Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms

Abstract

Background

Sexual abuse is associated with severe health consequences, and the European Union has, through the Istanbul Convention, urged its member countries to provide specialist care for victims of sexual abuse.

Aim

This aim of this study was to investigate patient- and abuse-related characteristics among patients seeking help at a specialist clinic in Sweden, with focus on disclosure, mental health and appropriate healthcare access.

Methods

This is a descriptive study where journal data from 100 consecutive patients January 2017 to February 2018 were analyzed. All adult individuals (women n = 80, men n = 8) who had taken part in the standardized semi-structured intake interview at the clinic were included (n = 88).

Results

At admission, mean age was 40.3 (SD 11.9), mean number of psychiatric diagnoses 6.3 (2.6), and 93% of the patients scored above cut-off (≥34) on IES-R for PTSD. A majority of the patients (87%) had been exposed to childhood sexual abuse (CSA), and mean time to first disclosure was 15.9 (SD 15.3) years. In total, 82% of the patients had, despite disclosure, experienced difficulties accessing appropriate healthcare before coming to the specialist clinic.

Conclusion

Adult victims of sexual abuse have difficulties accessing appropriate healthcare. This constitutes a gender-based equality problem. A model of gatekeeping mechanisms with two dimensions (external and internal) and three categories (Competence related, Organizational and Emotional) is proposed to understand these difficulties.

Keywords:

• Sexual abuse
• gatekeeping
• healthcare access
• disclosure
• PTSD

Author contributions

GR researched data, drafted the manuscript and researched the literature ACC, CGS and GR designed the study; PW, LW; BP and CW contributed to the planning and editing of the manuscript.

Disclosure statement

Gita Rajan is the founder and president of the non-profit organization World of No Sexual Abuse, WONSA.

Additional information

Notes on contributors

Gita Rajan

Gita Rajan, PhD candidate, is a physician, specialized in family medicine. Dr Rajan is also the founder of the NGO World of No Sexual Abuse (WONSA). The vision of WONSA is a world of no sexual abuse and the mission is to increase the access to efficient health care for victims of sexual abuse.

Lars Wahlström

Lars Wahlström, PhD, is an expert in consultation liaison psychiatry at Stockholm Health Care Services and clinician at the CL Unit, Psykiatri SV at Karolinska University Hospital Huddinge and doctor of psychiatry. Formerly at Crisis and Disaster Psychology Unit at the Centre for Family Medicine.

Björn Philips

Björn Philips, associate professor of psychology at the Stockholm University, is a clinical psychologist who's main area of research and teaching is psychodynamic therapy, especially contemporary variants such as mentalization-based therapy, affect-focused therapy, and relational psychotherapy, and he is experienced on treatment studies.

Per Wändell

Per Wändell, appointed professor of general medicine at Karolinska Institutet in 2010 and director of studies for the Research School in General Practice at KI. Wändell's research aims to identify the best way for the healthcare system to reach patients in order to implement preventive measures.

Caroline Wachtler

Caroline Wachtler, PhD, is a physician, doctor in medicine, specialized in family medicine. Dr Wachtler’s clinical work as a resident in primary care (Stuvsta Primary care Center AB since 2009) informs her interest in mental health as she is daily made aware of the gap between research and practice. Caroline boasts a rare combination of skills in both qualitative and quantitative methodologies.

Carl-Göran Svedin

Carl Göran Svedin, professor of child and adolescent psychiatry since 2002. Prof. Svedin's research has covered areas such as child physical and sexual abuse, sexual exploitation, children exploited in child pornography, prostitution. He has been responsible for three previous Swedish epidemiological studies on young people's sexuality and sexual abuse (2004, -09, -14) and now carrying out the fourth.

Axel C. Carlsson

Axel C. Carlsson, associate professor at Karolinska Institutet with a demonstrated history of working in the higher education. Skilled in biomarkers, epidemiology, molecular biology. Dr Carlsson is principal for the research school in family medicine and primary care. He is also working as investigator at the Swedish Public Health Agency.