Silencing by design: Lessons learned about child sexual abuse from a university sexual assault survey

Abstract

Background:

University students have been recognized as particularly being vulnerable to sexual victimization.

Purpose:

With little research to date, and acknowledgement for the need of a better understanding of sexual violence, our study analysed the CQUniversity Sexual Assault Survey’s qualitative responses. An open-ended qualitative question allowed students to provide information anonymously.

Methods:

A total of 109 participants contributed responses with 17 respondents commenting on the fact that the survey omitted to ask about child sexual abuse prior to the cut-off age of 12 years.

Results:

University students revealed unexpected disclosures of prepubescent child sexual abuse victimization and ongoing sexual victimization into adulthood. Furthermore, students’ comments indicated negative impacts including distress, mental health and substance use problems, distrust, and interpersonal difficulties. Strong feelings about ‘silencing’ prepubescent child sexual abuse in university surveys were expressed with a request that questions about child sexual abuse prior to the age of 12 years be included.

Conclusion:

Our study found that child sexual abuse victimization is important to students. Recommendations indicate the need for future research about sexual violence among university students without age restrictions to gain a better understanding about the impact of trauma including revictimization experiences.

Keywords

academic impact child sexual abuse revictimization sexual violence university students

Introduction

Sexual violence has been recognized as a global public health concern with extensive psychological and physical consequences not only for affected individuals, but their families, friends, and the broader community.¹ Its true extent is unknown² as the vast majority of victimized individuals never report the event to the authorities.^3,4 Sexual violence has been defined as a sexual act committed or attempted by one person against another who has not provided consent, has been unable to provide consent/refuse engagement, or has been verbally or physically pressured to engage in the act.^5,6 Sexual violence on university campuses has become recognised as a profound problem worldwide.⁷

Women aged between 18 and 35 years are most likely to experience sexual violence⁸ with female university students having been identified as particularly vulnerable to sexual victimization.^9–11 University students report high prevalence rates of sexual victimization^12–14 with an estimated one in five undergraduate women experiencing forced intercourse during the course of their studies.^14,15 Furthermore, up to 30% of male university students acknowledge sexual perpetration behaviours.⁹ These findings appear to be consistent as a study at 27 US universities with 150,072 students revealed. About 31% of students reported sexual violence in the year prior to the study with nearly 70% experiencing more than one incident of sexual victimization.¹⁶

In the United Kingdom, a national survey into university students’ experiences of sexual violence analysed responses from 4491 students across 153 institutions.¹⁷ Findings indicated that 70% of female respondents had been sexually victimized with 8% having been raped at university premises, which is double the national rate of women raped in the general community throughout England and Wales.¹⁷ In Australia, a national study with over 30,000 students from 39 universities completed a survey with results indicating that female university students aged between 18 and 24 years reported sexual victimization at twice the national rate of sexual violence.¹⁸ The above international evidence suggests that female students appear to be disproportionately affected by sexual victimization.

Numerous factors contribute to university students’ vulnerability to sexual assault.¹⁹ These include gender,^15,20,21 age,^8,22 and commencement at university.²³ In addition, the risk of sexual victimization has been found to be highest when students have experienced sexual violence prior to entering the university environment.^9,15,24 Students who enter university with a history of sexual victimization are at increased risk of re-victimization.¹¹ In this regard, childhood sexual victimization has been identified as a specific risk factor for subsequent exposure to sexual violence, which may be explained by reduced sexual risk awareness.^6,25

Childhood sexual abuse

Child sexual abuse (CSA) is commonly believed to be widespread and occurring all over the world.²⁶ It is generally agreed among researchers that CSA is an inherently complex issue, which occurs in various settings such as inside families, among peer groups, and in institutions. Not only are different behaviors subsumed under the concept of CSA, but apart from definition issues, prevalence data are commonly believed to be inaccurate due to methodological differences and the hidden nature of the phenomenon. Even against the background of evidence (e.g. confessions of the perpetrator, medical records, videos, and witness reports), research has found that up to 43% of CSA victim/survivors were unwilling or unable to disclose the abuse.²⁷ Many studies confirmed that the vast majority of CSA, particularly if occurring within the family home, go unreported.^28–30 While it is difficult to establish reliable prevalence data, it is clear that CSA does occur at higher rates than commonly assumed.

Globally, the sexual abuse of both girls and boys is significant, with statistics revealing victimization rates between 15% and 20% of girls, and 5% and 10% of boys.³¹ In Australia, a meta-analysis of the prevalence of CSA found victimization rates at 14.1% for girls and 5.5% for boys.³²

Furthermore, the Australian Bureau of Statistics (2017) reported an estimated 1.4 million (7.7%) adults (11% of women and 5% of men) experienced CSA before the age of 15 years. Of these, 58% were sexually abused for the first time before they were 10 years old.

Barth et al.³³ in a systematic review of 55 studies across 24 countries found wide-ranging prevalence rates between 9% and 31% for girls and 3% and 17% for boys. Similar rates were reported by Kloppen et al.³⁴ in Nordic countries, reporting that between 11% and 36% of girls and 3% and 23% of boys experienced CSA. While great disparities in prevalence rates have been reported in the literature, research consistently demonstrated that females are at a higher risk of CSA and adult sexual victimization than males.^9,15

