The coping skills and quality of life among rape survivors – A descriptive study from Kerala

Abstract

Background:

Rape is one of the most heinous of acts. It constitutes a major violation of an individual’s basic rights and intensely impacts their mental and physical health. Coping skills used to deal with the trauma could provide information on their quality of life (QOL).

Objectives:

To assess the coping skills and QOL of rape survivors and to explore its association with their coping skills.

Materials and Methods:

Data were collected through a questionnaire, and coping skills were assessed using the Brief COPE scale and QOL using the World Health Organization quality of life questionnaire (WHOQOL-BREF). Results were analyzed using the Kruskal–Wallis H test and Spearman rank correlation.

Results:

Adaptive coping skills such as use of instrumental support, active coping, use of emotional support, self-distraction, and acceptance had higher COPE mean scores. QOL in the domain of physical health (mean = 52.71) had the highest mean score, followed by the domains of environment (mean = 51.35) and psychological health (mean = 48.37). Use of coping skills like active coping, use of emotional support, use of instrumental support, positive reframing, and acceptance had a significant positive correlation with the QOL in the domains of physical health and environment. Active coping and positive reframing were positively correlated with the QOL in the domain of psychological health, while positive reframing and humor were positively correlated with the social relationships domain.

Conclusion:

Those who employed adaptive coping skills (active coping, use of emotional support, use of instrumental support, positive reframing, acceptance) showed significantly better QOL than those with maladaptive skills.

INTRODUCTION

The World Health Organization (WHO) defines rape as a form of sexual assault,[1] while the Centers for Disease Control and Prevention (CDC) includes rape in its definition of sexual assault; it defines rape as a form of sexual violence. According to latest available statistics from the National Crime Records Bureau (NCRB), crimes against women have been steadily rising over the years in India.[2] There were over 4 lakh reported cases of crimes committed against women in 2019, up from 3.78 lakh in 2018 and 3.59 lakh cases in 2017. In other words, there was a rise of over 7% in crimes against women in 2019 in India.[3]

Psychologists Richard Lazarus and Susan Folkman scientifically defined coping mechanism as the sum of cognitive and behavioral efforts, which are constantly changing, that aim to handle particular demands, either internal or external, that are viewed as taxing or demanding.[4] In other words, coping is an activity we do to seek and apply solutions to stressful situations or problems that emerge because of our stressors.

Sexual violence, especially rape, is a pervasive problem all over the world and it does not spare any socioeconomic group or culture, particularly among young children and adults.[5]

Coping skills can be commonly classified into active and avoidant coping strategies. Active coping strategies are responses that are utilized to modify the nature of the stressor or how one views it, whereas avoidant coping strategies lead people to maladaptive behaviors (substance use) or emotional states (denial) that prevent them from directly addressing traumatic events.[6] Therefore, active coping strategies are viewed to be better ways to deal with traumatic events, while avoidant coping strategies are thought to be a significant risk factor for adverse responses to stressful life events.

A study on African American women has discussed how they used religion and spirituality as a coping mechanism in times of adversity.[7] Optimism has also been described as a coping skill that shows a positive connection with the psychological and physical well-being of a person.[8] On the other hand, self-blame and avoidance is also commonly employed by sexual assault survivors, which creates a barrier for service providers focused on crisis intervention.[9] Patients using maladaptive coping mechanisms are more likely to engage in health-risk behaviors than those with appropriate mechanisms. Psychiatric disorders such as anxiety, posttraumatic stress disorder, and major depression are all correlated with coping styles related to avoidance. In addition, those using maladaptive coping skills are more likely to engage in substance use to cope.[10] Rape may interfere with the development of appropriate emotional regulation abilities, therefore predisposing victims of childhood sexual assault (CSA) to an over-reliance on avoidant coping skills.[11]

Being victim to sexual assault such as rape can impact an individual’s ability to perform across a variety of roles, including those related to parenting, intimate relationships, and occupational and social functioning. Although previous studies provide support for the role of coping in the process of adjustment following sexual assault, little effort has been made to link coping skills with quality of life (QOL) in these survivors.

There have been studies from India where the sociodemographic profile of rape victims has been studied.[12,13] However, there have been no studies from India that discuss the coping skills employed by the rape victims and how it affects their QOL. This study aims to bridge that gap.

Studying the impact of rape would help in the early identification of those survivors who are likely to experience slow recovery and in the development of appropriate therapies. Hence, our study has tried to elaborate on the different coping skills employed by rape survivors and the association to their QOL.

