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. Author manuscript; available in PMC: 2022 Jan 4.
Published in final edited form as: J Sex Aggress. 2020 Oct 8;27(3):387–400. doi: 10.1080/13552600.2020.1823496

Multiple Perpetrator Sexual Assault: Correlates of PTSD and Depressive Symptoms in a Sample of Adult Women

Casey Harris 1, Sarah E Ullman 1, Veronica Shepp 1, Erin O’Callaghan 1
PMCID: PMC8726190  NIHMSID: NIHMS1632447  PMID: 34987306

Abstract

While most sexual assaults are committed by a sole perpetrator, multiple-perpetrator assaults (MPSAs) still occur. However, less is known about their post-assault impacts. This study examined demographic, assault, and post-assault characteristics as correlates of post-traumatic stress disorder (PTSD) and depressive symptoms in a community sample of adult sexual assault survivors who experienced MPSA (N=350) in the Chicago area. This study also included demographic and assault characteristics of perpetrators as reported by survivors. Backward regression analysis showed that stressful life events, more violent assaults, post-assault maladaptive coping and characterological self-blame, and receiving acknowledgement without support (e.g., acknowledging the assault happened, but giving inadequate support) reactions were related to greater PTSD symptoms. Older age and greater perceived control over recovery were associated with fewer PTSD symptoms. Greater violence, maladaptive coping, and characterological self-blame were related to greater depressive symptoms, whereas more education and greater perceived control over recovery correlated with fewer depressive symptoms. This study adds to research on MPSA .and findings have implications for clinical treatment, intervention, and prevention with survivors.

Keywords: Multiple Perpetrator Sexual Assault, PTSD, Depression

Introduction

Sexual assault is a pervasive issue around the world with studies of adult samples reporting 19–22% of female participants having been raped and 43.7% of women experiencing other forms of sexual violence in their lifetimes (Breiding et al., 2014; Elliott, Mok, & Briere, 2004). However, one type of sexual assault that is severely understudied is assault perpetrated by more than one individual. Previous research has indicated that historically this type of sexual assault has been prevalent across the globe (da Silva, Harkins, & Woodhams, 2013). The term used to describe sexual assault perpetrated by more than one person has been discussed in prior research using a myriad of terms such as “group rape” (Porter & Alison, 2006), “gang rape” (Worthington, 2013), and “multiple offender rape” (Shackelford 2002). Previous research has suggested that to examine these types of assaults, especially at the international level, it is vital to use consistent terminology that can be used throughout studies (da Silva et al., 2013). Given the variety of terms used to refer to sexual assaults perpetrated by more than one person and the need to use consistent terminology, in this article we refer to this specific type of sexual assault as Multiple Perpetrator Sexual Assault (MPSA). MPSA is defined as the sexual assault of a person by two or more individuals (Horvath & Kelly, 2009). Additionally, although we will use the term survivor throughout the paper when referring to individuals who experienced MPSA, when referencing literature in which some of the individuals did not survive the MPSA (i.e., died) we will refer to them as victims. Throughout this paper we will be discussing background literature especially concerning characteristics of MPSA and post-assault psychological outcomes.

Prevalence and Demographics of MPSA

Estimates of MPSA are often varied, given the challenges to reporting and recording sexual assault; however, most studies estimate that of sexual assaults overall, the percentage of MPSA ranges between 2 and 33 percent (da Silva, Woodhams, & Harkins, 2014; O’Sullivan, 1991). Furthermore, MPSA is a serious global public health problem as a study of six countries in Asia and the Pacific regions, including Bangladesh, China, Cambodia, Indonesia, Papua New Guinea, and Sri Lanka, (Jewkes, Fulu, Roselli, & Garcia-Moreno, 2013) found the prevalence of multiple perpetrator rape perpetration was between 1% and 2%, and much higher in Cambodia (5%), Jayapura in Indonesia (7%), and Papua New Guinea (14%). This wide range of estimates may reflect the varied types of convenience samples used in such studies. MPSA appears to constitute a non-trivial portion of reported assaults; however, relatively little scholarship has been carried out to understand correlates of psychological symptom outcomes in survivors of this crime (see Ullman, 2013 for a review). The lack of understanding of MPSA is concerning, given the often greater severity of these assaults (e.g., violence) (Hauffe & Porter, 2009) and higher risk of psychological harm to survivors.

Although scholarship on MPSA is limited, some demographic information has been reported. Most commonly, there are 2–4 perpetrators involved in MPSA incidents and this type of assault is typically perpetrated against women more than men. (Chambers, Horvath, & Kelly, 2009; Harkins & Dixon, 2010; Woodhams, & Cooke, 2013). A study of news archives found that MPSA attacks were characterized by younger victims, two perpetrators, and extreme violence (Quarshie et al., 2018). The significance of age has been reported in one study which found a statistically significant interaction between survivor age and gender in relation to penetration and use of violence during MPSA. Specifically, younger women were more likely to experience violence and penetration than other demographic subgroups in MPSA assaults (Woodhams, Gillett, & Grant, 2007). A study across six countries in Asia and the Pacific found that men from a lower socio-economic population (identified by food insecurity) and men without high school education were more likely to engage in MPSA than those not food insecure or with more education (Jewkes et al., 2013).

