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. Author manuscript; available in PMC: 2026 Jul 9.
Published in final edited form as: J Child Sex Abus. 2025 Jul 9;34(4):365–385. doi: 10.1080/10538712.2025.2530403

Psychosocial Correlates of PTSD and Problem Drinking in Sexual Assault Survivors and their Informal Supports

Sarah E Ullman 1, Erin O’Callaghan 2, Caroline Bailey 3, Casey Harris 1
PMCID: PMC12309681  NIHMSID: NIHMS2099282  PMID: 40635318

Abstract

The current study examined predictors of PTSD and problem drinking using survey data (N = 432 matched pairs) from sexual assault survivors and informal support providers (SPs, e.g., family, friend, partner) to whom they disclosed. Perceptions of helpfulness, relationship satisfaction, social reactions to disclosure of sexual assault, coping strategies, and child sexual abuse (CSA) severity were examined in separate survivor and SP regression models. In the survivor model, White-identified and less educated survivors had more PTSD symptoms than those of other races and with more education, respectively. Greater avoidance coping, perceived SP empathy, and unsupportive acknowledgment (UA) reactions were all related to more PTSD symptoms for survivors. In the SP model, those identifying as White reported more PTSD symptoms than those of other races. SPs reporting greater use of approach and avoidance coping, and more ineffective and empathetic support, reported more PTSD symptoms. Those SPs identifying as men and those with higher educational attainment had fewer PTSD symptoms. SPs reporting more positive social reactions to survivors’ disclosure also had fewer PTSD symptoms. For survivors, greater avoidance coping, more PTSD symptoms, and receiving more positive reactions from the SP were each related to increased survivor problem drinking. For SPs, greater relationship satisfaction with the survivor and greater UA social reactions made to survivors were each related to less SP problem drinking. In addition, SPs reporting greater CSA severity, more PTSD symptoms, more avoidance coping, and more perceived empathy and positive social reactions to survivors were each related to increased SP problem drinking.

Keywords: Sexual assault, survivor, informal support, PTSD, problem drinking

Sexual assault is associated with a high risk of posttraumatic stress disorder (PTSD) and problem drinking (i.e., excessive drinking indicative of possible alcohol use disorder) in women (see Lorenz & Ullman, 2016 for a review). Significant research shows that various pre-assault, assault, and post-assault factors affect survivors’ recovery (Stockman et al., 2023). Specifically, a history of sexual trauma such as child sexual abuse (CSA), especially severe forms of CSA such as penetration abuse, and post-assault coping strategies are related to greater depression and PTSD in survivors (Ullman, Relyea, & Peter-Hagene, 2014). While much research has focused on survivors’ self-report data in survey and interview research, less research has incorporated self-report data from those to whom most survivors disclose. This article uses the term “informal support provider (SP)” to refer to individuals with whom survivors have a relationship, such as friends, family, and intimate partners, who are often disclosed to post-assault. Such work is important as approximately two-thirds of survivors disclose to informal SPs, whereas fewer than one-third of those disclose to formal support sources (e.g., police, medical, and mental health professionals; Ullman, 2023). General social support and social reactions to the assault (e.g., victim blame) both significantly impact survivors’ PTSD symptoms (Dworkin et al., 2019; Zalta et al., 2020) and other common post-assault sequelae, such as problem drinking (Ullman et al., 2008). Specifically, survivors who receive greater negative reactions from those to whom they disclosed the assault have more PTSD symptoms and report more problem drinking (see Ullman, 2023a for a review). Given the importance of social support, social reactions, and changes in survivors’ support networks and relationships post-assault (Jaffe et al., 2022), more research is needed on how these interpersonal factors predict such outcomes for survivors and their informal SPs, who they tell about their assault. This information may inform treatment and interventions for survivors and their SPs.

According to stress and coping theory, coping strategies and social support mobilized following sexual trauma may interact with each other and influence mental health outcomes (Lazarus & Folkman, 1984). Coping is particularly important as engaging in approach forms of coping (e.g., actively moving towards a stressor to seek information, support, plan ahead, positively reappraising by seeing beneficial aspects of adversity, and problem-focused coping (e.g., taking actions to reduce negative affect such as exercise), can facilitate better adjustment to trauma and contribute to lower symptomatology (Littleton et al., 2007). Conversely, avoidance forms of coping such as emotional disengagement (e.g., denial), behavioral disengagement (e.g., behavioral avoidance of trauma-related reminders), and substance use coping (e.g., using substances to cope with distress) can lead to worse psychological symptoms in sexual trauma survivors (Littleton et al., 2007). Survivors’ ability to engage in “positive” forms of coping can be affected by the social support (or lack thereof) they receive post-assault; thus, we need to understand coping and recovery outcomes from both survivor and informal SP perspectives.

