Sexual and Physical Assaults are Common Life Stressors for Women in Iceland, Linked to PTSD

Edda Bjork Thordardottir, PhD

Credit: ResearchGate

A recent study reported that sexual and physical assaults were the most common life stressors in women from Iceland and were linked to the greatest prevalence of probable PTSD.¹

Most women are exposed to trauma, and 3% to 16% experience PTSD at some point during their life. The PTSD risk varies by the trauma type, with violence often being associated with the greatest risk. Previous studies have evaluated the prevalence of PTSD across many life stressors while adjusting for the number of life stressors reported.² However, there is not yet comprehensive data on the prevalence of life stressors and their role in PTSD among women.

Investigators conducted a cross-sectional analysis from January 21, 2022, to September 13, 2024, using data from the population-based Stress-and-Gene Analysis.¹ The study examined 28,199 women in Iceland aged 18 – 69 years (mean age: 43.8 years) who completed an online survey from March 1, 2018, to July 1, 2019. The primary outcome measured was the likelihood of PTSD within the past month, evaluated in relation to the most severe life stressors experienced, using the PTSD Checklist for DSM-5.

“In this cross-sectional study of 28199 women residing in a Nordic welfare state with the highest gender-equality index worldwide, we found that 40% of women have been exposed to sexual or physical assaults and that these assaults were associated with the highest conditional risk of probable PTSD of all trauma types,” wrote investigators, led by Edda Bjork Thordardottir, PhD, from the University of Iceland.

The overall prevalence of probable PTSD was 15.9%, with the prevalence greater in younger than older women (22.6% vs 11.7%; P < .001), women with primary school education than women with B-level tertiary education (26.8% vs 9.2%; P < .001), and women receiving disability benefits (34.7%), were unemployed or on sick leave (30.9%) than women who were employed or studying (12.7%) (P < .001). Women also had a greater prevalence of probable PTSD if they had a low income, were single, had no children or > 5 children, and reported ≥ 5 life stressors.

Probable PTSD varies substantially across different life stressors. Among the sample, the prevalence of life stressors varied a lot, with the most frequent ones being unwanted sexual experiences (66.4%), life-threatening illness or injury (58.1%), and fire, explosion, or accident (51.1%). The least common life stressor was exposure to war or armed conflict (3.3%).

When assessing direct exposure separately from indirect exposure, the most frequent life stressors were divorce or break-up (62.3%), bullying (53.9%), and unwanted sexual experiences (56.9%). Additionally, 39.8% of women reported being directly exposed to either a sexual or physical assault or both.

Sexual assault had the greatest prevalence of probable PTSD (36.9%), and natural disasters had the lowest (3.3%). Using natural disasters as a reference category, sexual assault (adjusted prevalence ratio [APR], 6.66; 95% confidence interval [CI], 4.01 – 11.04), other unwanted sexual experience (APR, 4.33; 95% CI,2.53 - 7.42), and physical assault (APR, 4.44; 95% CI, 2.63 - 7.49) were linked to the greatest prevalence increase of probable PTSD.

“These findings call for widespread societal efforts to prevent violence against women and systematic efforts to reduce gender-based disparities in mental health,” investigators concluded. “This can be achieved through systematic screening of violence exposure and PTSD symptoms in health and social services and by increasing access to evidence-based treatments for PTSD.”

References

1. ^{Thordardottir, E, Song, H, Shen, Q, et al. Prevalence of Life Stressors and Posttraumatic Stress Disorder Among Women in Iceland. JAMA Network Open.2024;7(12):e2449430.doi:10.1001/jamanetworkopen.2024.49430.}
2. ^{Kessler RC,Aguilar-Gaxiola S, Alonso J, et al. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol. 2017;8(sup5):1353383. doi:10.1080/20008198.2017.1353383}