The long reach of sexual assault and sexual harassment: Both can worsen women’s health at midlife


Being a victim of sexual assault or of sexual harassment in the workplace can do more than crush a young soul and stunt a rising career. New research finds that the experience of sexual violence or intimidation can take a toll on women’s physical and mental health years later, at a crucial juncture.

A study published this week in JAMA Internal Medicine finds that women between the ages of 40 and 60 who reported an experience of sexual assault at some point in their lives were nearly three times as likely as other women to have significant depressive symptoms, and more than twice as likely to suffer anxiety problems.

Researchers also found that women who said they had been subjected to sexual harassment were more than twice as likely to have untreated high blood pressure than were women who did not experience such harassment.


And women with a history of either sexual assault or sexual harassment were roughly twice as likely to suffer sleep problems at midlife than their counterparts who did not report gender-based mistreatment.

The 304 women who participated in the study were enrolled in a research project about menopausal hot flashes and atherosclerosis, a condition characterized by a buildup of plaque that causes arteries to harden. All of the women lived in the Pittsburgh area, and researchers cautioned that they may not be representative of American women as a whole.

About 20% of the Pittsburgh women reported having been sexually harassed or sexually assaulted. That’s lower than the national average.

Nationwide, the Centers for Disease Control & Prevention has found that roughly 36% of women have been forced or pressured into “unwanted sexual contact,” and it’s estimated that somewhere between 40% and 75% of women have experienced gender-based physical or verbal harassment at work.

“This is a massive number of women, so it’s an enormous public health issue,” said study leader Rebecca C. Thurston, a psychologist and epidemiologist at the University of Pittsburgh. “If we want to prevent mental health problems, sleep problems and hypertension, I think we really need to think about these toxic exposures women are experiencing at the workplace and elsewhere.

”We’re reaching a point where we can’t ignore what’s going on anymore,” she added.

This array of health problems at midlife does not augur well for women’s well-being in their senior years, either. Hypertension in middle age raises a woman’s risk of heart disease, stroke and dementia. Depression and anxiety are also linked to poorer heart and brain health as women age.

And poor sleep quality is linked to — and in many cases, thought to contribute to — a number of health ills ranging from obesity and metabolic disorders to dementia.

Of the 304 participants, 58 (or 19%) said they had been sexually harassed at work, and 67 (or 22%) said they had been sexually assaulted; 10% of the women reported both.

In the Pittsburgh sample, women with a history of sexual harassment were more highly educated than was the norm among participants, but they also reported more financial strain.

Among the study participants with no reported history of sexual assault, roughly 12% experienced symptoms of depression and approximately 23% had clinical anxiety. Poor sleep afflicted roughly 40% of participants who reported no sexual assaults.

In women with a past experience of sexual assault, however, rates of depressive symptoms jumped to 25%, clinical anxiety rose to 40%, and poor sleep ticked up to about 57%.

After adjusting for factors that influence women’s risk for those conditions — including age, ethnicity, education and body mass index — the researchers determined that the risk of depressive symptoms was 2.86 times greater in women who had been sexually assaulted. The risk of anxiety was 2.26 times greater and the risk of poor sleep was 2.15 times greater.

About 18% of women who had not experienced workplace sexual harassment had untreated hypertension. But in women with a history of having been harassed at work, rates of high blood pressure jumped to about 23%. That was 2.36 times higher after researchers accounted for other factors that are linked to hypertension risk in women.

About 28% of women who had not been sexually harassed reported sleep difficulties, compared with 36% of those who had. That was 1.89 times higher after adjustment for other contributing factors.

The links identified in the new research are not evidence that sexual misconduct causes women to experience poorer health. But they are consistent with a wealth of research that has established severe health consequences among those who have suffered trauma and its stresses, said Patricia Resick, a sexual trauma researcher at Duke University who wasn’t involved in the study.

“The findings don’t surprise me,” she said.

Thurston said that while the corrosive effects of sexual assault on victims’ mental health were widely expected, it was less clear why women reporting sexual harassment in the workplace would be so much more likely than other women to have high blood pressure (which was defined as systolic blood pressure at or above 130 mmHG or diastolic blood pressure at or above 80 mmHG). She noted that women are most likely to be victims of sexual assault during their adolescence and young adulthood, while sexual harassment in the workplace tends to happen when a woman is a bit older.

The magnitude of the increase in systolic blood pressure that was seen in women with a history of sexual harassment is estimated to increase her risk for a heart attack, stroke or other symptoms of cardiovascular disease by 20%.

The study was presented Wednesday at the annual meeting of the North American Menopause Society in San Diego.