Contextual Factors Associated with Posttraumatic Stress Among Campus Sexual Assault Survivors.

Sexual assault has been repeatedly associated with multiple types of psychological distress, including posttraumatic stress. Post-assault outcomes are frequently linked to individual psychological processes (e.g. cognitions, behaviors) that are targeted in common psychotherapies, yet contextual factors (e.g. relationships, institutional factors) also play important roles in distress. Using a socioecological approach, this study examined how contextual factors such as institutional betrayal cross-sectionally predict posttraumatic stress in a sample of campus sexual assault survivors who enrolled at a large, public university in the Pacific Northwest of the United States and who disclosed their assault to another person (N = 245). Results indicated that multiple contextual factors outside of the individual (e.g. relationship with perpetrator, reactions to disclosure, institutional betrayal) were significantly associated with posttraumatic stress (r's = .27-.51) and explained significant unique variance in posttraumatic stress in regression analyses. These associations remained even after controlling for self-blame cognitions and avoidance coping behaviors - two individual-level factors frequently addressed by evidence-based treatments for posttraumatic stress. Such results highlight a need for psychological and public health interventions that target higher levels of the social ecology, such as relational or institutional interventions.