suggested that sample included the police (33.7%), mental health services a familial relationship with the assailant will postpone (40.7%). and self-referrals, i.e.. victims or parents (25.6%). disclosure, whereas a history of drug abuse in the house- hold. albeit this seems counterintuitive. makes prompt Procedure disclosure more likely. This study had some limitations. During admission, all patients underwent a psychological including the fact that the interviews were conducted by assessment, consisting of I) a structured interview for telephone and that the description of the relationship with obtaining demographic and post-rape characteristics and the assailant was limited. Therefore, in the present study. 2) self-report questionnaires to obtain information about we investigated a sample of female adolescent and young mental health functioning. Information from the inter- adult victims of rape who were admitted to a specialized view was transcribed onto a form designed for this mental health centre for victims of sexual assault. The first purpose. The following variables were obtained and aim of this study was to compare demographics. post-rape dichotomized or categorized for the purpose of the study: characteristics and psychological functioning between early and delayed disclosers in this group. The second aim. Demographic and victim characteristics based on the exploratory findings of Kogan (2004). was to We asked patients about their current age. educational determine the predictors for delayed disclosure in adoles- level (lower, middle. or higher). and whether they were of cents and young adults, including age, prior trauma, and Dutch origin (i.e.. in case of having parents born in the victim-assailant relationship using logistic regression Netherlands). Those between 12 and 17 years of age were analyses. Insight into the predictors for delayed disclosure defined as adolescents and those between I8 and 25 years for adolescents and young adults may reveal not only of age as young adults. We also asked whether the patient potential causal mechanisms but also possible targets for was living with their parent(s) (ycs/no). and whether the 2 COatogy aropean -roams ct Py.ychottal.enslobgy 2015. 8: 25883 • rmpPdx.eke.ony10.3402/cpi.v6.25893 Om. runew ,c to {men want; 3502-016 Page 2 of 9 EFIA_00001468 EFTA00156809  Predvors or delayed dsdosure of rape family structure was complete. i.e., whether the biological For the purpose of the study, only the total score was parents were living together (yes/no). Patients were then analysed. asked to confirm the presence of prior negative sexual experiences (yes/no), and whether they had a current Depression sexual relationship (yes/no). Children Depression Inventory (CDI; Kovacs. 1992; Timbremont & Braet. 2002) was used for participants Rape characteristics aged 12-17 years of age. The CDI is a 27-item ques- Information about date and time of the rape was ob- tionnaire. assessing cognitive, affective, and behavioural tained to calculate the time since rape at admission. Next, symptoms of depression. The Dutch CDI has a satisfac- patients were requested to describe the rape. Their re- tory internal consistency, with Cronbach's a ranging sponse was categorized into use of penetration (yes/no), between 0.71 and 0.89 (Timbremont & Bract. 2002). group rape (yes/no), use of physical violence (yes/no), and Behavioural problems use of threats verbally and/or with a weapon (yes/no). The Youth Self-Report (YSR; Achenbach & Rescorla. Also. information regarding the victim's relationship to 2001) was used for participants aged 12-18 years. This the assailant was obtained. The assailant was defined as questionnaire evaluates the teenager's perception of be- a stranger when the victim had never been in contact havioural and emotional problems. YSR has shown to with the assailant before the rape. Responses were used be internally reliable (Cronbach's a's ranging from 0.71 to form a closeness category (yes in case of family. (boy) to 0.95), and convergent and discriminant validity is friend, or mentor). Patients were also asked about the reported to be satisfactory• (Birube & Achenbach, 2006). (estimated) age of the assailant (categorized into 12-17 The YSR includes four broadband scales and nine years or > IS years). and whether