Medical mistrust among diverse survivors of sexual violence: implications for primary health care delivery and engagement.

backgroundIn the United States, approximately 25% of women experience attempted/ completed rape, and substantially more experience sexual assault, with minoritized women disproportionately. Survivors of sexual violence (SV) face higher odds of poor physical or mental health, leading to frequent interactions with healthcare systems. At the same time, survivors of SV may avoid care due to fear of re-traumatization, structural barriers, economic barriers, or fear and stigma. Despite high rates of medical mistrust (MM) among minoritized groups and previously identified associations between MM and health care avoidance, MM among SV survivors in this context has not been widely explored.

methodsThe THRIVE Study was a prospective case-control study of cisgender female past-month survivors of forced/threatened vaginal sex (rape) compared to consensually sexually active controls. Women completed three visits over three months, inclusive of surveys and biological sample collection. At baseline, participants were asked about past experiences of SV, including "sexual assault," past "forced/threatened sex" (not inclusive of past-month experiences), and recent "forced/threatened sex" (past month, assessed as eligibility criteria). Binary indicator variables were created for each experience. Using the Group-Based Medical Mistrust scale and sub-scales (discrimination, suspicion, lack of support), differences in MM were examined by SV history and self-identified race and ethnicity.

resultsSurvivors of past or recent rape had significantly higher MM than others, with survivors of recent rape having the highest mean MM score (µ = 31.00, SD: 9.06 vs. µ = 25.89, SD: 9.41, p = 0.027; µ = 32.28, SD: 8.97 vs. µ = 25.86, SD: 9.15, p = 0.006). Survivors of past rape had significantly higher discrimination domain scores (p = 0.027), while recent survivors had significantly higher suspicion (p = 0.002) and lack of support scores (p = 0.039). Variation by SV experience and MM domain was identified among Latina, White, and Multiracial women. Black women had significantly higher MM than non-Black women (µ = 33.94, SD: 9.39 vs. µ = 26.35, SD: 9.00, p = 0.005), but no associations with SV history were identified.

conclusionsFindings underscore the need for (a) patient-centered and trauma-informed care, with implementation of trainings or interventions to increase and knowledge to provide trauma-informed care, and (b) consistent, acceptable screening for experiences of violence across care settings, to inform provider interactions and responses.