Although literature on MPSA predominantly comes from the United States and the United Kingdom, scholarship, and the context of MPSA in other countries is important. In a Nigerian study, approximately 7% of reported assaults were defined as gang perpetration, out of a total of 596 cases (Gbemileke & Oladepo, 2015). Literature on prevalence and experiences of South African survivors highlights discourses that normalize male violence, particularly rape, in a post-apartheid context (Wood, 2005). Sexual violence estimates in South Africa are one in three women and MPSA rates are also very high, with some studies finding approximately 17% of rape cases to fit the definition of MPSA (Meel, 2019; Moffett, 2008). Additionally, Jewkes, Sikweyiya, Dankle, and Morrell (2015) found that of 27.6% of men who had admitted to rape perpetration, 8.8% had perpetrated MPSA. In Cambodia, MPSA was more prevalent than single perpetrator sexual assault and the majority of perpetrators who had raped a non-partner had also sexually assaulted a partner, either alone or with other perpetrators . It is clearly important to study MPSA throughout the world as it is a global issue.

Contextual Trauma and MPSA

Given that scholarship dedicated to MPSA is limited, we are reviewing sexual assault literature broadly to provide more context to our current study. A history of stressful life events and past traumas have also been shown to relate to psychological outcomes in sexual assault survivors. Previous research indicates that exposure to prior traumatic events such as rape and physical assault significantly predict PTSD (Kessler et al. 2018). Additionally, Nishith, Mechanic, and Resick (2000) studied a sample of female adult rape survivors, following a recent experience of rape and found that individuals who experienced child sexual abuse (CSA), were more susceptible to additional experiences of either adult sexual or physical assault, and PTSD symptoms. Ullman’s (2007) study of community sexual assault survivors showed most women who were MPSA survivors experienced significantly more traumatic events in their lives than single perpetrator sexual assault (SPSA) survivors and were also marginally more likely to have experienced child sexual abuse (CSA). While these studies did not state the number of offenders in the assaults reported, they did indicate either a relationship between sexual assault victimization and other traumatic events or they indicated a relationship between past sexual trauma exposure and PTSD.

MPSA Assault Characteristics

Prior literature on MPSA generally shows that it is more violent than incidents of SPSA (Koss, Dinero, Seibel, & Cox, 1988). Hauffe and Porter’s (2009) examination of 120 cases of MPSA from the United Kingdom, United States, and Israel showed that the characteristics of this type of assault differed from those of single perpetrators. Specifically, MPSA is far more violent, often involves the use of weapons as well as various types of penetration within a single incident. Another study found that instances of MPSA were more likely to involve completed rapes and more sexual acts as compared to single-perpetrator assaults (Morgan, Brittain, & Welch, 2012). Woodhams, Gillet, and Grant (2007) compared juvenile MPSA to SPSA and found that penetration happened more frequently for sexual assaults perpetrated by groups when there was also physical violence present. In another study examining a sample of MPSA cases, Porter and Alison (2006) found that weapons were often used to coerce and control the victim during the incident, to physically injure the victim in one quarter of cases, and to kill the victim in over one-fifth of cases. Additionally, the number of perpetrators is inversely related to the amount of survivor resistance reported, with greater survivor resistance in response to assaults with fewer perpetrators (Gidycz & Koss, 1990; Woodhams & Cooke, 2013). Assault characteristics may be unique in MPSA, as compared to SPSA, making greater study of these incidents important to determine whether characteristics of MPSA impact post-assault survivors’ symptoms differently.

Post-MPSA Impacts

Although sexual assault survivors have a variety of psychological outcomes following assault, PTSD and depression are often present and have been most frequently studied. Previous literature indicates that PTSD and depression often co-occur following a traumatic event, and particularly after sexual assault (Au, Dickstein, Comer, Salters-Pedneault, & Litz, 2013). Au et al. (2013) measured symptoms of PTSD and depression in a sample of adult female sexual assault survivors at four time points. They found that at each time point, PTSD and depression symptoms were comparable, indicating that they often co-occur. Although these studies show an existing and relevant relationship between sexual violence and PTSD/depressive symptoms, they examined SPSA, not MPSA.

While the examination of depressive symptoms and PTSD in relation to MPSA cases are rarely reported in the literature, convenience sample data from the community has shown that two-thirds of MPSA survivors had PTSD, slightly higher than single perpetrator victims, but no difference in depressive symptoms (Ullman, 2007). One study of sexual trauma occurring within the military found that those with MPSA reported an increase in PTSD hyperarousal and avoidance symptoms (Bennett et al., 2019). Another study found that survivors of MPSA were more likely to have harmed themselves at some point in their life compared to survivors of SPSA. However, the same study found no significant differences between the groups with regard to any other mental health impacts (Morgan, Brittain, & Welch, 2012). Similarly, Gidycz and Koss (1990) found survivors of MPSA were more likely to have contemplated suicide; however, found no significant differences compared to SPSA survivors on other psychological symptoms.