Sexual victimization in childhood and/or adulthood

Sexual victimization occurs across the life span, from early childhood into late adulthood;⁶ however, sexual violence research commonly uses ‘arbitrary age cutoffs’ (p. 814),³⁵ which makes comparisons of findings challenging and contributes to inconsistencies in relation to university student victimization studies. For example, some studies enquired about sexual violence of students during their undergraduate studies,^9,36,37 while others used undergraduate and postgraduate students as participants.⁹ Few studies ask university students about experiences of sexual victimization in childhood with discrepancies observed in relation to age cut-off. For example, Muehlenhard et al.¹⁴ reported that between 40% and 50% of university students experienced sexual victimization before the age of 17 years with ‘the modal age range for the first rape victimization between 11, or 12, and 17’ (p. 565). Similarly, Winters et al.³⁸ enquired about university students’ disclosure behaviours of CSA victimization before the age of 17 years. On the contrary, no age cut-off was used by Kenny et al.³⁹ who instead enquired about ‘sexual activity with someone who was at least 5 years older’ (p. 3). The above examples indicate varying approaches in research designs of sexual victimization among university students. This review of the literature indicates a need to study sexual victimization noting the hidden nature of CSA and the importance to consider early victimization. This article aims to shed light on the issue of CSA and students’ comments on methodological issues such as age cut-off decisions.

The present study

We are reporting here on a small part of a larger study (publication in progress). The study originally focused on tertiary students’ experiences of sexual violence on university campuses. We argue that due to the prevalence of sexual violence among university students and the potential for serious negative sequelae, it is essential that research in this area occurs. University students experience a range of sexual victimization events before, during, and after being enrolled in a tertiary institution, and our research attempted to capture prior and current victimization.

In this study, we used the concept of ‘sexual violence’ as an umbrella term representing unwanted sexual experiences that involve numerous acts of contact and non-contact sexual behaviors that are related to consent. We were guided by the following definition: ‘Sexual violence occurs when a perpetrator commits sexual acts without a victim’s consent, or when a victim is unable to consent (e.g. due to age, illness) or refuse (e.g. due to physical violence or threats)’ (p. 11).⁵

Setting

Australia has 39 universities with CQUniversity being one of the few dual sector universities, which provides qualifications across academic and skill-based topics. Interestingly, the concern regarding sexual violence in the context of higher education institutions has not yet translated to vocational education settings. CQUniversity is unique for the number of students who participate in their studies via distance education, rather than taking traditional face-to-face classes at university settings.

Most campus surveys are designed with a particular student body in mind. For example, the study by Solinas-Saunders et al.⁴⁰ included participants aged between 16 and 79 years who were not living on the university campus, whereas study by Bhochhibhoya et al.³⁶ focused on undergraduate university students who experienced sexual violence by a dating partner. On the contrary, the CQUniversity survey targeted students’ attitudes and experiences of sexual violence from the age of 12 years across undergraduate, postgraduate, and vocational students across all of its campuses in Australia regardless of their study mode (on-campus, online, residential, and non-residential). In an effort to gain a deeper understanding of forms of sexual violence experienced by university and vocational students, a team of researchers from CQUniversity, in collaboration with the Queensland Centre of Domestic and Family Violence Research (QCDFVR), developed a survey that took a broader approach to sexual violence than the Australian Human Rights Commission (AHRC) national student survey. The AHRC national student survey limited responses to incidents of sexual violence that occurred on university campuses, on the way to or from university, at a university event, or while employed by the university in the years 2015 and 2016 involving adult students and staff. On the contrary, the CQUniversity Sexual Assault Survey focused on students only.

Materials

The design of the CQUniversity Sexual Assault Survey was based on well-established and tested models such as the sexual experiences survey (SES)⁴¹ and the intimate partner survey of a university student population by Sudderth et al.⁴² The survey also included a set of attitudinal questions drawn from the Australian National Community Attitudes Towards Violence Against Women Survey.⁴³ Thus, the CQUniversity survey was a novel design to capture experiences and attitudes across a wider range of experiences to bring together experiences of sexual and other forms of violence. The results of many of these items will be presented in subsequent publications; here, we report specifically on student responses to childhood and adult sexual victimization. The survey questionnaire asked a series of questions related to a participants’ unwanted sexual experiences since the age of 12 years. In addition to the forced-choice answers, the participants were able to respond to an open-ended question that allowed them to add any information not covered in the survey or to elaborate on their responses: Is there anything you would like to share with the researchers that was not covered in this survey? The researchers who come from different disciplines including social work, psychology, and anthropology were concerned that inviting students to report their sexual experiences could trigger a desire to disclose sexual victimization in greater detail. It was an ethical consideration for the research team to recognize the ways in which questionnaires may trigger trauma-related experiences and to, therefore, provide a mechanism for respondents to ‘tell their stories’. Consequently, the qualitative question was intended to enable students who wished to provide additional information, to describe their experiences in greater detail, should this be their preference. To support student well-being, Statewide and University Helpline numbers were provided at the beginning of the survey.

Procedure

The study received ethics approval from CQUniversity’s Human Research Ethics Committee (HREC 20692) in November 2017. Students were invited to participate in the anonymous study via a video outlining the aim, anticipated outcomes, and their involvement by email that was distributed to the entire student body. In addition, the research team prepared a written information statement outlining the nature of the study and discussing procedural safeguards, conditions of confidentiality, and information for campus and community services offering therapy, support and other forms of care if the participant required follow-up services after completing the survey. The survey required participants to be 18 years or older, and fluent in English. Students were required to answer ‘yes’ to an informed consent statement prior to commencing the questionnaire. Demographic information such as age, gender identity, sexual orientation, marital status, postal code, highest level of education, ethnic identity, current housing situation, disability, and current enrolment status at the university indicated that participants represented the diversity of the CQUniversity student population.

All participants, after completing the survey, were given the option to provide their email address for a chance to win an iPad. The link to participate in the lottery for the iPad was uncoupled from the survey link. Reminder emails were sent to students during the data collection process and the survey link was sent to new students entering the university during enrolment periods at the beginning of each new term. Data were collected from 20 November 2017 to 13 January 2019.

