Women with a history of sexual assault or sexual harassment are more likely to have high blood pressure and difficulty sleeping during middle age than women without such a history, according to research published online Wednesday in JAMA Internal Medicine.
The study also found that middle-aged women who have been sexually assaulted are at greater risk of depression and anxiety.
“Efforts to improve women’s health should target sexual harassment and assault prevention,” conclude the study’s authors.
The study, which is also being presented this week at a medical conference in Washington, D.C., comes at a moment in U.S. history when women across the country are speaking out — often for the first time — about their painful and compelling personal stories of sexual assault.
Those stories include descriptions of the assault’s long-term physical and emotional toll.
It’s estimated that up to 70 percent of women in the United States experience some kind of workplace-related sexual harassment during their lifetime, and one in three (36 percent) is sexually assaulted.
Previous research has linked sexual assault and harassment to a range of long-term health problems, including asthma, migraines, chronic pain and high blood pressure. But those studies were marked by several important limitations that muddied their findings.
Some of the studies, for example, failed to adjust for critical confounding factors that are also associated with poor health, such as socioeconomic status and weight. And many relied only on the women’s self-descriptions of their health.
The authors of the current study — researchers at the University of Pittsburgh, Harvard University and University Hospital Zurich in Switzerland — decided to conduct a study that would use more objective measures of health and a more rigorous method of analysis.
The study involved 304 women, aged 40 to 60, living in the Pittsburgh. All had originally been selected to participate in a larger study that was looking to see if a relationship existed between menopausal hot flashes and early signs of arteriosclerosis (hardening of the arteries). Three-fourths of the women were white.
The women’s height, body mass index (BMI) and blood pressure were measured, and they filled out screening questionnaires designed specifically to assess whether they had depression, anxiety or sleep problems.The women were also asked about workplace sexual harassment and sexual assault.
The results revealed that 19 percent of the women (58) had a history of being sexually harassed at work, and 22 percent (67) had a history of sexual assault. Ten percent of the women (30) reported a history of both sexual harassment and sexual assault.
Those figures are high, but not as high as those found in other studies. The authors of the current study say that may be because their participants did not include women who were smokers, who had undergone a hysterectomy, or who took antidepressants or certain medications for heart disease.
The study found few differences between the women who had been sexually harassed and those who had been sexually assaulted, except that those with a history of sexual harassment tended to have more education, yet also more financial strain (defined in the study as finding it hard or very hard to pay for the basic necessities of life).
“Notably, women who are younger or are in more precarious employment situations are more likely to be harassed, and financially stressed women can lack the financial security to leave abusive work situations,” the study’s authors explain.
“Why more highly educated women in the present study were more likely to be harassed is unclear,” they add. “[T]hese women may more often be employed in male-dominated settings, be more knowledgeable about what constitutes sexual harassment, or be perceived as threatening; sexual harassment is an assertion of hierarchal power relations.”
After adjusting for a variety of factors, including age, race/ethnicity, education and body mass index (BMI), the study found that women who had experienced sexual harassment tended to have higher blood pressure than women without a history of harassment. The difference was enough to increase the risk of developing heart disease by 20 percent among those not taking blood pressure medications.
Women who had been sexually harassed also had poorer sleep quality — poor enough to double their risk of insomnia.
As for the women who had been sexually assaulted, they, too, were twice as likely to have insomnia. In addition, they were three times more likely to have clinical depression and twice as likely to have an anxiety disorder as women who had not been sexually assaulted.
“Notably, poor sleep, depressed mood, and anxiety are themselves linked [to] adverse physical health outcomes,” the researchers point out.
Limitations and implications
The study is observational, so it can’t show a direct cause-and-effect relationship between health outcomes and sexual harassment and sexual assault.
The study comes with other caveats as well. It included a relatively small number of women (particularly women from racial and ethnic minorities) and excluded large subgroups of women, such as those who smoke or take anti-depressants. In addition, the study did not measure the severity of the sexual harassment or sexual assault experienced by the women — or how often it had occurred in the women’s lives.
“Thus, the findings may not be generalizable to all women,” the study’s authors point out.
Still, the findings support other research that has shown that trauma experienced early in life can have long-term health consequences.
“Given the high prevalence of sexual harassment and assault, addressing these prevalent and potent social exposures may be critical to promoting health and preventing disease in women,” the researchers conclude.
FMI: You’ll find an abstract of the study on the JAMA Internal Medicine website, but the full study is behind a paywall.