Post-assault survivors’ responses such as attributions of self-blame, maladaptive coping strategies, and negative social reactions to assault disclosure have all been found to relate to greater PTSD and depressive symptoms in sexual assault survivors generally (Ullman et al, 2007; Ullman & Najdowski, 2011). Ullman (2007) found more negative social reactions were experienced by survivors disclosing MPSA compared to SPSA survivors. Although some studies have compared SPSA and MPSA, currently, to our knowledge, no studies of MPSA samples have examined whether these factors relate to psychological symptoms such as PTSD or depression in MPSA survivors specifically without comparing them to SPSA survivors. Therefore, it is important for research to examine what factors correlate to post-assault symptomatology in such cases.

Current Study

The majority of research regarding correlations of PTSD and depression in sexual assault survivors has focused on those who experienced SPSA so prior scholarship in the area is sparse. Given that the characteristics of MPSA and SPSA are often different (da Silva, Woodhams, & Harkins, 2014), it is important to address this gap to gain an understanding of experiences of MPSA survivors. These findings may also be useful for those working with MPSA survivors in a formal (e.g., therapists, social workers, law enforcement) or informal capacity (e.g., familial, or romantic partners). The current study examined the characteristics of the MPSA experiences, if there were group differences between survivors who experienced MPSA with two perpetrators versus survivors who experienced MPSA with three or more perpetrators, and various correlates of PTSD and depressive symptoms. In the current study, we hypothesized that key variables examined in past research on sexual assault generally, including demographics, assault characteristics, trauma history, and post-assault factors would be related to PTSD and depressive symptoms.

Materials and Methods

Sample

A volunteer sample of 1,863 women from the Chicago, Illinois metropolitan area participated in a larger study. Survivors had previously participated in a three-year longitudinal survey (N = 1,863) regarding unwanted sexual experiences and the social reactions they received when disclosing these experiences (for study description, see Ullman & Peter-Hagene, 2016). The present study used a subset of 350 women who reported a MPSA (18.8% of the full sample). Age ranged from 18 (our minimum cutoff for participation) to 67 (M =36.82, SD = 12.14). 18.4% of the sample had completed college or beyond, 43% had some college, 21.1% were high school graduates or equivalent and 17.5% had less than a high school degree. At the time of the study, most participants (64%) were unemployed. The participants were asked to select all of the categories that encompassed their racial identity. The majority of this subsample (59%) identified themselves as African American, 34.2% identified as white, 6.5% identified as other, 2.4% identified as American Indian or Alaskan Native and .9% identified as Asian. Of the total sample, 14.9% identified as Hispanic or Latina. Over half (52.7%) had annual incomes of $10,000 or less, 18.9% had $10,001 - $20,000, 9% had $20,001 – $30,000, 8.4% had $30,001-$40,000, 6% had $40,001-$50,000, and 5.1% had over $50,000.

Procedures

We recruited participants living in the Chicago metropolitan area via weekly advertisements in local free newspapers, on Craigslist, and through university mass mailings. We posted fliers in the community, at area colleges and universities, as well as at agencies that cater to community members in general and survivors of violence against women specifically (e.g., cultural, domestic, and rape-crisis centers, and substance abuse clinics). Interested participants called the research office and were screened for eligibility using the following criteria: (a) had an unwanted sexual experience at the age of 14 or older, (b) were 18 or older at the time of participation, and (c) had previously told someone about their unwanted sexual experience (because the larger study was about disclosure and social reactions to sexual assault). Women were informed about the amount ($25) of the compensation. Eligible participants received surveys, consent forms, community resources lists for survivors, and stamped return envelopes. Participants were paid upon receipt of their completed surveys. The response rate for Wave 1 was 85%. The University of Illinois at Chicago’s institutional review board approved all study procedures and documents (Protocol #2001–0156).

Measures

Demographics.

We collected data on demographics of victims (age in years, racial identity, education, employment, income) and their perceptions of perpetrators’ age in years.

Stressful life events.

Various contextual and interpersonal traumas were assessed with the revised 14-item Stressful Life Events Screening Questionnaire (SLESQ-Revised ; Green, Chung, Daroowalla, Kaltman, & DeBenedictis, 2006) including: child abuse and adult violence experiences, stalking, and a question we added on neighborhood/ community violence, “Have you ever lived in a neighborhood or community where you felt threatened or your life was in danger?” These events were summed into a total lifetime exposure to stressful life events score (M = 6.95, SD = 3.13, Cronbach’s α=.74).

Assault characteristics.