Qualitative data analysis

Data provided by the students’ qualitative responses about sexual victimization before (and after) the age of 12 years were analysed utilizing a case-oriented method.⁴⁴ This approach allowed understanding and interpreting experiences and impacts of early sexual victimization from the students’ perspective. Meaning making of the texts provided by participants in the comments involved iterative and reflexive processes of the information provided. Insights were gained by individually reading through the relevant texts, and multiple analytical discussions of interpretative thoughts among the multi-disciplinary research team who has theoretical knowledge and/or practical expertise in relation to working with victim/survivors who disclose lived experiences of sexual violence. This approach allowed mitigating possible bias through open and honest discussions about the interpretations of the data.⁴⁵

Results

Of the 748 returned questionnaires, 109 (14.6%) individuals contributed responses to the open-ended question. Seventeen of these commented on the fact that the survey did not ask questions about CSA prior to the age of 12 years. For example, one female participant used the comment section to suggest changes in relation to the age of sexual violence. She stated that sexual victimization experiences of students should include ages under 12 years. Some participants provided information about their own experiences of CSA victimization.

Of the 109 responses, 14 participants (13.8%; 1 female indigenous; 1 male non-indigenous; 13 female non-indigenous) indicated to have been subjected to CSA before the age of 12 years and one participant provided a comment that she was 12 years old when she was sexually abused (15/109). Of the participants who identified as CSA victim/survivors, one identified as indigenous with all others being non-indigenous. One participant was male while the others reported being female. The majority of participants, who reported CSA victimization, were aged 18–24 years (46.7%) closely followed by those aged 45–54 years (40%). Only two participants aged 25–34 years (13.3 %) provided comments in relation to CSA before the age of 12 years. The comments indicated that commonly students were subjected to coercive and forced sexual violence including fellatio, anal, and vaginal intercourse subsequent to CSA victimization. Two participants reported being coerced into unwanted sexual activity without force and one participant experienced no repeat victimization.

Nine of the 15 respondents who reported CSA victimization identified their perpetrator as father (22.2%), stepfather (11%), family member not identified (22%), uncle (11%), friend of the father (11%), neighbour (11%), and general practitioner (11%).

Participants who experienced CSA also reported negative impacts. These included ongoing distress, mental health problems, substance use problems, distrust, and interpersonal problems such as difficulties forming relationships.

Discussion

Sexual revictimization

One major finding of this study in relation to CSA, where students disclosed victimization, was in relation to subsequent coerced and forced sexual violence. The vast majority of respondents who identified as victim/survivors of CSA reported ongoing sexual victimization in adulthood (see Table 1). Individuals with a history of CSA are more vulnerable to sexual revictimization in adolescence and/or adulthood compared to those who have not been sexually abused as a child.^6,28,46–51 Evidence suggests that women with CSA victimization are at least twice as likely to experience sexual violence as an adult, and if CSA involved penetration, the risk has been found to triple.²⁵

Table 1.

Participants disclosing CSA and subsequent sexual victimization.