Survivor and Informal SP Studies

Some research to date has examined the impact of sexual assault disclosure on survivors and their informal SPs. For instance, an early dyadic study collected structured interview data from 128 survivors of a recent violent crime (68% rape/sexual assaults, 34% non-sexual assaults) and their significant others (e.g., family, romantic partner) and found that both survivors and their significant others reported similar levels of supportive (e.g., emotional support, tangible aid) and unsupportive (e.g., emotional withdrawal, victim blame) behavior from informal SPs after the survivor disclosed the assault. However, both survivors and their significant others reported that survivors of sexual assaults received higher levels of unsupportive behavior post-assault from significant others than did survivors of non-sexual assaults (Davis & Brickman, 1996). In addition, a small amount of mostly qualitative research on sexual assault survivors and their informal SPs has examined how survivors’ disclosure of sexual assault impacts their informal SP’s (Ahrens & Campbell, 2000; Banyard et al., 2010; O’Callaghan et al., 2021). Such research illustrates that informal SPs’ perceptions of their ability and knowledge of how to respond to and support survivors of sexual assault (e.g., ineffectiveness, confusion, and empathy) influence how they respond to survivors’ disclosure (Mauer et al., 2022). For example, a study of 783 college students who recently received a disclosure of sexual assault or domestic violence found that informal SPs (mostly friends) who reacted negatively to the disclosure were more confused (i.e., not knowing what to do), felt ineffective (i.e., unable to help), and were less empathetic towards the survivor post-assault (Mauer et al., 2022).

Finally, research on sexual assault survivor-informal SP dyads suggests that factors beyond social reactions to the disclosure may also be impacting survivors’ and informal SPs’ well-being. More specifically, factors such as survivors’ history of CSA and perceived relationship quality and satisfaction with the informal SP they disclosed to may impact survivors’ PTSD symptomatology (Ahrens & Aldana, 2012; Vitek & Yeater, 2021). For example, one study found that having a history of CSA increased adult survivors’ risk of developing PTSD after disclosing the assault to an informal SP (Briere et al., 2020). Another study indicated that the nature of survivors’ relationships and the social support generally available to them before and after the sexual assault (Jaffe et al., 2022) affected their likelihood of developing PTSD symptoms (Zalta et al., 2021). Finally, a recent meta-analysis found that negative social reactions (e.g., disbelief, blame, control) by informal SPs made in response to survivors’ disclosures of a sexual assault are also associated with increased PTSD symptoms for survivors (Dworkin et al., 2019).

To better understand how informal SPs’ support and reactions to survivors impact their recovery, quantitative data from both survivors and informal SPs are needed to bridge what are largely two separate literatures: 1) the large body of research on recovery from sexual assault in survivor samples; and 2) a smaller, but growing literature on survivors’ informal SPs. Specifically, this smaller research base has examined informal SPs’ perceptions of their responses to sexual assault disclosures and other factors (e.g., individual, relational, situational) that contribute to how informal SPs view the survivor and their ability to help them effectively (Mauer et al., 2022). However, research is lacking on how and whether survivors’ perceptions of informal SPs’ helpfulness influenced their recovery from the assault and the mental health of SPs from survivor and informal SP perspectives. Such research on disclosure dyads is needed because these perceptions impact survivors’ and their informal SPs’ well-being and their relationship (O’Callaghan et al., 2021). Indeed, for some, the relationship may improve after the survivor discloses a sexual assault due to receiving positive social reactions from the informal SP, most commonly friends. In contrast, family relationships can worsen due to SPs’ negative reactions to the survivor’s disclosure (O’Callaghan et al., 2021). Past research shows that CSA history, survivor coping, and social reactions to assault disclosure relate to their symptoms of PTSD and problem drinking (Ullman & Najdowski, 2009; Ullman et al., 2013). Other relational factors and perceptions of SP helping efforts are examined that have not yet been investigated in relation to survivor and SP PTSD and problem drinking. This quantitative study a) builds on stress and coping research on survivors’ recovery, b) examines factors related to informal SPs’ symptoms, including their helping responses to survivors, and c) is informed by qualitative dyadic studies of survivors and informal SPs.

Current Study

The current study examined a large, community sample of survivor–informal SP dyads to assess predictors of both survivor and informal SP PTSD and problem drinking symptoms.

Survivors

Based on previous research, we expected that younger survivors, those who have less education, and those who belong to a marginalized racial or ethnic group would report increased PTSD symptoms and problem drinking following a sexual assault disclosure (Mulia & Bensley, 2020; Ullman & Filipas, 2001). More severe CSA, avoidance coping, negative social reactions to the assault disclosure, lower relationship satisfaction with the SP, and negative perceptions of SP helping were expected to be associated with more PTSD and problem drinking symptoms for survivors as well.

Informal SPs

We had similar expectations that informal SPs who are younger, have less education, and belong to a marginalized racial or ethnic group would report increased PTSD symptoms and problem drinking following a disclosure of sexual assault from the survivor. CSA severity was also expected to be related to increased PTSD symptomatology and problem drinking for SPs. Given the lack of prior research on informal SPs, other factors (e.g., avoidance coping, negative social reactions, lower relationship satisfaction, and negative perceptions of their own helping of survivors) were explored in relation to their PTSD symptoms and problem drinking. While such perceptions may impact informal SPs less than survivors, given the salience of sexual assault disclosure and past qualitative research showing its effects on survivors and their relationships (Ahrens & Aldana, 2012; Kirkner et al., 2018; O’Callaghan et al., 2021; Vitek & Yeater, 2020), it is important to look at how these factors impact both survivors and their informal SPs.

