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

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.

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. Its true extent is unknown 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.

Women aged between 18 and 35 years are most likely to experience sexual violence 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. 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.

In the United Kingdom, a national survey into university students’ experiences of sexual violence analysed responses from 4491 students across 153 institutions. 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. 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. 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. These include gender,[15,20,21] age,[8,22] and commencement at university. 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. 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. 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. 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. In Australia, a meta-analysis of the prevalence of CSA found victimization rates at 14.1% for girls and 5.5% for boys.

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. 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. 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; however, sexual violence research commonly uses ‘arbitrary age cutoffs’ (p. 814), 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. 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. 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. 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. 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).

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. included participants aged between 16 and 79 years who were not living on the university campus, whereas study by Bhochhibhoya et al. 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) and the intimate partner survey of a university student population by Sudderth et al. The survey also included a set of attitudinal questions drawn from the Australian National Community Attitudes Towards Violence Against Women Survey. 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. 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.

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.

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 12Unwanted sexual experiences – unable to give consent (intoxication) since the age of 12Experienced threatened and actual physical violenceExposure to strangulationUnwanted sexual experiences with a partner and a stranger – unable to give consent (intoxication)	CSA by father from the age 5Sexual 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 forceExperienced threatened and actual physical violence (including a weapon)Exposure to strangulationPartner used force to engage in unwanted sexual activityPartner used coercion/ force to obtain intimate images	CSA from the age of 12Sexual revictimization since the age of 12DistressInterpersonal 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 yearUnwanted sexual experiences since the age of 12Unable to give consent (intoxication) since the age of 12Threatened 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 12Coerced intercourse in the past yearCoerced intercourse since the age of 12Unable to give consent (intoxication) in the past yearThreats of harm in the past yearThreats of harm since the age of 12Coerced anal intercourse in the past yearCoerced anal intercourse since the age of 12Multiple occasions when unable to give consent (intoxication) since the age of 12Frequent threats of harm in the past yearExperienced strangulationCoerced and forced intercourse by a partnerUnwanted sexual experience with a friend – unable to consent (intoxication)Partner used coercion/force to obtain intimate imagesPartner coerced/forced to watch pornPartner used coercion/force to produce pornPartner threatened to share intimate imagesPartner used coercion to re-enact what was seen in porn moviesAnal intercourse against will	CSA by fatherSexual 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 12Multiple occasions where she was unable to give consent (intoxication) since the age of 12Multiple occasions of coerced sexual activity under threat of physical violence since the age of 12Forced sexual activity in the past yearMultiple occasions of forced sexual activity since the age of 12Coerced and forced fellatio since the age of 12 and threats of physical violenceCoerced and forced fellatio in the past yearCoerced intercourse in the past yearCoerced and forced intercourse since the age of 12Threats and actual sexual violenceExperienced strangulationUnwanted (forced) sexual experiences with intimate partnerUnwanted sexual experiences with a friendCoerced/forced by a partner to take intimate imagesCoerced/forced by a partner to watch pornPartner 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 violenceUnwanted sexual experiences with a stranger and a friend – unable to give consent (intoxication)Unwanted sexual intercourse with a partner due to threat to end relationshipPartner used coercion/force to obtain intimate imagesPartner used coercion to re-enact what was seen in porn moviesAnal intercourse against her will	CSA before the age of 12Sexual 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 yearUnwanted sexual experiences since the age of 12Unable to give consentCoerced/forced intercourse in the past yearCoerced/forced intercourse since the age of 12	CSA from the age of 7Sexual 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 12Multiple occasions of coerced and forced fellatio since the age of 12Multiple occasions of coerced and forced intercourse since the age of 12Multiple occasions of intercourse when unable to give consent (intoxication) since the age of 12Experienced strangulationUnwanted sexual experiences with a friend – unable to consent (intoxication)Unwanted sexual experiences with a stranger – unable to consent (intoxication)	CSA from the age of 6Sexual 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 12Coerced and forced fellatio in the past yearCoerced and forced anal intercourse since the age of 12Coerced and forced anal intercourse in the past yearUnable to give consent (intoxication)Partner used actual/threats of physical violence to obtain sexual intercourseUnwanted sexual experiences with a strangerUnwanted sexual experiences with a friendCoerced/forced by a partner to take intimate imagesCoerced/forced by a partner to view pornPressured into re-enacting porn by a partnerPartner threatened to share intimate images	CSA for 4 years before the age of 12Sexual 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 uncleNon-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 uncleSexual 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 12Coerced fellatio with threats of physical harm since the age of 12Forced fellatio since the age of 12Forced intercourse since the age of 12Threats of and actual physical violence including strangulation to obtain sexual intercourse since the age of 12	CSA from the age of 7Sexual revictimization since the age of 12Trust 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 12Unable to give consent (intoxication)Coerced/forced intercourseUnwanted sexual experiences with several individuals including a stranger; a friend; and intimate partner due to intoxication	CSA by multiple perpetratorsSexual revictimization since the age of 12Distrust
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 yearUnwanted sexual experiences with a friendPartner shared intimate images without consent	CSA from the age of 9Sexual revictimization since the age of 12Mental health problemsSubstance use issuesSexual risk behavioursEducational impact
Sexual abuse as a child by a member of my own family	45–54	Experienced physical violenceUnwanted 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 memberSexual revictimization since the age of 12

CSA: child sexual abuse.

In line with our findings, Talmon and Ginzburg 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.

The consequences of sexual violence, in particular revictimization, 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. 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. 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. This vulnerability should be better recognized and used as targeted prevention for university students who have suffered sexual violence. 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. 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 University 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. 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. 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 Khan 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, 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.