Qualitative responses	Age category (years)	Questionnaire responses – subsequent sexual victimization	Issues identified
Before the age of 12 I was raped by my own dad (starting at 5 years of age till 8 years)	18–24	Frequent unwanted sexual experiences since the age of 12 Unwanted sexual experiences – unable to give consent (intoxication) since the age of 12 Experienced threatened and actual physical violence Exposure to strangulation Unwanted sexual experiences with a partner and a stranger – unable to give consent (intoxication)	CSA by father from the age 5 Sexual revictimization since the age of 12
The unwanted experience happened when I was 12 years old and has significantly impacted my ability to engage with others beyond being friends. I am overcome with distress when faced with an interaction that could potentially lead to a relationship	18–24	Unwanted sexual experiences since the age of 12 using force Experienced threatened and actual physical violence (including a weapon) Exposure to strangulation Partner used force to engage in unwanted sexual activity Partner used coercion/ force to obtain intimate images	CSA from the age of 12 Sexual revictimization since the age of 12 Distress Interpersonal problems – difficulty forming relationships
My answers aren’t from the perpetrator being a partner they were my dad. So it isn’t just partners, it’s very much so family	18–24	Unwanted sexual experiences in the past year Unwanted sexual experiences since the age of 12 Unable to give consent (intoxication) since the age of 12 Threatened and actual physical violence since the age of 12 (including use of weapon) Experienced physical violence in the past year (including use of a weapon) Coerced and forced fellatio since the age of 12 Coerced intercourse in the past year Coerced intercourse since the age of 12 Unable to give consent (intoxication) in the past year Threats of harm in the past year Threats of harm since the age of 12 Coerced anal intercourse in the past year Coerced anal intercourse since the age of 12 Multiple occasions when unable to give consent (intoxication) since the age of 12 Frequent threats of harm in the past year Experienced strangulation Coerced and forced intercourse by a partner Unwanted sexual experience with a friend – unable to consent (intoxication) Partner used coercion/force to obtain intimate images Partner coerced/forced to watch porn Partner used coercion/force to produce porn Partner threatened to share intimate images Partner used coercion to re-enact what was seen in porn movies Anal intercourse against will	CSA by father Sexual revictimization since the age of 12
Coerced into things too young to know any better; told not to tell parents/family because I would get into trouble	18–24	Unwanted sexual experiences since the age of 12 Multiple occasions where she was unable to give consent (intoxication) since the age of 12 Multiple occasions of coerced sexual activity under threat of physical violence since the age of 12 Forced sexual activity in the past year Multiple occasions of forced sexual activity since the age of 12 Coerced and forced fellatio since the age of 12 and threats of physical violence Coerced and forced fellatio in the past year Coerced intercourse in the past year Coerced and forced intercourse since the age of 12 Threats and actual sexual violence Experienced strangulation Unwanted (forced) sexual experiences with intimate partner Unwanted sexual experiences with a friend Coerced/forced by a partner to take intimate images Coerced/forced by a partner to watch porn Partner shared intimate images against her will	Sexual revictimization since the age of 12
A few of those things did happen to me but I was under 12 when they happened	18–24	Experienced threatened and actual physical violence Unwanted sexual experiences with a stranger and a friend – unable to give consent (intoxication) Unwanted sexual intercourse with a partner due to threat to end relationship Partner used coercion/force to obtain intimate images Partner used coercion to re-enact what was seen in porn movies Anal intercourse against her will	CSA before the age of 12 Sexual revictimization since the age of 12
Sexually assaulted by a family member when I was 5	18–24	No victimization reported since age 12	CSA from the age of 5
I was also sexually assaulted/raped by my mother’s partner from ages 7–11	18–24	Unwanted sexual experiences in the past year Unwanted sexual experiences since the age of 12 Unable to give consent Coerced/forced intercourse in the past year Coerced/forced intercourse since the age of 12	CSA from the age of 7 Sexual revictimization since the age of 12
I am a victim of child sexual abuse, I was abused for six years by my mother’s partner. After she left him and I turned 18 years old I sought advice from a counsellor, pressed charges of which he was convicted. . ..	25–34	Multiple forced unwanted sexual experiences since the age of 12 Multiple occasions of coerced and forced fellatio since the age of 12 Multiple occasions of coerced and forced intercourse since the age of 12 Multiple occasions of intercourse when unable to give consent (intoxication) since the age of 12 Experienced strangulation Unwanted sexual experiences with a friend – unable to consent (intoxication) Unwanted sexual experiences with a stranger – unable to consent (intoxication)	CSA from the age of 6 Sexual revictimization since the age of 12
I was sexually abused for 4 years as a child under 12 years of age	25–34	Coerced and forced fellatio since the age of 12 Coerced and forced fellatio in the past year Coerced and forced anal intercourse since the age of 12 Coerced and forced anal intercourse in the past year Unable to give consent (intoxication) Partner used actual/threats of physical violence to obtain sexual intercourse Unwanted sexual experiences with a stranger Unwanted sexual experiences with a friend Coerced/forced by a partner to take intimate images Coerced/forced by a partner to view porn Pressured into re-enacting porn by a partner Partner threatened to share intimate images	CSA for 4 years before the age of 12 Sexual revictimization since the age of 12
The small amount of childhood touching of clothing was from an uncle, however, at the time I was not aware that this was classed as abuse	45–54	Experienced threatened and actual physical violence (including with a weapon)	CSA by uncle Non-sexual intimate partner violence
My one off incident was before the age of 12 by a friend’s father	45–54	Coerced sexual activity since the age of 12	CSA by uncle Sexual revictimization since the age of 12
For many of us I would imagine sexual assault occurred much earlier – in my case 7 years old. . . many of us have learned from a very early age that others can’t be trusted, noting that this serves to protect us but also deprives us of the opportunity to have fun similar to our peers which creates a different set of consequences	45–54	Unwanted sexual experiences since the age of 12 Coerced fellatio with threats of physical harm since the age of 12 Forced fellatio since the age of 12 Forced intercourse since the age of 12 Threats of and actual physical violence including strangulation to obtain sexual intercourse since the age of 12	CSA from the age of 7 Sexual revictimization since the age of 12 Trust issues
I was molested as a child by a neighbour and had a doctor grab my genitals without permission during an unrelated medical examination	45–54	Unwanted sexual experiences since the age of 12 Unable to give consent (intoxication) Coerced/forced intercourse Unwanted sexual experiences with several individuals including a stranger; a friend; and intimate partner due to intoxication	CSA by multiple perpetrators Sexual revictimization since the age of 12 Distrust
My non-consensual coerced sexual experiences happened around 9 years which then later led to excessive substance use, promiscuity, mental health issues and dropped out of uni. . .	45–54	Frequent unwanted sexual experiences in the past year Unwanted sexual experiences with a friend Partner shared intimate images without consent	CSA from the age of 9 Sexual revictimization since the age of 12 Mental health problems Substance use issues Sexual risk behaviours Educational impact
Sexual abuse as a child by a member of my own family	45–54	Experienced physical violence Unwanted sexual experience with friend – unable to consent (intoxication) Coerced intercourse by partner (threat to end relationship) Partner threatened to share intimate images	CSA by family member Sexual revictimization since the age of 12

CSA: child sexual abuse.

In line with our findings, Talmon and Ginzburg⁵² found that university students with a history of CSA reported interpersonal difficulties in adulthood. Their study reported that discomfort was experienced during interactions that resulted in an exaggerated sense of threat. This may explain high rates of revictimization among students with a history of CSA victimization. Research indicates that ambivalent attachment and interpersonal skills deficits have been associated with intimacy problems among victim/survivors of CSA, especially among those with father–daughter perpetrated sexual abuse.⁵³

The consequences of sexual violence, in particular revictimization,⁵⁴ can significantly impact multiple aspects of victim/survivors’ lives including their mental health.^12,55–57 Specifically PTSD has been found to have a strong relationship with victim/survivors being up to 5.5 times more likely to suffer symptoms than individuals with no CSA victimization. Furthermore, sexual revictimization has been found to be associated with cognitive impairment, physical health impacts due to chronic hyperarousal and related stress responses, along with eating disorders and substance use problems.^6,11,54 Consequently, it is not surprising that sexual revictimization negatively impacts academic achievement of university students.