Method

Participants

A sample of 432 sexual assault survivors and their informal SPs to whom they disclosed the assault was recruited using several methods. Advertisements, fliers, and targeted emails were used in both off- and online venues, including agencies serving survivors, college campuses and their surrounding neighborhoods and businesses, listservs, women-oriented businesses, local bookstores, and libraries, although most of the earlier recruitment was primarily done online via social media advertisements due to the COVID-19 pandemic. Women aged 18 or older, residing in the Chicago metropolitan area, who had an unwanted sexual experience that they had disclosed previously to someone in their life, also aged 18 or older, who they were willing to refer to participate in the study, were recruited. Survivors were 26.51 years old (SD = 4.40), and informal SPs were 28.22 years old (SD = 5.27) on average. Survivors all self-identified as women at eligibility screening as per study criteria, and informal SPs were 85% women, 13% men, and 2% nonbinary or transgender women. Over half (58.9%) of survivors reported having some college or less and 41.1% had a college degree or more; 48.3% of SPs had some college or less education, and 51.7% had a college degree or more. Survivor self-identified race was: White (48.5%), followed by Black (43.1%), multiracial (3.5%), Pacific Islander (3.5%), Asian (3.2%), Native American (1.2%), and Arab American (.2%). For a separate question asking if they were Hispanic/Latinx ethnicity, 14.4% identified as Hispanic/Latina. Informal SP race was: White (49.9%), Black (39.5%), multiracial (4.6%), Pacific Islander (5.8%), Asian (4.2%), Native American (1.2%); 17% of SPs identified as Hispanic/Latinx. Survivor – SP relationship was 77.1% friend/acquaintance, 13% romantic partner/spouse, 9.3% family/relative, and .4% other/missing.

Survivors’ sexual assault characteristics were assessed with a series of questions. For most of the assaults (91.4%), perpetrators used coercion and force tactics, including insistence (25.5%), threats (45.1%), twisting arm/holding down (45.1%), hitting, slapping (33.6%), choking, beating (34%), and weapon (12.3%), with only 6.3% indicating no force. Additionally, most survivors used one or more forms of resistance during the assault: physical resistance (39.3%), flee (9.8%), verbal resistance (38.9%), and freeze or no resistance (12.1%). Injuries included broken bones/gunshot wounds (14%), cuts, bruises, scratches, soreness (67.5%), or no injuries (8.5%). In terms of adult sexual assault, survivors experienced unwanted: fondling/kissing (17.8%), oral sex (14.8)%, and vaginal or anal sex (67.3%). Most survivors knew the perpetrator prior to the assault (60.4%), of whom 77% were acquaintances. Most survivors had used alcohol and/or drugs prior to the assault (63.5%).

Procedures

Survivors meeting the eligibility criteria who also provided contact information for a friend, family member, or romantic partner they told about the assault were contacted simultaneously to complete separate online surveys. After consenting to participate in the study via an online consent form, the survivor and the informal SP were each emailed links to their respective surveys. Informed consent forms and surveys were done via Qualtrics with sexual assault survivors and their informal SP whom they told about the assault. Participants were compensated $30 each via Venmo or Amazon gift cards after completing their respective surveys. Participants were given community resource information, including counseling services, rape crisis, and other local community agencies. This study followed ethical standards for human subjects research and was approved by the University of Illinois Chicago IRB.

Measures

Demographics assessed included age (years) at the time of the study, education level (four ordinal categories ranging from less than 12th grade to college degree or beyond), and time since the assault occurred (years; see Table 1 for additional descriptives). Race was dummy-coded as other marginalized races (e.g., Black/African American, Asian, Pacific Islander/Native Hawaiian, American Indian/Alaskan Native) (0) and White (1) categories for analyses, as these were the largest subgroups in the sample. Ethnicity was coded separately for non-Hispanic (0) or Hispanic (1) ethnicity. All survivors self-identified as women during eligibility screening. Gender was assessed using pre-determined categories (i.e., female, male, nonbinary, transgender woman, transgender man, other) in which both the survivor and informal SP could select all categories that applied to them on their respective surveys. Survivors and informal SPs who selected ‘Other’ as their gender category were too small a group to include as a separate variable, so those eight cases were specified as missing for the main regression analyses. Informal SP gender was coded as male (0) or female (1) for the regressions, including all participants indicating one of those options, regardless of other categories indicated. Survivor and informal SP surveys included questions about demographic background, history of sexual trauma exposure, including sexual victimization, assault characteristics (for survivors only), assault disclosure and social reactions, coping, perceptions of informal SP helping, relationship quality, PTSD symptoms, and problem drinking. Measures used in the analyses are described below for survivor and informal SPs.

Table 1.

Sample Descriptive Characteristics

Survivors Informal Supports
Measure Mean SD Skew Kurtosis Mean SD Skew Kurtosis
Age 26.51 4.40 1.69 6.82 28.22 5.27 2.25 10.99
CSA severity 1.97 1.72 −.01 −1.72 1.31 1.67 .68 −1.29
Approach cope 7.56 2.70 −.46 .25 6.19 3.40 −.39 −.54
Avoidance cope 12.15 4.69 −.33 .51 10.03 5.57 −.36 −.55
Relation sat 3.65 .75 .12 −.79 3.86 .87 −.72 .40
TA reactions 2.51 .93 −.19 −.82 2.54 .97 −.06 −.65
UA reactions 3.06 .82 −.45 .21 3.12 .76 −.36 .54
POS reactions 3.62 .82 .03 −.64 3.75 .77 .04 −.72
SP Confusion 3.02 .97 −.57 −.55 3.03 .93 −.64 −.07
SP Ineffective 2.95 .92 −.41 −.52 2.81 .90 −.45 −.52
SP Empathy 3.61 .81 −.54 .84 3.67 .81 .68 1.71
PTSD severity 3.49 .85 −1.89 3.42 2.85 1.46 −1.00 −.53
Problem drinking 2.09 3.31 1.12 −.67 1.18 2.59 2.51 5.95
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Survivors’ and informal SPs’ history of sexual assault both in childhood (i.e., before 18) and adulthood (i.e., 18 or older) was assessed with Testa et al.’s (2004) revised Sexual Experiences Survey-Revised (SES-R). The SES-R assesses various forms of sexual assault (e.g., unwanted sexual contact, verbally coerced intercourse, attempted rape, rape due to force or incapacitation) for survivors and their informal SPs, respectively. Highest severity of sexual assault was coded as a continuous variable following Koss et al.’s (1987) guidelines, which ranged from 1 (least severe) to 6 (most severe). CSA severity was assessed to compute a parallel severity score for the same sexual experiences under age 18 for survivors and informal SPs, respectively.