the victim had used narrow-band scales to assess behaviour problems. For alcohol prior to the rape (yes/no). the purpose of the study, only the total score on behaviour problems was included in the analyses. Post-rape characteristics Patients were asked when they first talked about the rape. General psychopathology The response was used to calculate the disclosure time The Symptom Checklist-90-R (SCL-90-R; Arrindell & and the help-seeking time. At the end of the interview. Ettema„ 1986) was used for participants aged 12-25 years. patients were asked whether they had reported to the This is a 90-item self-report inventory to assess psycho- police after the incident (yes/no), and whether they had social distress. Patients were instructed to indicate the received any medical care after the incident (yes/no). amount they were bothered by each of the distress The study was performed in accordance with the symptoms during the preceding week. Patients rated 90 precepts and regulations for research as stated in the distress symptoms on a five-point Likert scale with 1 Declaration of Helsinki. and the Dutch Medical Research being "not at all" and 5 being "extremely." The state- involving Humans Subjects Act concerning scientific ments are assigned to eight dimensions reflecting various research. According to the Ethical Medical Committee types of psychopathology: anxiety. agoraphobia. depres- of the University Medical Centre Utrecht. this act was not sion, somatization„ insufficiency, sensitivity, hostility, and applicable to the present study. Written informed consent insomnia. The Global Severity Index (GSI) can be used was obtained from both patients and parents. as a summary of the test and reflects the severity of all answered statements as a global measure of distress. Measures Cronbach's x has been found to range from 0.73 to 0.97. For the purpose of the study. only the GSI was analysed. Posttraumatic stress The Children's Responses to Trauma Inventory (CRT!: Data analyses Alisic. Eland, & KJeber, 2006) was used for participants To compare demographic and post-rape characteristics aged 12-18 years. This is a 34-item questionnaire asses- between the early and delayed disclosers. chi-square tests sing severity of PTSD symptoms according to DSM-IV. were used. To compare multiple continuous psychological Patients are asked to indicate to what extent a reaction scores. MANCOVA was used with "time since trauma" as to a traumatic event was present during the past week. a covariate to correct for the potential influence of time Scores range from 1 to 5. with higher scores indicating since trauma. more symptomatology. The four subscalcs: Intrusion, Delayed disclosure was used as a dependent 'amiable. Avoidance, Arousal, and Other Child-Specific Reactions The strength of the univariate associations between each consist of 7, 11. 6, and 10 items, respectively. The reli- potential risk factor and delayed disclosure was estimated ability of this instrument is good to excellent (Cronbach's by calculating the odds ratio (OR) along with 95% a 0.92 for total score. 0.79 for Intrusion. 0.77 for confidence intervals (95% CI). To determine the strongest Avoidance, 0.71 for Arousal; Alisic & Michel-. 2010). risk factors for delayed disclosure. each potential risk alfstiOrt ELIMPOM Journal of Psych:traumatology 2015. 6: new - Illtplictc.0a.crar10.3402kaalvt25883 3 3502-016 Page 3 of 9 EFIA_00001469 EFTA00156810 Iva A. E. Scenic et al. factor identified in the univariate analyses with a sig- lithle 2. Victim-assailant relationship (N=323) in valid nificant OR (p <0.05) was entered as a predictor variable percentages into the multivariable model, using a stepwise forward logistic regression (LR) analysis with delayed disclosure as the outcome variable. The Flosmer-Lemeshow goodness- of-fit chi-square was used to calculate how well the Stranger 94 29.5 (Ex-)Boyfriend 32 10.0 data fit the model. For all statistical analyses. a p-value Friend 33 10.3 of <0.05 was considered statistically significant. Acquaintance 61 19.1 All statistical analyses were conducted using SPSS Person met during nightfife 30 9.4 (IBM SPSS Statistics for Windows. Version 20.0. IBM Second-degree relative 15 4.7 Corp., Armonk, NY). Person seen only once 15 4.7 Person from school 14 4.4 Results Person met on the intemet 12 3.8 Colleague 10 3.1 Socio-demographic characteristics Mentor 3 1.0 Socio-demographic characteristics of the sample are pre- sented in Table I. Victims' age ranged from 12 to 25 higher [4269) =24.297. p <0.001) compared to the gen- years. with a mean age of 16.7 years (SD =2.7) and a eral population (M=118.28. SD =32.38; Arrindell & median age of 16.1 years. Victims' mean age at time of Enema. 