Sexual victimization in adulthood (i.e., 14 or older) was assessed using Testa, VanZile-Tamsen, Livingston, and Koss’s (2004) modified version of the Sexual Experiences Survey (SES, Koss, Gidycz, & Wisniewski, 1987). Testa et al.’s (2004) revised version (SES-Revised) assesses various forms of sexual assault, including unwanted sexual contact, verbally coerced intercourse, attempted rape, and rape resulting from force or incapacitation. This version of the SES has an internal consistency reliability of .73, which is higher than that of the original SES (Koss & Gidycz, 1985). The scale was also reliable in the present sample, Cronbach’s α = .73. We coded highest severity of sexual victimization as a continuous variable, according to the guidelines by Koss et al. (1987). The final scale ranged from 1 (least severe) to 6 (most severe), M = 5.33, SD = 1.49. Most assaults were completed rapes (92%). Child sexual abuse (CSA) was also assessed and derived from the SES-R. The designated time period for CSA was before 14 years of age. A 5-level ordinal variable (0 = no victimization, 1 = sexual contact, 2 = sexual coercion, 3 = attempted rape, and 4 = completed rape) was used to assess the severity of CSA, M = 2.62, SD = 1.63.

We also assessed the highest level of physical violence used by perpetrators during the sexual assault. Women endorsed one or more of the following items, from least to most violent: insistence, threats of physical force, twisting arm and holding down, hitting and slapping, choking, and beating, or use of a weapon. Summary scores were computed indicating the highest level of violence experienced from 1 (least violence) to 6 (most violence), M = 3.81, SD = 1.80. We assessed survivor resistance (M = 4.59, SD = 2.14) with an ordinal measure ranging from 1 (low physical/verbal resistance) to 6 (high physical resistance) computed from several items (stay still/freeze, reason/plead, cry/sob, scream for help, run away, physically struggle/push away/hit/scratch, or physically fight/kick/punch/use a weapon/martial arts), with summary scores indicating the level of resistance. Level of physical injury (M = 2.24, SD = 1.06) sustained during the assault was measured with an ordinal measure ranging from 1 (no physical injury) to 5 (most physical injury), computed from several items (soreness, bruises/scratches, cuts, broken bones, knife/gunshot wound), with summary scores indicating the level of physical injury. In addition to the objective measure of violence, we examined the negative peritraumatic response of whether survivors thought their lives were in danger during assault (79.1%% yes, 20.9% no).

Perceived control over recovery.

Women completed the seven-item Present Control subscale of the Rape Attribution Questionnaire (Frazier, 2003). They indicated perceived control over recovery in the past year on a scale from 1 (strongly disagree) to 5 (strongly agree), M = 3.60, SD = 0.81 (e.g., “There are things I can do to lessen the effects of the assault”). Frazier (2003) reported an average alpha of .75 for present control over recovery from assault across four time periods in 1 year. The scale was also reliable in our sample, Cronbach’s α = .71.

Social reactions to disclosure.

The Social Reactions Questionnaire (SRQ; Ullman, 2000) measured how often survivors received each of 48 social reactions in response to disclosures since the assault. The SRQ consists of seven subscales of various types of negative (controlling, blaming, egocentric responses, distracting the survivor, or treating the survivor differently) and positive (emotional support, tangible support) reactions to assault disclosure. Overall, women received more positive (M = 2.30, SD = 1.03) than negative (M = 1.25, SD = 0.94) reactions. We further separated negative reactions into acknowledgment-without-support reactions (e.g., acknowledging the assault happened, but failing to give adequate support, misplaced efforts to control the survivor’s decisions) and turning against reactions (e.g., blaming the victim, not believing her story) based on the confirmatory factor analyses reported elsewhere (Relyea & Ullman, 2015a). The turning-against scale consisted of 13 items, M = 1.13, SD = 1.13, α = .94. The acknowledgment-without-support reactions scale consisted of 13 items as well, M =1.36, SD = .93, α = .86.

Attributions of self-blame.

Two 5-item subscales of the Rape Attribution Questionnaire (Frazier, 2003), a valid and reliable self-report measure of sexual assault survivors’ attributions about why the assault occurred, assessed behavioral (e.g., “I should have resisted more”) and characterological (e.g., “I am a careless person”) self-blame on scales ranging from 1 (strongly disagree) to 5 (strongly agree). Both scales were reliable: behavioral self-blame, Cronbach’s α = .77 and .81 (Frazier, 2003; present sample, M = 3.50, SD = 1.07); characterological self-blame, Cronbach’s α’s = .79 and .73 (Frazier, 2003; present sample, M = 2.77, SD = 0.97).

Coping strategies.

The Brief COPE is a 28-item self-report scale of coping strategies (Carver, 1997). Strategies used in the past 12 months to cope with the assault were assessed on a scale ranging from 1 (I didn’t do this at all) to 4 (I did this a lot). Based on a factor analysis, Maladaptive Coping was computed as the average of responses to eight items, including behavioral disengagement, denial, self-blame, and substance-use subscales (M =18.19, SD = 6.07, α = .80).

Depressive symptoms.