Coping strategies were assessed with the Brief COPE scale (Carver, 1997). Both approach and avoidance coping were computed for this study. Avoidance coping was a composite of eight items capturing four types of strategies: denial, behavioral disengagement, substance use, and self-blame. Approach coping was computed from 4 items capturing emotional support and tangible aid forms of coping. Participants rated how often they used each strategy over the past 12 months on a scale from 1 = I didn’t do this at all to 4 = I did this a lot. Scores were summed, with higher scores indicating more avoidance and approach coping for survivors (α’s = .79, .86) and SPs (α’s = .78, .80) in our sample.

The Social Reactions Questionnaire – Shortened (SRQ-S, Ullman et al., 2017) measure was used to assess negative and positive social reactions to sexual assault disclosure. The SRQ-S administered to survivors assessed the social reactions they received from their informal SP, who participated in the study with them following the survivor’s sexual assault disclosure. For informal SPs, items were reworded to ask what reactions they gave when survivors disclosed their assault. The measure is a short, validated measure of the full SRQ (Ullman, 2000; Relyea & Ullman, 2015a) with 16 items derived from confirmatory factor analyses of the measure using college student and community sexual assault survivor datasets (see Ullman et al., 2017). Three widely used SRQ subscales were computed for two negative social reactions: turning against (TA), comprised of blame, stigma, and infantilizing items, and unsupportive acknowledgment (UA), comprised of control, distract, and egocentric items, and one positive social reaction scale (POS), comprised of emotional support and tangible aid reactions. Subscale scores were scale item means with good reliability for TA and moderate reliability for UA and positive reactions for survivors and SPs respectively (α’s = .89, .90 TA; α’s = .81, .78 UA; α’s = .77, .76 Positive).

Perceptions of SP helpfulness in their responses to survivors’ disclosure of sexual assault were assessed using the Impact on Friends Scale (Ahrens & Campbell, 2000), developed to assess various factors impacting informal SPs’ responses to sexual assault survivors. The original version was initially developed to assess survivors’ perceptions of SPs’ helping and was used in survivor samples. The wording on the original scale was revised to create a parallel version that specifically asks informal SPs about their perceptions of their response to and support of survivors after a sexual assault disclosure. In this study, we examined the effect of subscales assessing informal SPs’ confusion about how to help (5 items; e.g., Survivor: “SP didn’t know how to act towards me” SP: “I didn’t know how to act towards them”), perceived ineffectiveness regarding their response (6 items; e.g., Survivor: “SP felt their efforts could cause me more harm” SP: “I felt that my efforts were causing them more harm”), and empathy toward the survivor (3 items; e.g., Survivor: “SP was able to empathize with my emotions” SP: “I was able to empathize with their emotions”). Response items ranged from 1 = strongly disagree to 5 = strongly agree, with final scale scores computed as the mean of the items with good reliabilities for survivors and SPs respectively, except for empathy, which were low (α’s = .89, .89 confusion; α’s = .87, .87 ineffectiveness; α’s = .57, .57 empathy).

Survivor and informal SPs’ perceived relationship quality and satisfaction was assessed with Hendrick et al.’s (1988) brief 5-item Likert-style Relationship Satisfaction measure (Hendrick et al., 1998). The mean of items assessed several aspects of relationship quality, including extent of satisfaction with the relationship, how well it meets their expectations, how good the relationship is compared to others, how well the other person in the relationship meets their needs, and how much they love/care about the other person in the relationship (e.g., “how well do they meet your needs”). The same measure was used on survivor and informal SP surveys and was valid and reliable in our sample (α’s = .85, .90).

The Posttraumatic Diagnostic Scale (PDS-5; Foa et al., 2016) was used to assess PTSD symptoms of survivors and their informal SPs in response to exposure to a traumatic event (sexual assault for survivors and any traumatic event for SPs). The measure was scored as the sum of 20 items for a total PTSD symptom score (Foa et al., 2016). Both survivors and informal SPs rated the frequency of their symptoms (i.e., reexperiencing/intrusion, avoidance/numbing, hyperarousal) over the past 12 months in relation to their most upsetting sexual assault on a scale ranging from 0 = never or only one time to 3 = almost always. The PDS has acceptable test-retest reliability for a PTSD diagnosis in assault survivors and demonstrated good internal consistency in our sample for survivors and SPs (α’s = .95, .97).