Our findings indicated that some students with CSA victimization stated that they experienced negative impacts on their education. For example, a participant stated that she ‘dropped out of uni’ after having been exposed to CSA from the age of 9 years with numerous sexual revictimization experiences including past year sexual violence. Recent attention has been paid to the potential negative consequences for academic performance for victim/survivors of sexual violence and the increased likelihood of leaving their studies.^58,59 Students who are victimized by sexual violence often find it challenging to continue their academic studies, with some choosing to avoid lectures and tutorials, while others terminate their studies.⁶⁰ Past research has found significant differences in relation to academic achievement between students who were exposed to sexual violence and those who have not experienced sexual victimization.^58,60 These negative psychological and academic effects require further investigation to ensure that all students regardless of their histories of sexual violence before and during university have equal opportunities to successfully complete their studies.

Implications

Fifteen respondents indicated to have been subjected to CSA, of which 14 were younger than 12 years at the time of their first victimization. Furthermore, students explicitly asked the researchers to revise the questionnaire and include CSA experienced prior to the cut-off age of 12 years. This unexpected disclosure prompted the research team to reflect on the age restrictions placed on our survey and to examine the reasons for omitting to ask questions about sexual victimization as a prepubescent child.

We found that most surveys focused on university student experiences of sexual violence as an adult,^14,36 and how this past experience may impact their well-being and success in higher education. Furthermore, ethical considerations led us to follow previous research that enquired about sexual violence from the age of 12 years.

Based on our findings of students wanting to report CSA from any age, their sexual revictimization experiences and negative impacts on educational success, we recommend that further studies should examine the nature and scope of students’ past exposure to CSA and subsequent sexual violence victimization along with the educational impact for victim/survivors. It would be interesting to examine whether help-seeking behaviours increase with awareness of specialist counselling services and how universities may cope with the demand of trauma-informed counselling for victim/survivors of sexual violence. This is a growing area of concern for universities as the complexity and demand for counselling services often outweighs available resources.⁶¹ It is important to note that universities are in a unique position to reach individuals who have been exposed to sexual violence who may not seek help otherwise.^54,62–64 Universities have an opportunity to improve students’ mental health and well-being by providing much needed counselling support and promoting preventive health strategies.^61,63,65

As discussed above, effects of CSA victimization may include impaired progress in higher education.^58,66 This has implications for university student support beyond provision of counselling services.^58,66 Students who have suffered CSA not only experience an increased risk of revictimization but also are less likely to seek help from student services.⁵⁴ This vulnerability should be better recognized and used as targeted prevention for university students who have suffered sexual violence.⁹ Factors such as raising awareness, education about sexual violence, and posttraumatic growth have been found to act as protective mechanisms for victim/survivors to reduce the risk of revictimization, promote mental health/well-being and increase successful completion of university studies.^{57,61,67–69}

University counsellors play a critical role in supporting students who consider early exit due to high stress levels.⁶¹ However, not all students will disclose current or prior sexual victimization. In relation to CSA, consideration needs to be given to recall and/or refuse disclosure of sexual abuse in childhood when adult experiences are discussed. Some evidence suggests inaccurate recall and failure to disclose CSA victimization when, in fact, students were sexually abused as a child.^29,30 However, as our research suggests, some university students are not only willing, but also keen to report their sexual victimization in early childhood as well as adulthood. Some respondents in our study indicated that they felt aggrieved that sexual victimization in early childhood was not included in the survey design. They indicated strong feelings about this ‘silencing’ to the researchers. The exclusion of prepubescent CSA victimization can exacerbate ongoing stigma and shame that victim/survivors may experience and thus contribute to keeping the phenomenon hidden. The recent impact of the SHIFT study from Columbia University⁶³ has demonstrated how critical it is for universities to not only be aware of the impact of childhood sexual experiences, including CSA, but to promote a sexual health culture in the communities and schools from a much younger age. The longer the phenomenon remains hidden, less likely it is that investment will be made into tertiary education support services to offer trauma-informed intervention, which, in turn, may reduce the risk of sexual revictimization. We note that there are specific implications for university student support services in having skilled and knowledgeable counsellors available and information about specialist support services. Specific trauma interventions are recommended for CSA victim/survivors particularly in relation to the experience of shame, guilt, and impact on sexual development and risk of later revictimization. Surveys that include questions about CSA without an age cut-off may provide an opportunity for students to acknowledge their experiences and the questions may act as a trigger to access support – so, rather than retraumatizing, surveys may provide a potential prompt to recovery.

Our research team may repeat the survey in the near future. Questions that we will consider include a person’s first knowledge of sexual violence victimization, its circumstances, the relationship to the perpetrator, and the type of sexual violence (e.g. physical, non-physical, penetrative forms). In addition, age of first victimization is important, given the significant life disruptions in relation to school, work, and support structures.⁵ Finally, information around mental healthcare received during university attendance may yield important information for support service delivery.

Moving forward, educational institutions and future researchers should recognize the negative impact of sexual violence on a students’ academic performance.⁵⁸ There is a call for universities to be responsive to the impacts of sexual violence on students through education and training, policy development, increased awareness, and provision of support and resources.^70,71 As our findings indicate that early experiences of sexual violence matter to students, university policies should include recognition that students may enter with vulnerabilities from historical trauma and pay attention to students’ needs along with the provision of opportunities to facilitate mental health. Strategies such as sharing experiences of sexual victimization and peer mentoring programmes may help build support initiatives and facilitate resilience. University staff need to be equipped with the knowledge and skills to respond to students who have been subjected to sexual violence with empathy and a non-judgemental stance, which includes referral mechanisms to appropriate professional services.^61,70,71

Strengths and limitations

While the research team decided to reduce the risk of CSA retraumatization by asking about experiences of sexual violence from age 12, we inadvertently gave students a confidential space to report on their experiences of CSA prior to the cut-off age. Furthermore, our study brings CSA into the realm of university sexual violence studies and, therefore, gives victim/survivors a voice on an issue that still remains largely hidden. In addition, recognizing the risk of revictimization, the study highlights potentials for preventive efforts. In this regard, Hirsch and Khan⁶³ provided a comprehensive overview of recommendations for university communities that takes into consideration the impact of CSA on university students’ lives.