1986). For the CDI, mean scores were in the rape was 14.3 years (SD =2.7) and a median age of 13.9 clinical range (M=17.2. SD =4.6) and rape victims years. Penetration occurred in 79.6% of the cases. None had significantly higher mean scores (t(230) =15,923. of the victims reported prior chronic child sexual abuse. p <0.001). in comparison to previously reported data of Data about victim-assailant relationship are presented in the general population of adolescent girls (Timbremont, Table 2. Victims first disclosed after a mean 20.8 weeks Bract. & Roelofs. 2008: M=9.01, SD =6.45). (SD = 56.8. range 1-624 weeks), although 58.5% of the cases told within 1 week. First disclosure was to a friend Differences between early and delayed disclosers (45.8%). parent(s) (17.1%), (ex) boy-friend (9.4%). family Fifty-nine percent of the sample consisted of early dis- member (6.8%), professional (5.8%). or other adult closers (disclosure within 1 week). No significant differ- (15.2%). With regard to post-rape services. 53.8% of all ences in demographic characteristics were found between victims consulted a doctor for medical care and 51.4% early and delayed disclosers. except that there were reported to the police. On average, victims were admitted more delayed disclosers in the age category 12-17 years to the centre 59.8 weeks post-rape (SD = 93.7. range compared to the early disclosers group (/ (1) = 6.96; 1-676). The mean GSI of the rape victims on the SCL-90- p =0.008). For rape characteristics, significant differences R (Af = 209.7. SD =61.8) was comparable with previously between groups were found for the use of penetration. reported data of psychiatric populations [A4=203.55. with more victims of penetration in the delayed disclosers SD =61.60; t(269) = 1.629. p = 0.1041 and was substantially group compared to the early disclosers group (z2 (11= 5.37; p =0.02). Also, the delayed disclosers group pre- lid* I. Demographic characteristics of rape victims sented more victims of verbal and/or weapon threats (N =323) in valid percentages than the early disclosers group (x2 (I) =5.35; p =0.02). Furthermore. among the delayed disclosers more victims identified the assailant as a close person compared to the Dutch might 274 84.8 early disclosers (22 (I) =10.84; p=0.001). Akohol was Education lever used more often in the early disclosers group compared Low 182 58.0 to the delayed disclosers group (2,2 ( 1)=20.24; p <0.001). Medium 76 24.2 With respect to post-rape characteristics, a significantly High 56 17.8 smaller proportion of the delayed disclosers (15.9%) Parents divorced 102 31.9 utilized medical services following the rape compared Lives at parental home 273 85.3 to the early disclosers (30.3%; 22 (1)=5.32; p =0.02). Current relationship 81 26.6 Similarly, a significantly smaller proportion of the delayed Prior negative sex 46 14.8 disclosers (14.6%) compared to the early disclosers (34.3%) reported the rape to the police (x2 (1) = 16.15; °Dutch origin was defined as beeig a child from parents ban in the Netherlands: °after 6 years of general primary school. at the p <0.001). The time since trauma at admission was sig- age of 12 years. students enter low (4 years). medium (5 years). nificantly lower for early disclosers (M=41.1 weeks. or high (6 years) secondary education level. SD =79.4) than for delayed disclosers (M=82.9 weeks. 4 aropean ALMS d Psychotraurrolobgy 2015. 6: 25823 hltithdx4a.cregt10.3402/oplA6.25863 na `r (1°.