Depressive symptoms were assessed using a seven-item version of the Center of Epidemiologic Studies Depression Scale (CES-D-7) modified by Mirowsky and Ross (1990). Participants rated their symptoms over the past 12 months on a 5-point Likert scale ranging from 0 (never) to 5 (always). Items were averaged (α = .84, M= 2.16, SD= 0.75).

PTSD symptoms.

PTSD symptoms were assessed with the Posttraumatic Stress Diagnostic Scale (PDS; Foa, 1995), a standardized 17-item instrument based on DSM–IV–TR (APA, 2000) criteria. On a scale ranging from 0 (not at all) to 3 (almost always), women rated how often they experienced each symptom (i.e., re-experiencing/intrusion, avoidance/numbing, hyperarousal) during the past 12 months, in relation to their most serious sexual assault. The PDS has acceptable test–retest reliability for a PTSD diagnosis in assault survivors over two weeks (α = .74; Foa, Cashman, Jaycox, & Perry, 1997). It was also reliable in the current sample (α = .93). The 17 items were summed to assess the extent of posttraumatic symptomatology (M = 25.02, SD = 13.10). Seventy-two percent of the sample qualified for the PTSD diagnosis.

Analysis Strategy

In order to analyze our data, we used Statistical Package for the Social Sciences (SPSS) Version 25. First, we conducted correlations of outcome variables, with pairwise deletion of missing data for the outcome variables. Prior to the regression we compared assaults based on number of perpetrators to ensure combining all numbers of perpetrators into one analysis was appropriate. We then conducted a backward regression analysis to identify significant correlates of symptoms in MPSA survivors. Although the backward regression method has been controversial in research, we felt it was necessary given the exploratory nature of our study (Smith, 2018). We entered several domains of variables into the full model including survivors’ demographics (e.g., age, education, racial identity), trauma history variables (e.g., CSA, stressful life experiences), assault-related factors (e.g., perceived life threat, highest level of violence, highest level of sexual abuse), and post-assault factors (e.g., maladaptive coping, perceived control over recovery, positive reactions to disclosure following assault, reactions of acknowledgement without support, reactions of being turned against, characterological self-blame). Missing data were handled case-wise in the regression analyses. Given the exploratory nature of the study and in order to avoid missing any variables that may have marginal significance, we included variables in the final model significant at p < .10 threshold, although our cutoff for statistical significance was kept at the standard p < .05 level.

Results

Characteristics of the Sexual Assault

Of the total sample of 1863 sexual assault survivors, 350 reported a sexual assault involving two people (10.3%) or three or more people (9.0%). The assault took place in both public and private spaces including the perpetrators’ home or yard (36.7%) in the perpetrators’ car (9.1%), in the survivor’s home or yard (15.8%), in the survivor’s car (1.2%), in the street (5.0%), in the woods, field, or park (4.1%), or other location (17%). The gender of perpetrators in MPSA incidents was as follows: male (88.8%), female (8%), and both male and female (3.2%). The social relationship between perpetrators and survivors varied. Survivors reported the perpetrators were strangers only (27.7%), acquaintances or causal/first dates only (28.3%), romantic acquaintances or the survivor’s husband (6%), relatives only (10.3%), and multiple types of offenders (27.7%). Participants reported their own age at the time of the MPSA ranged from 7 to 56, with a mean age of 20.64, and a modal age of 14. Participants reported multiple ages of offenders in response to a single open-ended question as follow: M = 25.65 (SD = 9.77), M = 28 (SD = 10.85), and M= 29.43 (SD = 10.34). Given that responses were provided to a single open-ended question, we cannot determine which offender (i.e. first, second, third) mean that the ages are connected to. The majority of participants (46.3%) did not know whether or not the perpetrator(s) were using any substances; 10.9% of participants reported the perpetrator was not using any substance, 14.4% reported the perpetrator was using alcohol, 5.5% reported the perpetrator was using drugs, and 22.7% reported the perpetrator was using both alcohol and drugs.

Participants reported various levels of abuse during the multiple-offender-assault, 6.5% of participants experienced the fondling of sexual body parts, 3.8% of participants reported unwanted kissing, 2.4% of participants experienced unwanted oral sex being performed on them, 4.7% of participants were forced to perform oral sex on someone, 2.1% of participants experienced anal rape, and 80.5% of participants experienced vaginal rape. During the assault, 16% of perpetrators used insistence, 7.7% used threats, 25% used tactics of twisting the survivors’ arm or holding them down, 9.6% used hitting or slapping, 13.6% used choking or beating, and 28.1% used a weapon. Participants experienced multiple injuries such as soreness (22.7%), bruises or scratches (47.8%), cuts (19.3%), broken bones (3.1%), and knife or gunshot wounds (7.1%). Participants used various tactics to resist assault including 13.5% that stayed still or froze, 7.2% attempted to reason or plead with the perpetrators, 18.3% cried or sobbed, 3.0% screamed for help, 4.5% attempted to run away, 32.7% physically struggled, pushed the offender away, hit, or scratched them, and 20.7% tried to physically fight, kick, punch, use a weapon or martial arts.

