Sexual Assault, Harassment Raise Women's Risk for Physical and Mental Health Issues

In the United States, an estimated 40% to 75% of women have experienced sexual harassment in the workplace, and an estimated 36% of women have experienced sexual assault. At the same time as lawmakers are addressing sexual assault allegations against Supreme Court nominee Judge Brett Kavanaugh, 2 new papers, published in JAMA Internal Medicine, highlight the prevalence and health impacts that harassment and assault can have.

The first of these publications sought to assess the link between the health of midlife women and harassment and assault.¹ While harassment and assault have been broadly linked with poorer self-reported health outcomes in previous survey-based studies, the researchers in this investigation sought to use validated measures to assess impacts on several important health issues affecting women: blood pressure (BP), mood, anxiety, and sleep.

The investigators enrolled 304 women aged 40 to 60 years, none of whom were smokers, from the Pittsburgh, Pennsylvania community. Assessments included physical measurements, interviews, and questionnaires. The interviews and questionnaires revealed that 19% of the women enrolled had a history of workplace sexual harassment, 22% had a history of sexual assault, and 10% had a history of both harassment and assault.

After adjusting for demographic and biomedical covariates, women with a history of sexual harassment had significantly higher systolic BP, marginally higher diastolic BP, and significantly poorer sleep quality than women without such a history. Harassment was associated with significantly higher likelihood of stage 1 or stage 2 hypertension among women who were not taking antihypertensive medications (odds ratio [OR], 2.36; 95% CI, 1.10-5.06; P = .03) and of poor sleep that was consistent with clinical insomnia (OR, 1.89; 95% CI, 1.05-3.42; P = .03).

Women with a history of sexual assault had more symptoms of depression and anxiety, and poorer sleep quality, than women with no such history. Assault was associated with significantly higher odds of clinically depressive symptoms (OR, 2.86; 95% CI, 1.42-5.77; P = .003), anxiety (OR, 2.26; 95% CI, 1.26-4.06; P = .006), and poor sleep (OR, 2.15; 95% CI, 1.23-3.77; P = .007).

The authors of the study write that, given the high prevalence of harassment and assault, addressing these social exposures is important in improving health and preventing disease in women. Furthermore, a research letter, also published today in JAMA Internal Medicine, served as a reminder that no workplace is immune to harassment.

The letter, which focuses on sexual harassment in the medical field, reveals the results of a study on the prevalence of sexual harassment at a tertiary referral center in Berlin, Germany.² A research team invited all physicians working in the center to participate in a 36-item survey during 2015. A total of 737 physicians—448 women and 289 men—were included in the analysis.

Among all participants, 70% reported some form of misconduct while performing their work. Nonphysical misconduct, such as degrading speech, was perceived as harassment by 76% of the clinicians (though more frequently by women; 61% of men and 83% of women viewed degrading remarks as harassment), while physical misconduct was perceived as harassing by 89%, with no marked difference between women’s and men’s perceptions. Women reported that harassers were almost exclusively male (85%), though fewer men reported the same (38%). Colleagues were reported as the main harassers by similar rates of men and women, but women reported that their supervisors were the perpetrators of harassment more frequently (37%) than did men (18%).

The authors write that, “While perpetrator patterns differed between male and female victims, strong institutional hierarchies were associated with sexual harassment in both sexes, highlighting the importance of organizational culture.” In order to address these issues, they say, “structural and widespread action” will be necessary to reduce the incidence and mitigate the impacts of sexual harassment.

References

1. Thurston RC, Chang Y, Matthews KA, von Känel R, Koenen K. Association of sexual harassment and sexual assault with midlife women’s mental and physical health [published online October 3, 2018.] JAMA Intern Med. doi:10.1001/jamainternmed.2018.4886.

2. Jenner S, Djermester P, Prügl J, Kurmey C, Oertelt-Prigione S. Prevalence of sexual harassment in academic medicine. [Published online October 3, 2018.] JAMA Intern Med. doi:10.1001/jamainternmed.2018.4859.