Results should be interpreted against the background of the following limitations. Many individuals choose not to disclose sexual victimization across their life span, consequently, it is not possible to make inferences on the number of students who stated they had experienced CSA. Furthermore, they may have defined CSA differently. Utilizing a standardized definition of CSA will be critical in future research. The findings may also be limited due to the use of a retrospective self-report research design with risk of recall bias. Since we included CSA questions from the age of 12 years, it is likely that some respondents did not disclose sexual victimization prior to the cut-off even though they experienced CSA at an age younger than 12 years, as they were inadvertently silenced. Finally, given the number of responses, it is important to acknowledge that limited generalizations can be made. However, the feedback from students points to a critical lacuna in how campus sexual violence surveys are designed. Consequently, despite these limitations, findings of the qualitative part of this study made an important contribution to the current knowledge and students’ desire to discuss CSA from an early age.

Conclusion

Sexual violence has been identified as a public health concern with university student populations at a higher risk than the general public, thus it was timely that our research examined the specific issues around sexual violence among university students. With little research to date, and acknowledgement for the need of a better understanding, this study extended previous research and filled an important gap in the literature. Our analysis of the CQUniversity Sexual Assault Survey’s qualitative responses revealed unexpected disclosures of CSA prior to the age of 12 years and suggestions that these early experiences of sexual violence should have been included in the survey instrument. The research team only serendipitously found that CSA experienced by prepubescent children was important to students, and the student responses indicated that the researchers did not make it easy for them to report CSA experienced prior to puberty. Therefore, the survey design contributed to silencing those students who were subjected to CSA prior to the age of 12 years.

Our study found that CSA is important to students to recognize and include in survey design. This will contribute to a more nuanced understanding of the complexities of campus sexual assault and the types of responses necessary to support students’ psychological health and well-being. During the time of conducting the survey and writing the results, a new book was published by Hirsch and Khan,⁶³ which is the first large-scale research project to directly correlate experiences of CSA with the forms of abuse and violence we see on university campuses. It appears the research community is coming to a common awareness that our research designs, which focuses on adult encounters of campus rape, were universally missing an important story our students want to tell.

Further research is needed to better understand the scope and impact of CSA without age restrictions among university students. Investigations in how support services are delivered and what needs of students with CSA victimization are not yet met will provide valuable insight into the impact of trauma among sexual violence victim/survivors who attend university.

Footnotes

Author contributions

All authors were responsible for the conceptualization and writing of this article. M.G. and H.J.H. undertook the analysis and interpretation of the data with discussions of the texts and analytical thoughts involving all authors. V.L. conducted the initial review of the literature. All authors contributed to the initial draft with M.G. and H.J.H. contributing substantively to earlier versions and the other authors critically reviewing numerous drafts, providing commentary on revisions during the pre-publication stage.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Marika Guggisberg

References

World Health Organization. Violence against Women: Intimate Partner and Sexual Violence against Women (Fact sheet 239), 2016, http://www.who.int/mediacentre/factsheets/fs239/en/

Relyea

Ullman

SE.

Unsupported or turned against: understanding how two types of negative social reactions to sexual assault relate to post-assault outcomes. Psychol Women Quart 2015; 39(1): 37–52.

Australian Bureau of Statistics. 4906.0 Personal Safety, Australia, 2016. Canberra, ACT, Australia, 2017, http://www.abs.gov.au/ausstats/abs@.nsf/mf/4906.0

Guggisberg

Women, violence and comorbidity: the struggle with victimisation, mental health problems and substance use. Saarbrücken, Germany: LAP Lambert Academic Publishing, 2010.

Basile

Smith

Breiding

, et al. Sexual violence surveillance: uniform definitions and recommended data elements. Version 2.0. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2014.

Guggisberg

The impact of violence against women and girls: a life span analysis. In: Guggisberg

Henricksen

(eds) Violence against women in the 21st century: Challenges and future directions. New York: Nova Science Publishers, pp. 3–27, 2018.

Phipps

Ringrose

Renold

, et al. Rape culture, lad culture and everyday sexism: researching, conceptualizing and politicizing new mediations of gender and sexual violence. J Gender Stud 2018; 27(1): 1–8.

Australian Bureau of Statistics. Personal Safety, Australia, 2012 (No. 4906.0). Canberra, ACT, Australia, 2014, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4906.0-2012

Campbell

Sabri

Budhathoki

, et al. Unwanted sexual acts among university students: correlates of victimisation and perpetration. J Interpers Violence 2021; 36(1–2): 504–526.

10.

Carlson

Duckworth

MP.

Sexual victimization and benefit expectations of risky behavior among female college students. J Interpers Violence 2019; 34: 1543–1562.

11.

Neilson

Gilmore

Pinsky

, et al. The use of drinking and sexual assault protective behavioral strategies: associations with sexual victimization and revictimization among college women. J Interpers Violence 2018; 33(1): 137–158.

12.

Carey

Norris

Durney

, et al. Mental health consequences of sexual assault among first-year college women. J Am College Health 2018; 66: 480–486.