Correlation Analysis

We conducted correlations to explore associations among all study variables with participants’ total summed PTSD scores and participants’ average CES-D scores. The variables included in this analysis were age, education, racial identity (dummy-coded), CSA, stressful life events, feelings of life being in danger during the assault, highest level of violence used by the perpetrator, highest level of sexual abuse experienced during the assault, participants’ maladaptive coping, reactions after disclosure (positive reactions, reactions of acknowledgement without support, and reactions of turning against the survivor), and characterological self-blame. Please see Table 1 for significant correlations.

Table 1.

Correlational Analyses

PTSD Depression
Childhood Sexual Abuse .31** .17**
Stressful Life Experiences .34** .25**
Feelings of Life Being in Danger .19** .16**
Highest Level of Physical Violence .24** .16**
Highest Level of Sexual Violence --------------- .12*
Maladaptive Coping .54** .48**
Good Reactions .13** --------------
Acknowledgement without Support .38* .22**
Reactions of Turning Against .28* .16**
Characterological Self-Blame .29** .25**
Education −.25** −.24**
Perceived Level of Control Over Recovery −.23** −.24**
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*

p < .05.

**

p < .01

Univariate Analysis

First, two ANOVAs were run in order to identify if there were differences in PTSD and CES-D scores based on whether MPSA incidents had two perpetrators or three or more perpetrators. ANOVAs showed no significant differences in PTSD scores, F(1, 312) = 2.841, p = .09 or CES-D scores F(1, 346) = 1.202, p = .27 between participants who experienced a MPSA with two perpetrators compared with those with three or more perpetrators. Since there were no significant differences, we decided to keep the two groups combined in our regressions.

Regression Analysis

In order to explore the significant relationships of PTSD total score and CES-D average score, all variables were entered into the regression equation for each outcome variable (see Table 2 for full models). The backward method was used to remove non-significant predictor variables in order to identify significant variables in the reduced models (see Table 3 for final model). In addition, we also checked for multicollinearity in our variables, and the tolerances and variance inflation factor (VIF) scores were acceptable.

Table 2.

Hierarchical Backwards Regression (Full Models)

Total PTSD Score
 Total Depression Score
B SE β B SE β
Age −.10 .07 −.09 −.00 .00 −.04
Highest Level of Education −.83 .83 −.06 −.07 .05 −.09
Racial Identity: Black or African American −1.37 2.53 −.05 −.05 .17 −.03
Racial Identity: White or Caucasian −1.26 2.74 −.05 −.05 .16 .03
Childhood Sexual Abuse .26 .26 .07 −.01 .02 −.05
Sum of Stressful Life Experiences .53 .30 .13* .03 .02 .11
Feelings of Life Being in Danger .15 2.13 .01 .06 .13 .03
Highest Level of Violence 1.01 .49 .14** .03 .03 .06
Highest Level of Sexual Abuse .11 .53 .01 .02 .03 .04
Perceived Control Over Recovery −1.78 .97 −.11* −.12 .06 −.13
Maladaptive Coping .71 .16 .33*** .05 .01 .37***
Good Reactions .16 .90 .01 .02 .06 .02
Acknowledgement Without Support 1.23 1.42 .09 −.00 .09 −.00
Reactions of Turning Against .05 1.01 .00 −.03 .06 −.04
Characterological Self-Blame 1.36 .84 .10 .07 .05 .09
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Note: Coefficients for backward original model shown.

*

p < .10

**

p < .05.

***

p < .01

Table 3.

Hierarchical Backward Regression (Reduced Models)

Total PTSD Score
 Total Depression Score
B SE β B SE β
Sum of Stressful Life Events .70 .24 .17***
Age −.10 .06 −.09*
Highest Level of Education −.08 .04 −.10*
Highest Level of Violence 1.02 .38 .14*** .05 .02 .11*
Perceived Control over Recovery −1.86 .83 −.12** −.11 .05 −.12**
Maladaptive Coping .76 .13 .435*** .05 .01 .38***
Characterological Self-Blame 1.33 .72 .10* .08 .04 .10*
Acknowledgement without Support 1.43 .81 .10*
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Note: Coefficients for backward reduced model shown.

*

p < .10

**

p < .05

***

p < .01

When using PTSD total score as the outcome variable, the reduced model showed that higher total stressful life experiences, higher level of perpetrator violence used in the assault, more maladaptive coping, higher characterological self-blame, and more social reactions that acknowledged the survivors’ experiences without showing support, were each related to higher PTSD total scores. Additionally, lower perceived control over recovery and younger age were related to higher PTSD total scores. The reduced model for CES-D scores showed that highest level of perpetrator violence used in the assault, greater maladaptive coping, and greater characterological self-blame were related to greater depressive symptoms, whereas greater perceived control over recovery and higher education related to lower depressive symptoms.