Past-year problem drinking symptoms were assessed among survivors and informal SPs with the short version of the Michigan Alcoholism Screening Test (SMAST; Selzer et al., 1975) comprised of 16 (no = 0, yes = 1) items (e.g., “Are you able to stop drinking when you want to?”). Because the MAST was initially developed on male problem drinkers that assessed symptoms/behaviors (e.g., violence, arrest) that were less common in women, several additional gender-specific items (e.g., Has your drinking led to an accident in your home?’) were added to the scale used in the surveys. Richman modified these gender-specific items based on Richard and Sharon Wilsnack’s questions (J. Richman, personal communication, December 10, 2000). Items were summed to compute a total symptom score indicating the degree of problem drinking in the past year for survivors and SPs (α’s = .89, .89).

Data Analysis

Predictors were selected based on past research on sexual assault-related PTSD and problem drinking and correlates of helping (e.g., Mauer et al., 2022; Ullman et al., 2014). First, correlations were conducted to examine whether demographic, CSA severity (ranging from none to penetration abuse), coping strategies, social reactions, and perceptions of SPs’ responses post-assault were related to PTSD and problem drinking symptoms in survivors and their SPs (available upon request). Linear regression analyses were run in SPSS 29, including significant variables from the preliminary correlational analyses for survivors and informal SPs to assess how these factors relate to PTSD and problem drinking symptoms. Pairwise deletion was used to minimize missing cases (1–2% for variables). Second, parallel regression models including the same variables were run for survivors and their SPs, including only demographic control variables that were significantly correlated with PTSD and problem drinking symptoms (e.g., the dependent variables) in preliminary analyses. All other predictors were in all regressions, except for PTSD symptoms, which were also included in the problem drinking model because they are typically associated with and precede problem drinking in sexual assault survivors (Bailey & Stewart, 2014).

Results

Regression models were run for survivors and their SPs for PTSD and problem drinking.

PTSD Symptoms

The regression model for survivors was statistically significant, F(13, 411) = 17.13, p < .001, with predictors explaining 34.0% of the variance in reported PTSD symptoms for survivors (see Table 2). Survivors with higher educational levels (e.g., college or more) reported fewer PTSD symptoms than those with less education; whereas survivors identifying as White reported more PTSD symptoms than those identifying as other racial identities. Greater use of avoidance coping, higher levels of perceived informal SP empathy, and receiving more unsupportive acknowledgment (UA) reactions were all related to more PTSD symptoms. Perceived informal SP ineffectiveness and confusion when it came to informal SP helping were unrelated to survivor’s PTSD symptoms. Greater use of approach coping was associated with more PTSD symptoms. CSA severity, relationship satisfaction, and both turned against (TA) and positive social reactions to disclosure, were unrelated to survivors’ PTSD symptoms.

Table 2.

Regressions Predicting PTSD and Problem Drinking (Survivors)

PTSD (n=411) Problem Drinking (n=426)
b SE 95% CI b SE 95% CI
Age −.04 .01 −.14 .05 --- ---
Education −.18* .05 −.27 −.10 --- ---
Race .09* .07 .07 .18 --- ---
CSA severity .06 .02 −.04 .17 −.05 .03 −.16 −.06
PTSD severity --- --- .10+ .06 −.02 .21
Approach cope .10* .02 .00 .19 −.09 .02 −.19 .03
Avoidance cope .34* .01 .23 .45 .19* .01 .05 .33
Relation sat −.06 .06 −.16 .05 −.03 .07 −.15 .09
TA reactions −.02 .07 −.16 −.12 .04 .08 −.13 .21
UA reactions .19* .06 −.08 .31 −.10 .07 −.23 .03
POS reactions −.05 .06 −.16 .07 .14* .07 .00 .28
Confusion .01 .07 −.14 .15 −.00 .08 −.18 .17
Ineffective .06 .08 −.11 .23 .06 .10 −.14 .26
Empathy .10* .05 .01 .19 −.03 .07 −.14 .09
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Note.

*

p < .05,

+

p < .10.

The regression model for informal SPs was also statistically significant, F(13, 415) = 68.73, p < .001, with predictors explaining 68.0% of the variance in PTSD symptoms (see Table 3). For the informal SP regression model, SPs with higher educational levels had fewer PTSD symptoms than those with less education. Informal SPs identifying as men had fewer PTSD symptoms than those identifying as women, whereas informal SPs’ PTSD symptoms did not differ by their racial or ethnic identity. Age was not included in the informal SP model as it was not significant in the correlational analyses. Greater severity of informal SP CSA and greater use of both approach and avoidance coping strategies were all related to significantly more PTSD symptoms for informal SPs. Greater relationship satisfaction with the survivor was unrelated to informal SP’s PTSD symptoms. Informal SP confusion in response to the survivor’s sexual assault disclosure was marginally significantly related to fewer PTSD symptoms for informal SPs (p < .10); whereas perceived ineffectiveness was unrelated to PTSD symptoms. Greater perceived empathy toward the survivor was related to more PTSD symptoms for informal SPs. In contrast, greater TA and UA negative social reactions from informal SPs to survivors’ assault disclosure were related to more PTSD symptoms for informal SPs. Greater perceived positive social reactions were related to fewer PTSD symptoms for informal SPs.

Table 3.