MATERIALS AND METHODS

The study was conducted in the different state government-run women and children’s homes (Nirbhaya homes) in the district of Thiruvananthapuram, Kerala, after obtaining prior permission from the Department of Women and Child Development. Permission was also obtained from the Institutional Ethics Committee for conducting the study.

It was a descriptive survey, aiming to study the coping skills and QOL. The sample was selected through the convenient sampling technique. The basic information was taken from the welfare officers of the care homes.

Sixty-three participants were assigned unique identification numbers to ensure confidentiality, and informed consent was taken. With the help of the project coordinator (non-governmental organization [NGO]), data were collected from the consenting participants and tools were administered.

Tools used

Modified Kuppuswamy socioeconomic status scale

It takes account of education, occupation, and income of the family to classify the study groups into high, middle, and low socioeconomic status.[14]

The Brief- COPE (Coping Orientation to Problems Experienced Inventory) for assessing coping skills

This scale was developed as a short version of the original 60-item COPE scale,[15] which was theoretically derived based on various models of coping. It is a 28-item self-report questionnaire designed to measure effective and ineffective ways to cope with a stressful life event and a wide range of adversity, including a cancer diagnosis, heart failure, injuries, assaults, natural disasters, and financial stress.[15] The scale can determine someone’s primary coping styles as either approach (adaptive) coping or avoidant (maladaptive) coping.

The scale consists of 14 subscales with two items per subscale measuring active coping, planning, positive reframing, acceptance, humor, religion, use of emotional support, use of instrumental support, self distraction, denial, venting, substance use, behavioral disengagement, and self blame. The first 8 scales were grouped together as adaptive coping skills, and the latter 6 scales were considered maladaptive coping skills. The intraclass correlation coefficient for the 28-item Brief COPE scale was 0.60 (95% confidence interval [CI]: 0.38–0.75), indicating marginal test–retest reliability.[16] The Cronbach’s alpha for the overall Brief COPE was 0.70, indicating good consistency among the items.[16]

WHO quality of life questionnaire

QOL was assessed using the World Health Organization quality of life questionnaire (WHOQOL-BREF) – Malayalam version. It is a 26-item, self-administered scale which measures four domains of QOL. They are physical health, psychological health, environment, and social relationships. These items are scored from 1 to 5, with higher scores indicating better QOL in each domain and in the total score. Reliability was assessed by Sreedevi et al.[17] and the scale was found to be reliable with a Cronbach’s alpha of 0.86. Validity was studied by Agnihotri et al.[18] on Indian adolescents. The instrument showed good internal consistency (Cronbach’s a = 0.87, P < 0.01) as well as good content, construct, and predictive validity (P-values <0.05).

Statistical analysis

Variables were presented as mean (standard deviation [SD]) and numbers (percentage). For comparison of more than two groups, the Kruskal–Wallis H test was used, since the distribution of coping skill scores was not normal. The interactions between variables were calculated using Spearman rank correlation analysis. The criteria for statistical significance were set at P < 0.05. For the purpose of statistical analysis, Statistical Package for the Social Sciences (SPSS) 25.0 software was used.

RESULTS

The characteristics of the sample are summarized in Table 1. The age ranges of the survivors were between 11 and 24 years, with the mean age of the sample being 16.33 (SD = 3.823) years. The most affected age group (37%) was the 15–18 years age group. Around 35% of the survivors were educated up to higher secondary, and 85% of them came from lower socioeconomic background. All the survivors were unmarried.

Table 1.

Sociodemographic and clinical characteristics of victims

Variable	Frequency (%)
Age groups
<14 years	20 (31.7)
15-18 years	37 (58.7)
>18 years	6 (9.5)
Educational status
Primary	21 (33.3)
Secondary	14 (22.2)
Higher secondary	22 (34.9)
Graduate	6 (9.5)
Socioeconomic background
Lower	54 (85.7)
Middle	7 (11.1)
Upper	2 (3.2)

Data presented in Table 2 show that adaptive coping skills such as use of instrumental support, active coping, use of emotional support, self distraction, and acceptance had higher COPE mean scores compared to other coping skills in rape survivors. Also, coping skills of substance use and humor had the least COPE mean scores compared to other coping skills in rape survivors. This shows that adaptive (approach) coping skills were used more often than avoidant coping skills.

Table 2.