Discussion

The current exploratory study adds to the small body of research examining post-assault outcomes for survivors of MPSA and is the first to examine correlates of PTSD and depression in MPSA survivors. While previous research on MPSA is still sparse, past research suggests that these assaults are more violent than SPSA (see Ullman, 2013 for a review). Therefore, while MPSA does not make up the majority of sexual assaults, their greater severity and impact make them important to study for understanding survivors’ recovery.

Sample Characteristics

Similar to other MPSA studies (da Silva, Woodhams, and Harkins, 2014; Horvath and Kelly, 2009), the majority of sexual assaults in the larger sample from which these incidents were drawn were committed by a single perpetrator with about 19.3% of survivors experiencing a MPSA. Although previous studies overall show a range of prevalence of MPSA, the current study shows similar prevalence to community samples, which typically have higher MPSA.

The average age in our sample was 36.82 at the time of study participation, with the mean age of assault occurring at age 20; however, most of the MPSAs occurred at age 14 for survivors. For offenders, the average ages were also young at 25.65, 28, and 29.43. This replicates prior studies which have also shown a younger age of victims and perpetrators (Porter & Alison, 2006). Although previous research has indicated that survivors and offenders in MPSAs are often younger than in SPSAs, there is not a known reason. However, Mustaine (1997) points out that younger individuals may have increased vulnerability to victimization. Additionally, our sample was primarily African American, and although we did not compare MPSA to SPSA survivors, prior studies show MPSA survivors are more likely to be Black than SPSA survivors (da Silva, Woodhams, & Harkins, 2014). This is not surprising, since MPSAs tend to be more violent than SPSAs, and African American women are more likely to experience various forms of sexual assault and more severe violence (Richie, 2012; Ritchie, 2017).

Assault Characteristics

This study indicates that survivors of MPSA experience very violent attacks, in which the survivors made attempts to resist, sustained injuries, and various forms of sexual abuse, most of which involved vaginal rape. These results replicate previous research showing that offenders’ use of additional violence, such as weapons, is common (Hauffe & Porter, 2009; Porter & Allison, 2006). Additionally, this study supports prior literature regarding the severity of MPSA. This study does add to the small body of literature on correlates of psychological impacts of MPSA. Given the especially violent assaults typically experienced by MPSA survivors, future scholarship should work with MPSA survivors to better understand post-assault consequences.

PTSD and Depressive Symptoms

While there has not been much research exploring PTSD in MPSA survivors (see Ullman, 2007 for an exception), evidence suggests that they are potentially more susceptible to PTSD symptoms than victims of SPSA. Our study found a number of correlates of PTSD symptoms in MPSA survivors in a diverse community sample. Specifically, factors such as stressful life experiences, assaults with more perpetrator violence, more maladaptive coping, higher characterological self-blame, more reactions that acknowledged the survivors’ experiences without showing support, lower perceived control over recovery, and younger age were related to a higher PTSD total score. While previous research has not examined predictors of PTSD in MPSA, a history of trauma has been shown to be predictive of PTSD in rape survivors (Nishith, Mechanic, & Resick, 2000; Kessler, et al. 2018) Previous research has also shown that individuals with less education, higher perceived life threat, and more negative social reactions were likely to have higher PTSD severity (Ullman & Filipas, 2001). Additionally, previous research has also indicated that overall MPSA survivors have experienced more traumatic life events (Ullman, 2007). Although the results of previous research regarding sexual assault generally is not replicated in the current study, this may be because MPSA survivors experience assaults that are unique from SPSA incidents. Given that there is little research examining psychological symptom outcomes of MPSA survivors, future research should further explore the associations. In particular, researchers should strive to understand what factors might explain differences in recovery outcomes of PTSD and depression in MPSA survivors selected from various subpopulations (e.g., clinical, student, general population). For example, lower perceived control over recovery and less education were each related to more PTSD and depressive symptoms, so research is needed to explain these associations.

Current research on factors related to depressive symptoms in MPSA is lacking. Our analyses indicated higher levels of violence used in the assault by the perpetrator, higher levels of maladaptive coping, and higher levels of characterological self-blame were each related to higher levels of depressive symptoms. In addition, higher levels of perceived control over recovery and having more education are related to less depressive symptoms. Previous research has shown that lifetime suicide attempts are higher in individuals who experience MPSA versus SPSA (Ullman, 2007). Previous literature has not explored depression in survivors of MPSA and has explored PTSD symptoms in only one known study (Ullman, 2007); however, research has discussed the comorbidity of these two psychological phenomena. Research specifically examining PTSD, depression, and sexual violence has shown that PTSD and depression often co-occur (Au et al. 2013). This study does provide some information regarding these two symptom outcomes in MPSA survivors; however, future research should seek to examine these two symptom outcomes in a manner that addresses the issues of comorbidity.

Future Research

Previously, the majority of research examining MPSAs has primarily focused on the perpetrators of the assaults and not the survivors’ experiences during the assault or the outcomes for them post-assault. Future research should aim to study experiences of MPSA survivors to replicate and expand on these results to understand these associations more thoroughly. Future research can also examine the specific variables that were correlated with PTSD and depression, by further examining the associations.