13.

Moylan

Javorka

Widening the lens: an ecological review of campus sexual assault. Trauma, Violence Abuse 2020; 21: 179–192.

14.

Muehlenhard

Peterson

Humphreys

, et al. Evaluating the one-in-five statistic: women’s risk of sexual assault while in college. J Sex Res 2017; 54(4–5): 549–476.

15.

Hawn

Lind

Conley

, et al. Effects of social support on the association between precollege sexual assault and college-onset victimization. J Am College Health 2018; 66(6): 467–475.

16.

Kaasa

Fisher

Cantor

, et al. Recurring victimization in the AAU climate survey on sexual assault and sexual misconduct. Rockville, MD: Westat, 2016, https://cpb-us-w2.wpmucdn.com/sites.wustl.edu/dist/e/1789/files/2019/03/2015-Recurring-Victimization-in-the-AAU-Climate-Survey-on-Sexual-Assault-and-Sexual-Misconduct.pdf

17.

The Student Room & Revolt Sexual Assault. Students’ experience of sexual violence, 2018, https://www.thestudentroom.co.uk/docs/misc/Sexual%20Violence%20at%20University%20-%20Revolt%20Sexual%20Assault%20-%20The%20Student%20Room%20-%20March%202018.pdf

18.

Australian Human Rights Commission. Change the Course: National Report on Sexual Assault and Sexual Harassment at Australian Universities. Sydney, NSW, Australia, 2017, https://www.humanrights.gov.au/sites/default/files/document/publication/AHRC_2017_ChangeTheCourse_UniversityReport.pdf

19.

Wood

Hoefer

Kammer-Kerwick

, et al. Sexual harassment at institutions of higher education: prevalence, risk, and extent. J Interpers Violence 2018; 36: 4520–4544.

20.

Carey

Durney

Shepardson

, et al. Incapacitated and forcible rape of college women: prevalence across the first year. J Adolesc Health 2015; 56(6): 678–680.

21.

Cusack

Bourdon

Bountress

, et al. Prospective predictors of sexual revictimization among college Students. J Interpers Violence. Epub ahead of print 26 May 2019. DOI: 10.1177/0886260519849680.

22.

Cantor

Fisher

Chibnall

, et al. Report on the AAU campus climate survey on sexual assault and misconduct. The Association of American Universities, 2020, https://www.aau.edu/Campus-Safety/AAU-Campus-Climate-Survey/Revised(01-16-2020_FINAL).pdf

23.

Griffin

Read

JP.

Prospective effects of method of coercion in sexual victimization across the first college year. J Interpers Violence 2012; 27(12): 2503–2524.

24.

McMahon

Wood

Cusano

, et al. Campus sexual assault: future directions for research. Sexual Abuse 2019; 31(3): 270–295.

25.

Walker

Freud

Ellis

, et al. The prevalence of sexual re-victimization: a meta-analytic review. Trauma Violence Abuse 2019; 20(1): 67–80.

26.

Mathews

New international frontiers in child sexual abuse: Theory, problems and progress. Cham: Springer, 2019.

27.

Townsend

Child Sexual Abuse Disclosure: What Practitioners Need to Know. ( Charleston

S.C

, Darkness to Light), 2016, www.D2L.org

28.

Cashmore

Shackel

Gender differences in the context and consequences of child sexual abuse. Curr Issue Criminal Justic 2014; 26(1): 75–104.

29.

McDonald

Recovered memory of childhood sexual abuse: an overview of research evidence and guidelines. Melbourne, VIC, Australia: Psychotherapy & Counselling Federation of Australia, 2017.

30.

Mills

Kisely

Alati

, et al. Self-reported and agency-notified child sexual abuse in a population-based birth cohort. J Psychiat Res 2016; 74: 87–93.

31.

Mathews

Bromfield

Walsh

, et al. Reports of child sexual abuse of boys and girls: longitudinal trends over a 20-year period in Victoria, Australia. Child Abuse Neglect 2017; 66: 9–22.

32.

Moore

Scott

Ferrari

, et al. Burden attributable to child maltreatment in Australia. Child Abuse Neglect 2015; 48: 208–220.

33.

Barth

Bernetz

Heim

, et al. The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. Int J Public Health 2013; 58: 469–483.

34.

Kloppen

Haugland

Svedin

, et al. Prevalence of child sexual abuse in the Nordic Countries: a literature review. J Child Sex Abuse 2016; 25(1): 37–55.

35.

Kilimnik

Meston

CM.

A developmentally relevant approach to classifying non-consensual sexual experiences in the study of women’s sexual well-being. J Sex Res 2018; 55(7): 824–836.

36.

Bhochhibhoya

Maness

Cheney

, et al. Risk factors for sexual violence among college students in dating relationships: an ecological approach. J Interpers Violence. Epub ahead of print 22 March 2019. DOI: 10.1177/0886260519835875.

37.

Coultier

RWS

Rankin

. College sexual assault and campus climate for sexual- and gender-minority undergraduate students. J Interpers Violence 2020; 35(5–6): 1351–1366.

38.

Winters

Colombino

Schaaf

, et al. Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure. Behav Sci Law 2020; 38(6): 586–611.

39.

Kenny

Helpingstine

Long

College students’ recollection of childhood sexual abuse prevention programs and their impact on reduction of sexual victimization. Child Abuse Neglect 2020; 104: 104486.

40.

Solinas-Saunders

Sexual violence among college students attending a nonresidential campus. J Interpers Violence 2018; 36: 2273–2297.

41.

Koss

Abbey

Campbell

, et al. Revising the SES: a collaborative process to improve assessment of sexual aggression and victimization. Psychol Women Quart 2007; 31(4): 357–370.