Regression Predicting PTSD and Problem Drinking (Informal Supports)

PTSD (n=415) Problem Drinking (n=421)
B SE 95% CI b SE 95% CI
Education −.12* .07 −.17 −.06 --- ---
Race .05 .09 .00 .11 --- ---
SP gender −.14* .09 −.20 −.09 --- ---
CSA severity .13* .03 .06 .19 .11* .09 .00 .21
PTSD severity --- --- .01 .14 −.15 .16
Approach cope .25* .02 .19 .32 −.10+ .05 −.21 .04
Avoidance cope .38* .01 .30 .45 .16* .04 .00 .30
Relation sat .04 .05 .02 .11 −.16* .15 −.26 −.06
TA reactions .10* .07 .01 .19 .14+ .20 −.01 .28
UA reactions .08* .07 .01 .15 −.12* .21 −.24 .00
POS reactions −.130* .07 −.21 −.06 .10 .21 −.02 .22
Confusion −.08+ .07 −.17 .01 .04 .20 −.10 .19
Ineffective .09 .08 −.01 .19 .02 .24 −.15 .19
Empathy .13* .06 .06 .19 .14* .18 .03 .26
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Note.

*

p < .05,

+

p < .10

Problem Drinking Symptoms

The problem drinking regression model for survivors was statistically significant, F(11, 426) = 2.29, p = .010, and explained 3.2% of the variance. Avoidance coping and positive reactions from the informal SP were each related to greater survivor problem drinking. More PTSD symptoms were marginally associated with greater problem drinking for survivors (p < .10). Approach coping, relationship satisfaction, and TA and UA social reactions were all unrelated to problem drinking for survivors. Demographics were not included in the survivor model as they were not significantly correlated with problem drinking in initial correlational analyses.

The problem drinking regression model for informal SPs was also statistically significant, F(11, 421) = 5.19, p < .001, and explained 10% of the variance. Greater CSA severity was significantly related to increased problem drinking, whereas PTSD symptoms were unrelated to informal SPs’ problem drinking. Greater use of approach coping strategies by informal SPs (e.g., emotional support seeking, tangible aid seeking) was marginally significantly related to less problem drinking (p < .10). However, more use of avoidance coping strategies (e.g., denial, behavioral disengagement, substance use, self-blame) was significantly related to increased problem drinking for informal SPs. Greater relationship satisfaction by informal SPs was related to less problem drinking. Perceived UA social reactions made to the survivors’ assault disclosure were related to less problem drinking for informal SPs. In contrast, perceived TA reactions were marginally significantly related to increased problem drinking for informal SPs (p < .10). Perceived positive social reactions from the informal SPs to survivors were unrelated to problem drinking for informal SPs. Greater perceived empathy for the survivor was related to more problem drinking, whereas confusion and perceived ineffectiveness were unrelated to informal SPs’ problem drinking.

Discussion

This study builds on past research on survivor experiences of sexual assault disclosure and their post-assault recovery (see Ullman, 2023b for a review) by examining how disclosure impacts informal SPs using past research on perceptions of responding to and helping survivors (Ahrens & Campbell, 2000; Banyard et al., 2010; Mauer et al., 2022). While studies have been done on survivors’ disclosure of the assault and informal SPs’ responses to such disclosures (see Ullman, 2023b), very few dyadic studies have been done examining the perspectives of both survivors and their informal SPs using quantitative data (Ullman et al., 2022). This study addresses this gap by investigating predictors of PTSD and problem drinking symptoms in a sample of sexual assault survivors and their informal SP to whom they disclosed their assault. Analyses on both samples in some ways align with past research but also diverge, which we discuss in more detail below.

Sexual assault survivors are affected not only by the assault but by other individual and relational factors that can influence their post-assault recovery. PTSD and problem drinking are two of the most common impacts of sexual assault and commonly co-occur (Dworkin et al., 2023; Gilmore et al, 2023; Peter-Hagene & Ullman, 2014). Consistent with past research (Ullman & Filipas, 2001), more highly educated survivors and males reported fewer PTSD symptoms, likely due to better access to resources (e.g., economic, healthcare, support). In contrast, age was not significant, perhaps due to the lower average age (M = 26) in this sample compared to past sexual assault studies. Survivors identifying as White reported greater PTSD symptoms than those not identifying as White, while research is mixed regarding race differences in PTSD (Spoont & McClendon, 2020).

Partially supportive of stress and coping theory, avoidance coping and informal SP’s UA reactions, but not TA reactions, to survivors’ disclosure of assault were related to greater survivor PTSD symptoms (Ullman et al., 2007; Ullman & Relyea, 2016). However, it remains unclear why experiencing unsupportive acknowledgement from an informal SP in response to their sexual assault disclosure resulted in more PTSD symptoms for survivors, rather than if the informal SP turned against them. Perhaps this pattern was due to survivors expecting to receive TA reactions more frequently, so receiving more UA reactions may have violated their expectancies and thus been associated with more PTSD symptoms, consistent with expectancy violations theory (Burgoon, 1993).

In relation to perceptions of helping, survivors’ perception of greater empathy from informal SPs was related to increased PTSD symptoms for survivors. This may be due to survivors with PTSD eliciting greater empathic responses from their informal SPs, who are upset at how the survivor is suffering. Another possible reason for this finding could be that informal SPs may exhibit greater empathy due to similar experiences of sexual trauma; however, learning about their shared histories may exacerbate the survivors’ PTSD as they witness the pervasiveness of this type of trauma in our current society. Indeed, a study of college students found that of those who had received a disclosure of sexual assault or intimate partner violence, those who had their own sexual trauma histories reported having more empathy towards the survivors who disclosed to them (Mauer et al., 2022).