In SPSAs, research has shown that perpetrators are typically known to the survivor prior to the assault (Fisher, Cullen, & Turner, 2000), but when a stranger assault occurs, these assaults are typically more violent (Koss, Dinero, Seibel, & Cox, 1988). According to Porter and Alison (2006), in MPSAs the amount of violence used by offenders was related to the social relationship between the group and the survivor; multiple violent acts were likely to occur when the offenders were strangers to the survivor. Since there seems to be a link between use of violence and a stranger perpetrator, in both MPSA and SPSA, this should be further examined in research. Additionally, survivors reported perpetrators were strangers only (27.7%), acquaintances or causal/first dates only (28.3%), romantic acquaintances or the survivor’s husband (6%), relatives only (10.3%), and multiple types of offenders (27.7%). These large percentages align with previous research indicating that most sexual assault perpetrators knew survivors prior to the assault (Breiding et al., 2014) although there is also a high percentage in the other categories. In the current study, the highest percentage for social relationship was acquaintances or casual/first dates only, but the second highest percentage was strangers only and multiple types of offenders. So, it is worth examining in further detail the mix of relationships of perpetrators to the survivor in future research on MPSA. .

Limitations

The data collected from this study is self-report which includes survivors’ perceptions of perpetrators. Although survivors’ perceptions of perpetrators are important, we cannot be sure of the accuracy of this information. For example, survivors’ perception of offender age may have been inaccurate and was only asked with respect to the index assault, but not with respect to the number of perpetrators. Additionally, survivors were asked to report their most serious unwanted sexual experience as an adult; however, many of the participants indicated that they had experienced a MPSA in childhood or adolescence. Although we examined symptoms of depression and PTSD, we did not measure the actual diagnoses and these symptoms are self-reported. Retrospective recall bias is a limitation of the study given that time since the assault varied for participants and may have led participants to have errors in recall.

This study was a part of a larger study and many of the questions asked were not MPSA-specific. This includes a particular question in which survivors were asked if the perpetrator was using substances. Because this question asked about a single perpetrator, there was not space for participants to include information about multiple offenders. In the future, researchers should prioritize examining substance use for each perpetrator comprising the group of offenders.

Implications for Research and Practice

Survivors’ experiences are often ignored, but unfortunately, MPSA survivors’ experiences are even more understudied in research. The results of this study contribute to the field of sexual assault research for survivors of MPSA to further understand what they experience post-assault regarding common psychological symptoms and their correlates. Since there is no prior research specifically examining depression and PTSD as outcomes, this research can be used to better understand the psychological impact of MPSA and the construction of interventions for this population of survivors. This research is particularly valuable for individuals who work with sexual assault survivors in treatment, intervention, and prevention. In particular, social workers and counselors who work with survivors of sexual assault should screen for experiences of MPSA, given the implications for treatment plans regarding PTSD, depressive symptoms, and severe violence. Similarly, organizations and service providers that see survivors of sexual violence should assess their intake questions so survivors can more accurately self-report experiences of MPSA. As seen in our own limitations, if the questions are not framed in ways that speak to the experiences of all survivors, then valuable information that could be used to improve treatment and intervention will be missed. Lastly, because more perceived control over recovery was related to less depressive symptoms, clinicians and others working with survivors of sexual assault may wish to focus their intervention efforts on increasing agency for the survivor as they move through treatment.

Prior research has primarily examined treatment and primary prevention in perpetrators of the assaults (Etgar, 2013); however, this research can be helpful when considering secondary and tertiary prevention in survivors within the context of coping and social support interventions. At this time, many sexual assault prevention programs focus on sexual assault broadly instead of prevention aimed at individual types of sexual assault. Prevention programs need to be geared to specific types of assault, and MPSA specifically, given that circumstances of these assaults are unique. Additionally, because our results suggest many survivors of MPSA are young, African American, and experience extreme levels of violence, it is of the utmost importance to focus on these unique characteristics in intervention and prevention efforts. Lastly, many prevention efforts are focused on college campuses given the increased dialogue in the public sphere regarding campus sexual violence (DeGue et al., 2014); however, this study’s sample suggests that community women are at a risk for sexual violence and specifically MPSA. Prevention efforts should diversify and funding for said prevention programming should seek to prioritize women in community settings who may not have institutional resources from a University.

Acknowledgements:

The authors have no conflict of interests and the findings have not been published in other journals. This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (AA 17429) to Sarah Ullman, principal investigator. We thank Amanda Vasquez, Katherine Lorenz, Rannveig Sigurvinsdottir, Mark Relyea, Liana Peter-Hagene, Meghna Bhat, Cynthia Najdowski, Saloni Shah, Susan Zimmerman, Rene Bayley, Farnaz Mohammad-Ali, Shana Dubinsky, Diana Acosta, Brittany Tolar, and Gabriela Lopez for assistance with data collection.

Footnotes

Declaration of interest statement: The authors have no conflicts of interest.

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