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Abstract
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Sexual violence (encompassing sexual assault [SA], child sexual abuse [CSA], and rape) remains a major public health concern. An estimated 1 in 3 women globally experience physical or sexual intimate partner violence or nonpartner sexual violence during their lifetime.1 In the US, the Centers for Disease Control and Prevention estimates that 1 in 4 women and 1 in 26 men have experienced a completed or attempted rape in their lifetime.2 Two articles in JAMA Network Open report on the incidence of CSA and adult SA cases reported to emergency departments (EDs) in Hong Kong and the US, respectively.3,4
Wong et al3 report on incident rates of CSA among youth presenting to EDs in Hong Kong before and during the COVID-19 pandemic. By using medical record data from EDs across Hong Kong, they found that the number of ED visits to report CSA decreased more than 50% during the pandemic. However, the study's core finding was that the proportion of CSA cases among adolescent girls increased during 2020 to 2021 compared with previous years, using either the overall population or ED visits as the denominator. They also note a significant increase in reporting of CSA and ED visits as schools reopened after approximately 10 months of closure. The authors suggest that the observed increase in CSA cases may be associated with parental economic insecurity, additional stressors related to the pandemic, and shifts in social networks that occurred during the shutdown. The increased incidence rate observed for adolescent girls was not seen among boys. The authors' analyses accounted for survivors' sex and did not report on transgender or nonbinary children. As is true for sexual violence prevalence estimates that rely on official reporting, the observed prevalence is likely to be a significant underestimate of actual cases of sexual violence, given the vast number of incidents that are not reported.1
Vogt et al4 studied trends in US ED use after adult SA from 2006 to 2019, before the COVID-19 pandemic, finding a 15-fold increase in ED use during that period. The authors speculated that overall increases in survivor help seeking at EDs may be related to 2 factors: increased recognition and reporting of SA among ED staff and International Classification of Diseases, Tenth Revision coding changes that allow for more specific documentation of SA. They then compared these trends with Federal Bureau of Investigation-reported rapes/SA from 2015 to 2019 and found 7% and 22% increases during that period based on changes in definitions of SA used by law enforcement agencies (LEAs). However, despite an increase in ED use, the authors highlight that even in 2019, far fewer survivors sought ED care compared with those reporting to LEAs. The authors posit that shifts in social norms that occurred after high-profile events, such as the #MeToo movement, and national discourse condemning SA subsequently raised its prominence and encouraged more reporting of exposures to EDs and LEAs about such violence. The growth of the field of forensic nursing has contributed to better documentation, evidence collection, treatment protocols, and connection to support, including survivor service advocates. Thus, EDs have become critically important settings for SA response and tracking trends in SA care seeking. From these ED data, the authors also observed disparities associated with income, race, and hospital admission after an ED visit among SA survivors. For example, Asian or Pacific Islander, Native American, and White patients were more likely to be admitted after presenting with an SA diagnosis. In addition, although fewer individuals were admitted to the hospital over time, older and Medicaid-insured patients were more likely to be admitted, noting contextual factors that contribute to making particular populations vulnerable to more severe forms of violence that require hospital-based care...
Language: en |