Perceived support from others is typically associated with fewer PTSD symptoms in survivors (Dworkin et al., 2019) and their informal SPs. This is evident in our study, as informal SPs experienced increased PTSD if they felt that they responded negatively to survivors’ disclosures of sexual assault, especially if they did not supportively acknowledge the disclosure or if they turned against the survivor. These findings suggest that informal SPs with lower PTSD symptoms of their own may be better equipped to support survivors. This finding regarding informal SP perceptions of their reactions to the survivor’s assault disclosure is also consistent with research on how social reactions impact survivors’ recovery and well-being (Ullman & Peter-Hagene, 2014). Finally, informal SPs’ use of approach and avoidance coping and greater empathy toward the survivor were all related to increased PTSD symptoms for informal SPs. This may be due to informal SPs being impacted by the survivor’s trauma vicariously, which is common for those who interact with survivors (Christiansen et al., 2012; Mauer, 2023).

Our finding that greater avoidance coping was related to more problem drinking for survivors is consistent with past research on sexual assault and problem drinking among women (Ullman et al., 2005; 2009). Interestingly, informal SPs’ positive reactions to survivors’ disclosure of the assault were related to increased problem drinking for survivors, but negative social reactions had no effect. Both of these findings differ from limited past research, suggesting that informal SPs’ negative reactions particularly impact problem drinking for survivors (Ullman et al., 2008). However, typically, social reactions are more strongly related to PTSD than to problem drinking (Ullman, 2023b). We did not account for reactions received by the survivor from others in this study, and it could be that receiving positive reactions from one informal SP is not enough to protect against harm if they also encounter negative reactions from formal service providers or other people they disclose to, resulting in increased problem drinking for survivors. While survivor coping and support seeking may mitigate some of the negative impact on PTSD symptoms, lack of access to quality mental health care, negative social reactions and/or institutional betrayal by formal support systems (e.g., police, medical) may exacerbate them (Smith & Freyd, 2013), including problem drinking in some survivors (Dworkin et al., 2019). Future research is needed to examine these relationships further. It may also be beneficial for researchers to examine qualitative data to further explore this association from the perspective of survivors in the context of their assaults and the circumstances in which the assault was disclosed.

Finally, some findings were unexpected, such as CSA severity being unrelated to survivors’ PTSD symptoms and problem drinking in the regression models. While this is inconsistent with past research showing that having a CSA history, particularly more severe (e.g., completed rape), is related to problem drinking (Wilsnack et al., 1997), the correlational analyses of CSA severity with survivor’s PTSD and problem drinking were both positive and statistically significant as predicted, meaning this factor could have been less predictive than others in the models. This finding supports the need for professionals working with survivors of sexual assault to take multiple experiences of victimization (e.g., child abuse and intimate partner violence) into account when working with such clients. Mental health professionals also need to assess the severity of CSA to help survivors with their recovery process, as such survivors are more likely to have complex trauma sequelae (e.g., complex post-traumatic stress disorder--CPTSD) than those without histories of childhood trauma (Briere et al., 2020).

In terms of problem drinking for informal SPs, avoidance coping was also related to this outcome, similar to survivors. In contrast, greater relationship satisfaction with the survivor was related to less problem drinking, suggesting that the relationship between the survivor and their informal SP may protect against problem drinking for informal SPs. This finding is consistent with research on close relationships’ protective effects as they relate to problem drinking, which can occur through intimate partners’ moderating influence on one’s drinking behavior (Fischer & Wiersema, 2012). That perceived empathy was related to increased problem drinking for informal SPs suggests that empathy may be associated with other factors related to trauma history, and/or that receiving such a sexual assault disclosure can be distressing for informal SPs despite the positive impact their empathy may have had on survivors. It could also indicate the impact of vicarious trauma, which is documented in the literature of informal and formal support providers who receive sexual assault disclosures (Christiansen et al., 2012; Maier, 2023). Some research shows that empathy is associated with having a trauma history and with PTSD in supporters (Oginska-Bulik et al., 2022), indicating that more empathetic individuals may have greater emotional sensitivity, putting them at risk for increased PTSD symptoms as a result of receiving a sexual assault disclosure (Wendt et al., 2022). Informal SPs’ UA reactions to survivors were related to less problem drinking, which needs to be replicated. However, perhaps these mixed reactions where SPs acknowledge the assault disclosure but do not provide further support are related to less burden on SPs, which translates into less problem drinking. Conversely, survivors may view UA reactions negatively, so future research is needed to explore this mismatch and its impact.

Limitations

The study was limited in relying on self-report data from a cross-sectional study where sexual assault survivors volunteered to participate, as well as their nominated informal SPs to whom they disclosed the assault. Thus, directionality of effects is unknown, as well as whether some associations may be bidirectional and/or due to other variables. It is unknown whether the findings generalize to sexual assault victims and/or their informal SPs more broadly. Having to make race and gender variables binary also limited our ability to get at demographic differences in a more nuanced way with PTSD and problem drinking in these samples. Despite these limitations, the sample was relatively diverse and recruited from the community, various agencies, and college and universities in a large, metropolitan area. In addition, while they had evidence of reliability and validity, some short versions of measures (e.g., problem drinking, SRQ, coping) were used to make the online surveys more reasonable in length for participants to complete. It should also be noted that whether sexual assaults were alcohol-related and/or non-alcohol-involved assaults was not included in our models, as this variable was not significantly correlated with either PTSD or problem drinking in correlational analyses. Finally, alphas for survivor and informal SP empathy were low, so replication is needed for this construct in particular.