^ woxow 3502-016 Page 4 of 9 EFTA_00001470 EFTA00156811  Predicters ce delayed disclosure or rape SD =103.3; 0314)=4.06. p <0.001). Mean and median delayed disclosers were less likely to use medical services time to seek help were 37.7 and 12.0 weeks. respectively. and to report to the police than early disclosers. Mean time to seek help did not differ between groups Furthermore. this study identified a number of factors (4309)=2.54. p<0.48). Excluding outliers (M±3 SD. related to the timing of rape disclosure, showing that N = I I) did not change the outcome of this analysis. Both delayed disclosers represented significantly more adoles- early and delayed disclosers scored in the highest level cents than young adults significantly more victims of of psychological distress when compared to previously penetration than assault, significantly more victims who reported norm scores (CRTI. Alisic, Eland, Huijbregts. were threatened than not threatened, and significantly & KJeber, 2012; CDI, Timbremont et al.. 2008: YSR. more victims who were close with the assailant. Achenbach & Rescorla, 2001; SCL-90. Arrindell & The finding that delayed disclosers are less likely to Ettema. 1986). but the MANCOVA results showed that utilize medical services and report to the police than early when comparing multiple continuous psychological disclosers is in line with previous studies in adult women scores the overall psychological functioning (posttrau- (Ahrens et al.. 2010: Ullman, 1996; Ullman & Filipas. matic stress depression, behavioural problems. and gen- 2001). It suggests that disclosure latency is important for eral psychopathology) did not differ significantly between public health and safety, as delayed disclosure may not early and delayed disclosers (F(6.198) =0.88. p = 0.51). only impede reception of proper medical care, such as Table 3 shows the ORs with 95% Cls for the associa- treating anogenital injuries and preventing the onset of tions between potential risk factors and delayed disclosure. STDs and unwanted pregnancy (Linden. 2011). but also Delayed disclosers, when compared to early disclosers. impede the forensic investigation and apprehension of the were significantly more likely to be in the age category assailant (Lacy & Stark. 2013). of 12-17 years (OR =2.10). to have experienced rape by Three variables were identified that successfully pre- a close person (OR =2.35), to have been threatened dicted delayed disclosure: age category 12-17 years. verbally and/or with a weapon (OR =1.75). and to have penetration. and the assailant being a close person. The experienced penetration (OR = L99). Delayed disclosers finding that the victim's age significantly predicts disclo- were also found less likely to have used alcohol prior to sure latency is in line with previous research showing that the rape (OR = 0.22). None of the other factors were adolescents are at a greater risk for delayed disclosure found to be significant risk factors for delayed disclosure. when compared to their older counterparts (Kogan. 2004; Smith et al.. 2000). Adolescents may be less able to over- Predicting delayed disclosure come the barriers to disclose. including factors such as A stepwise forward LR analysis was conducted to predict assailant tactics for maintaining secrecy. stigma that often delayed disclosure, using "age category." "close assailant." accompanies rape. and fear that their parents would "use of threats." and "penetration" as predictors. Victims' consequently limit their freedom (Crisma. Bascelli. Paci. alcohol use was not entered in the analysis because of & Romito. 2004). Also, as victims approach adulthood. missing values for 33.4% of the cases. The use of threats they may possess more information about their rights and was not a significant predictor in the model. A test of the options after victimization, and have more possibilities for full model against a constant-only model was statistically whom to disclose. In our study. most adolescents disclosed significant. indicating that the predictors (i.e., age cate- the rape event to peers, in line with prior research (Crisma gory 12-17 years. close assailant. penetration) reliably et al.. 2004: Priebe & Svedin. 