42.

Sudderth

Leisring

Bronson

EF.

If they don’t tell us, it never happened: disclosure of experiences of Intimate Partner Violence on a college campus. Canada Woman Stud 2010; 28(1): 56–64.

43.

Webster

Pennay

Bricknall

, et al. Australians’ Attitudes to Violence against Women: Full Technical Report. Melbourne, VIC, Australia: Victorian Health Promotion Foundation, 2014.

44.

Ragin

CC.

Turning the tables: how case-oriented research challenges variable-oriented research. In: Brady

Collier

(eds) Rethinking Social Inquiry: Diverse Tools, Shared Standards. Lanham, MD: Rowman & Littlefield Publishers Inc, 2004, pp. 123–142.

45.

Creswell

JW.

Qualitative inquiry and research design: choosing among five approaches (3rd ed.). Thousand Oaks, CA: SAGE, 2013.

46.

Astbury

Violating children’s rights: the psychological impact of sexual abuse in childhood. Inpsych 2013; 35: 5, https://www.psychology.org.au/inpsych/2013/october/astbury

47.

Hines

DA.

Predictors of sexual coercion against women and men: a multilevel, multinational study of university students. Archiv Sex Behav 2007; 36(3): 403–422.

48.

Salter

Child sexual abuse. In: DeKeseredy

Rennison

Hall-Sanchez

(eds) The Routledge International Handbook of Violence Studies. Abingdon: Routledge, 2019, pp. 244–253.

49.

Santelli

Grilo

Choo

, et al. Does sex education before college protect students from sexual assault in college? PLoS ONE 2018; 13(11): e0205951.

50.

Scoglio

AAJ

Kraus

Saczynski

, et al. Systematic review of risk and protective factors for revictimization after child sexual abuse. Trauma Violence Abuse 2021; 22(1): 41–53.

51.

Stathopoulos

Sexual Revictimisation: Individual, Interpersonal and Contextual Factors. ACCSA Research Summary. Melbourne, VIC, Australia: Australian Centre for the Study of Sexual Assault, 2014, https://aifs.gov.au/sites/default/files/publication-documents/ressum6.pdf

52.

Talmon

Ginzburg

‘Body self’ in the shadow of childhood sexual abuse: the long-term implications of sexual abuse for male and female adult survivors. Child Abuse Neglect 2018; 76: 416–425.

53.

Guggisberg

The wide-ranging impact of intra-familial child sexual abuse: utilising neurobiology to provide scientific evidence. Curr Opin Neurol Sci 2017; 1(5): 255–264.

54.

Stepleton

McMahon

Potter

, et al. Prior sexual victimization and disclosure of campus sexual violence among college students. J Coll Counsel 2019; 22: 56–69.

55.

Adams

Mrug

Knight

DC.

Characteristics of child physical and sexual abuse as predictors of psychopathology. Child Abuse Neglect 2018; 86: 167–177.

56.

Kennedy

Prock

KA.

‘I still feel like I am not normal’: a review of the role of stigma and stigmatization among female survivors of child sexual abuse, sexual assault and intimate partner violence. Trauma Viol Abuse 2018; 19(5): 512–527.

57.

Littleton

Abrahams

Bergman

, et al. Sexual assault, sexual abuse and harassment: understanding the mental health impact and providing care for survivors. International Society for Traumatic Stress Studies, KAR id: 70282, 2018, https://kar.kent.ac.uk/70282/

58.

Baker

Frazier

Greer

, et al. Sexual victimization history predicts academic performance in college women. J Counsel Psychol 2016; 63(6): 685–692.

59.

Jordan

Combs

Smith

GT.

An exploration of sexual victimization and academic performance among college women. Trauma Violenc Abuse 2014; 15(3): 191–200.

60.

Mengo

Black

BM.

Violence victimization on a college campus: Impact on GPA and school drop out. J Coll Student Retent: Res Theory Pract 2015; 18(2): 234–248.

61.

Browne

Munro

Cass

Under the radar: the mental health of Australian university students. J Austral New Zealand Stud Serv Assoc 2017; 25(2): 51–62.

62.

Adelman

Haldane

Wies

JR.

Mobilizing culture as an asset: a transdisciplinary effort to rethink gender violence. Violence Against Women 2012; 18(6): 691–700.

63.

Hirsch

Khan

Sexual Citizens: A Landmark Study of Sex, Power, and Assault on Campus. New York, NY: W.W. Norton & Company, 2020.

64.

Wies

JR.

Title IX and the state of campus sexual violence in the United States: power, policy, and local bodies. Human Organ 2015; 74(3): 276–286.

65.

Veness

BG.

The wicked problem of university student mental health, 2016, https://www.churchilltrust.com.au/media/fellows/Veness.pdf

66.

Hardner

Wolf

Rinfrette

ES.

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors. Child Abuse Neglect 2018; 86: 375–383.

67.

Arias

Johnson

CV.

Voices of healing and recovery from childhood sexual abuse. J Child Sex Abuse 2013; 22(7): 822–841.

68.

Domhardt

Münzer

Fegert

, et al. Resilience in survivors of child sexual abuse: a systematic review of the literature. Trauma, Viol Abuse 2014; 16(4): 476–493.

69.

Ullman

SE.

Correlates of posttraumatic growth in adult sexual assault victims. Traumatolo 2014; 20(3): 219–224.

70.

Sedlacek

Stevenson

Kray

, et al. The impact of a history of childhood abuse on life as a college student. J Res Christian Educ 2015; 24(2): 169–184.

71.

Universities Australia. Statement on national student prevalence survey on sexual assault and harassment by Universities Australia, 2018, www.universitiesaustralia.edu.au