Depression, that is, “major” or “clinical” depression, is so prevalent that many mental-health authorities call it “the common cold of mental illness.”
Depression has a host of known risk factors: female gender, family history, distorted thinking patterns, medication side effects, adverse life events (divorce, financial reverses, the death of loved ones), and chronic illnesses (diabetes, multiple sclerosis, heart disease, Alzheimer’s, Parkinson’s diseases, and hormonal disorders).
Recently, researchers at the University of Michigan and a Belgian university added a new risk factor that affects mostly women, forced sex.
The Study
The investigators used a nationally representative database to explore forced sex and depression among 1,298 respondents who identified as women. They chose the term “forced sex” instead of “rape” or “sexual assault” because it was more general, less emotionally loaded, and allowed the inclusion of situations that felt coerced but were not violent or assaultive. Independent of age, race, income, religion, family history of depression, and personal history of childhood depression or other trauma (physical abuse, parental fighting), women who reported forced sex were more than twice as likely—2.28 times more likely—to suffer depression later in life.
Previously Unnoticed
The researchers observe that this is the first study to show an association, let alone such a strong association, between forced sex and later depression. Which raises a question. Why has it taken so long to document this?
Depression is so prevalent and has so many risk factors that doctors and psychologists may be forgiven for failing to notice that forced sex deserves a spot on the long list. In addition, many women feel reluctant to mention forced-sex experiences, and if they do, they may not link them to depression years, even decades later.
Of course, forced sex is far from the only cause of trauma. In 2001, a group of psychologists suggested that therapists routinely consider clients’ full range of trauma experiences when evaluating and treating mental health issues. The seed they planted took root and eventually germinated.
In 2013 the fifth edition of the American Psychiatric Association’s bible of mental illness, the Diagnostic and Statistical Manual (DSM-5) spotlighted the effects trauma in later life. This spurred many therapists to embrace “trauma-informed” therapy, which involves a commitment to inquire about previous trauma experiences and explore their impact years later.
One Woman in Five, One Man in 50
According to the CDC, at some point in life, 20 percent of women and 2 percent of men suffer some level of forced sex, from being groped momentarily to hours of gang rape. The population at greatest risk is young women starting in their late teens through their twenties.
Since 2000, record numbers of college and military women have reported sexual assaults. The numbers are eye-popping and unnerving, but have less to do with any surge in rapes than with the efforts of anti-assault activists. Media coverage of the MeToo movement, and increasingly vocal advocates for women’s sexual safety have persuaded more survivors to report assaults, documenting a serious problem that has remained veiled way too long.
For years, colleges and the military minimized women’s rape risk, partly from ignorance of its prevalence, and partly because they feared that addressing it would threaten recruitment. Imagine parents hearing, On our campus, your daughter faces a one-in-five chance of being raped. Who would send their daughters there?
It’s good news that more women are willing to report sexual victimization. But it remains unclear what proportion of mental health professionals take good sexual-trauma histories. Women with histories of forced sex have more than double women’s general risk of depression. Every clinician should take thorough sexual histories, and ask about past trauma, particularly forced sex.