2008). distinguished between early and delayed disclosers (g2 The use of penetration was found to make victims (3) =23.09. p <0.000). There were no significant interac- more likely to postpone disclosure, opposite to the results tions between the predictors. Nagelkerke's R2 of 10.5% from Priebe and Svedin (2008), but in line with an older suggests only a modest association between the predic- study by Arata (1998). who found that more severe forms tors and delayed disclosure. although the model did show of sexual abuse were acvvr•iated with less disclosure. an adequate fit to the data (Hosmer-Lcmcshow g2 (4) = Penetration may influence disclosure latency through 2.77. p <0.60). In total, 62% of the respondents were a variety of mechanisms. It could be argued that more categorized correctly. when using the three predictors severe rape indicated by the use of penetration. is more that contributed significantly to the prediction of delayed likely to be accompanied by extensive coercive use of disclosure: age category 12-17 years (OR 2.05. CI 1.13- tactics to maintain the victim's silence. with fear of re- 3.73). penetration (OR 2.36, CI 1.25-4.46). and closeness prisal possibly contributing to the finding of delayed dis- to the assailant (OR 2.64, CI 1.52-4.60). closure (Kogan, 2004). Also, adolescents may think that social reactions in response to disclosure are more nega- Discussion tive in case of completed rape compared to assault. The results of this study show that. although no dif- Another factor that seems to make immediate dis- ferences were found between delayed and early disclosers closure of rape less likely is closeness to the assailant. in psychological functioning and time to seek help. as indicated by the assailant being a (boy)friend. family °tali= European -tuna, of Re.ychotreramarologr 2315.1: 25883' http://dcdatcaVID2402/q0m525883 5 3502-016 Page 5 of 9 EFIA_00001471 EFTA00156812 Iva A. E. Scenic et al. liiNe 3. Demographic and (post-)rape characteristics by disclosure time (early vs. delayed disclosers) and odds ratios for delayed disclosure Early disclosure Delayed disclosure (N=185) (.e.. >1-week past-rape). N =131 Demographic and (post-)rape characteristics N 96 N 45 OR 95% CI Age category (Years) 18-25 55 17.4 22 7.0 12-17 130 41.1 109 343 2.10 1.20-3.85' Dutch origin No 27 8.5 22 7.0 Yes 158 50.0 109 343 0.85 0.46-1.56 Living with parent(s) No 29 9.2 16 5.1 Yes 155 49.2 115 363 1.35 0.70-2.59 Complete family structure No 58 18.4 42 13.3 Yes 127 40.3 88 27.9 0.96 0.59-1.55 Current sexual relationship No 127 41.8 97 31.9 Yes 53 17A 27 8.9 0.67 0.39-1.14 Prior negative sexual experience(s) No 152 49.4 110 35.7 Yes 32 10A 14 43 0.61 0.31-1.19 Known assailant No 56 17.7 36 11.4 Yes 129 40.8 95 30.1 1.15 0.70-1.88 Close to assailant No 150 47.6 84 26.7 Yes 35 11.1 46 14.6 2.35 1.40-3.93' Group rape No 160 50.8 116 36.8 Yes 24 7.6 15 4.8 0.86 0.43-1.71 Age of assailant (years) 12-17 63 20.6 54 17.6 >18 117 382 72 233 0.72 0.45-1.14 Use of penetration No 46 14.7 19 6.1 Yes 136 43.5 112 35.8 1.99 1.10-3.6O' Use of threats No 90 31.6 48 16.8 Yes 76 26.7 71 24.9 1.75 1.09-2.82' Use of physical violence No 130 42.6 82 26.9 Yes 51 16.7 42 13.8 1.31 0.80-2.14 Victim's alcohol use No 72 33.5 69 32.1 Yes 61 28.4 13 6.0 0.22 0.11-0.44' 73 <0.05. Seven participants were dropped from analyses due to missng disclosure time data. member, or mentor. This finding is consistent with pre- woman was to report this victimization to anyone (Koss. vious studies showing that the closer the relationship 1988; Rickert et al., 2005; Wolitzky-Taylor et al.. 2011). between the victim and assailant, the less likely the young The dynamics of intrafamilial abuse is often proposed as 6 Citation: Oropean Journal d Psychotrzurnalobgy 2015. 6:25867' hit0fick0a.n110.3402/opt‘6.25803 3502-016 Page 6 of 9 EFTA_00001472 EFTA00156813  Predictors of delayed ciscbsure of reps the explanation for delayed or non-disclosure (Kogan, generalizable to all rape victims, because the percentage 2004: Smith et al.. 2000). In the present study, however. of victims that consulted a medical professional and only 5% of the assailants were identified as a family reported to the police was higher in our sample than in member. Most close relationships referred to (boy)friends. most studies (Hanson et al.. 2003; Resnick et al.. 2000; suggesting that a significant percentage of the sample Zinzow, Resnick. Barr. Danielson. & Kilpatrick. 