Implications for Research, Treatment, and Prevention

The current study’s results have several implications for research, practice, and prevention. Further dyadic research is needed on sexual assault survivors and their informal SPs to understand better how disclosing a sexual assault can impact survivors, their supporters, and their relationship within the context of larger social networks (Dworkin et al., 2016; Jaffe et al., 2022). The fact that our models explained much more variance in PTSD symptoms suggests that other general social reactions (e.g., reactions unrelated to the survivor’s disclosure of substance use) and coping strategies, as well as helping perceptions examined here, may not be as important in understanding problem drinking for survivors or their informal SPs. Further research is needed examining alcohol/drug-specific social reactions to disclosure, specifically to alcohol/drug-involved assaults (e.g., blaming the victim’s drinking for her assault), which are more closely related to problem drinking than general social reactions (Lorenz & Ullman, 2016). Reactions to substance-involved SA disclosures are important because substances used during assaults are often used to blame, shame, or disbelieve the survivor’s story (Lorenz & Ullman, 2016). In addition, survivors’ use of substances to cope post-assault and/or negative reactions to their assault disclosure (especially if it was substance-involved assault), as well as substance use by informal SPs to cope with hearing such a disclosure and supporting the survivor, may be important to examine in future work examining problem drinking among survivors (Relyea & Ullman, 2015b) and their informal SPs. While substance use coping was included in the avoidance coping measure used in this study, it may need to be disaggregated to see a unique effect in relationship to survivors’ and informal SPs’ problem drinking (Relyea & Ullman, 2015b; Ullman & Najdowski, 2009).

Research is needed to inform treatment for survivors and their informal SPs, particularly in cases where both the survivor and their informal SP have victimization experiences. Education and prevention efforts are needed to improve the social reactions made to survivors’ disclosures of sexual assault and the helping capacity of their informal SPs. Also, mental health professionals and others working with survivors and their informal SPs need to take into account that many survivors disclose to other survivors who may need help dealing with their own assaults while supporting other survivors who disclose to them (e.g., see Edwards et al., 2022 for findings from an intervention program on how to support survivors). Clinicians and advocates who work with survivors can utilize this information in couples therapy and support/advocacy for victims and their friends, partners, and family members, respectively. When working with survivors, advocates and clinicians can prioritize helping them to decide who they want to disclose to and how they want to approach disclosing to loved ones. Additionally, sexual assault prevention educators can use the results of our study to teach about vicarious trauma and how to cope with it in a healthy way, and the importance of positively responding to disclosures of sexual assault and avoiding negative social reactions. This is important to ensure that disclosure to informal SPs is a positive and supportive experience for survivors, especially because receiving positive social reactions can result in survivors seeking post-assault follow-up care (Ullman & Filipas, 2001; Ullman & Lorenz, 2020). Scholars should further examine the experiences of informal SPs and the factors that impact their responses to disclosures, especially when they are also survivors themselves. Previous research shows that one’s own survivorship can impact empathy for someone else’s disclosure of sexual assault (Mauer et al., 2022). As many informal SPs themselves are also survivors, further research is needed to understand the complexities of the disclosure process for informal SPs who are also survivors, including the role of gender and relationship type. Given that survivors mostly disclose to friends, who are often also survivors, both gender identity and sexual assault history should be considered in research, treatment, and prevention as both impact survivors’ experiences of sexual assault and their recovery.

Acknowledgements

We thank Veronica Shepp, Anahi, Acosta, Sammyjo Lueg, Maricela Nateras, Kim DeSouza, Imani McDonald, Kennis Van Dyke, Eisha Sharjeel, Emily Tellez, Lynette Lewis, Darby Chamness, Christina Neri, Kenia Monroy, Milcah Rivera, Rahal Khan, Elene Yassin, Lara Abuata, Karen Garcia, Veronica Canadas, Eniola Fatoye, Erica Murschel, Adriana Guadarrama, Fajar Nadeem, Rabeea Omar, Chloe, Lowry, Leslie Tulip, and Veronica Canadas for their assistance with data collection. This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA #28483) to Sarah Ullman, Principal Investigator.

Biographies

Sarah E. Ullman, PhD., is Professor of Criminology, Law, and Justice at University of Illinois Chicago and social psychologist whose research concerns the impact of sexual assault and traumatic life events on women’s health and substance abuse outcomes and rape. She has conducted NIH-funded longitudinal and dyadic studies of sexual assault survivors’ recovery, informal support, and help seeking with a focus on how social reactions from formal and informal support sources affect recovery outcomes. The second edition of her scholarly monograph, Talking About Sexual Assault: Society’s Response to Survivors was published in 2023 by the American Psychological Association.

Erin O’Callaghan, PhD., is Assistant Professor of Sociology at Colorado State University, Fort Collins. Her research concerns sexual assault, sexual assault disclosure, substance-involved sexual assault, workplace sexual violence, and recovery in women.

Caroline Bailey, MSW., M.A., is a doctoral student in the Community Prevention and Research Program at the University of Illinois Chicago. Her research interests include system responses to survivors of sexual and domestic violence as well as community-based research and evaluation that can influence policy and practice.

Casey Harris, M.Ed., M.A., is a doctoral student in the Department of Criminology, Law, and Justice, at the University of Illinois Chicago. Her research focuses on survivors of multiple perpetrator sexual assault, long-term outcomes for sexual assault survivors, specifically focusing on social support, sexual assault prevention, and disclosure behaviors and reactions.

Footnotes

Ethical Standards and Informed Consent This study followed ethical standards for human subject’s research and was approved by the University of Illinois Chicago IRB.

Disclosure The authors report there are no competing interests to declare.

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