2012). experienced peer-to-peer victimization. This type of vic- Perhaps. these differences could, at least partially. be timization is most likely to occur during adolescence. as explained by the fact that stranger rape, representing 30% compared to childhood or young adulthood, and greatly of our sample. leads to higher likelihood of help-seeking increases the risk of revictimization (Humphrey & White. and police reporting because of its association with higher 2000). Hence, victims of rape by peers may be a target acknowledgment of victim status (Resnick et al.. 2000; group for interventions promoting early disclosure. Smith et al.. 2000). The fact that this is a help-seeking Clearly, there are many variables working in tandem to sample is critical for the reasons cited in the discussion. affect the timing of victim's disclosure. A closer look at but also because the generalizability of these data to rape the final model, which identified three unique variables that victims who never tell anyone—perhaps the group most contributed significantly to the prediction of delayed dis- at risk—simply cannot be known. Besides these limita- closure. can help us to better understand the phenomenon tions. several strengths of the current study need to be of initial disclosure in adolescents and young adults. noted. One strength is the unique set of adolescents and Younger adolescent victims who are raped by a close per- young adults who presented at a mental health care son are more likely to delay disclosure than older victims centre after a single rape event, but who reported no prior of attempted rape by a stranger or acquaintance. Perhaps. chronic sexual abuse in childhood. For 85% of the they struggle with the notion that someone close to them sample. the index trauma was a first time rape. Moreover. performed such a violent act against them, which con- data were collected at a designated referral centre for fuses them about what might happen in terms of safety victims of rape and, therefore, the sample is likely to if they would disclose (or not). This finding is especially represent the clinical population of Dutch victims in the important in the light of the fact that approximately 80% age group of 12-25 years. of victims had some sort of relationship with their per- The findings of the current study, suggesting that petrator prior to the assault (Basile. Chen. Black. & delayed disclosers are less able to benefit from emergency Saltzman. 2007). With regard to rape types, it would medical care and evidence collection, have a number of intuitively seem that less severe forms of sexual assault practical impliaitions. One of the strategies to enhance are associated with delayed disclosure and that completed victims' willingness to disclose within the first week post- rape would be easier to identify as clearly inappropriate rape may be sexual education campaigns in school and and wrong. Victims of completed rape. however. may be media. as being uninformed is one of the reasons for them more likely to experience negative psychological reac- not to disclose (Crisma et al.. 2004). Education may tions. e.g.• self-blame and avoidance coping. It is con- include medical information on rape-related pregnancy ceivable that they delay their disclosure as a result of and STDs, as well as the need for timely emergency rape-induced psychological distress (Starzynski. Ullman, contraception and prophylaxis. given that these concerns Filipas. & Townsend, 2005), not necessarily the severity appear to be facilitators of seeking medical help (Zinzow of the assault. et al.. 2012). Also. practical information about DNA evi- Although the final model showed acceptable goodness dence and how to best protect it. e.g.. related to shower- of fit, the percentage of explained variance of delayed ing. clothing. eating. and drinking. may increase the disclosure was modest. Thus. there must be other variables awareness of opportunities in the early-phase post-rape. predictive of delayed disclosure. such as the assailant's Moreover. facts about the potential psychological impact use of alcohol or weaker support systems. that we did not of rape. such as PTSD and revictimization. but also in- assess in this study. Besides this limitation, there are other formation about evidence-based treatments (Elwood et al.. drawbacks of this study that should be mentioned. First, 2011; Littleton & Ullman. 2013: McLaughlin et al.. 2013). a clinical sample was used with patients reporting high may increase help-seeking behaviour in an early stage. mean levels of psychological distress. This ceiling effect Furthermore efforts to encourage early disclosure must may explain why no differences were found between consider peer-to-pee