Mean scores of QOL domains and coping skills in the victims

Variables	Mean	n	Sth deviation
QOL domains
Physical health	52.71	63	13.813
Psychological health	48.37	63	18.338
Social relationship	32.48	63	17.633
Environment	51.35	63	20.923
Coping skills
Self-distraction	6.10	63	1.563
Active coping	6.17	63	1.571
Denial	5.06	63	1.585
Substance use	2.29	63	0.974
Use of emotional support	6.16	63	1.558
Use of instrumental support	6.38	63	1.419
Behavioral disengagement	4.68	63	1.740
Venting	5.44	63	1.329
Positive reframing	5.90	63	1.434
Planning	5.25	63	1.685
Humor	3.95	63	1.736
Acceptance	6.06	63	1.554
Religion	5.46	63	1.933
Self-blame	4.94	63	1.731

QOL = quality of life

In the QOL measures [Table 2], the domain of physical health (mean = 52.71) had the highest mean score, while the social relationship (mean = 32.48) domain has the least mean score compared to other domains.

There was significant difference between age groups and different coping skills in rape survivors in active coping (H (2) = 8.289, P = 0.016), venting (H (2) = 8.731, P = 0.013), and positive reframing (H (2) = 7.435, P = 0.024), where participants in the age group of above 18 years showed a higher rank score for these skills than their younger counterparts [Table 3]. However, in the post hoc analysis, Dunn’s pairwise tests were carried out for the three pairs of groups. There was very strong evidence (P < 0.05, adjusted using the Bonferroni correction) of a difference in active coping between the groups I and II. Similarly, there was very strong evidence of a difference (P < 0.05) in venting between the groups above 18 (III) years and 15–18 (II) years. There was no significant difference between the groups for positive reframing.

Table 3.

Coping skills and age groups

Coping skill	Age group	n	Mean rank	Kruskal–Wallis H	Asymp. sig.
Self-distraction	Below 14	20	24.33
	15-18	37	36.05	5.606	0.061
	Above 18	6	32.58
Active coping	Below 14	20	22.83
	15-18	37	35.46	8.289	0.016
	Above 18	6	41.25
Denial	Below 14	20	28.55
	15-18	37	31.99	3.232	0.199
	Above 18	6	43.58
Substance use	Below 14	20	32.08
	15-18	37	30.70	4.851	0.088
	Above 18	6	39.75
Use of emotional	Below 14	20	27.65
support	15-18	37	33.92	1.74	0.419
	Above 18	6	34.67
Use of instrumental	Below 14	20	24.83
support	15-18	37	34.66	5.102	0.078
	Above 18	6	39.50
Behavioral disengagement	Below 14	20	28.45
	15-18	37	34.74	2.117	0.347
	Above 18	6	26.92
Venting	Below 14	20	32.30
	15-18	37	28.64	8.731	0.013
	Above 18	6	51.75
Positive reframing	Below 14	20	23.35
	15-18	37	35.19	7.435	0.024
	Above 18	6	41.17
Planning	Below 14	20	27.63
	15-18	37	31.96	5.276	0.071
	Above 18	6	46.83
Humor	Below 14	20	30.58
	15-18	37	30.69	3.417	0.181
	Above 18	6	44.83
Acceptance	Below 14	20	28.40
	15-18	37	31.91	3.738	0.154
	Above 18	6	44.58
Religion	Below 14	20	28.28
	15-18	37	33.55	1.268	0.53
	Above 18	6	34.83
Self-blame	Below 14	20	26.93
	15-18	37	33.77	2.619	0.27
	Above 18	6	38.00
Post hoc analysis of coping skills in age groups
Age groups	Pairwise comparison		Test statistic (std error)	Sig.	Adj. sig.
Positive reframing
Below 14 years (I)	I–II		−11.839 (4.962)	0.017	0.051
15-18 years (II)	I–III		−17.817 (8.323)	0.032	0.097
Above 18 years (III)	II–III		−5.977 (7.869)	0.447	1.000
Active coping
Below 14 years (I)	I–II		−12.634 (4.953)	0.011	0.032
15-18 years (II)	I–III		−18.425 (8.307)	0.027	0.080
Above 18 years (III)	II–III		−5.791 (7.854)	0.461	1.000
Venting
Below 14 years (I)	I–II		3.665 (4.935)	0.458	1.000
15-18 years (II)	I–III		−23.115 (7.826)	0.003	0.009
Above 18 years (III)	II–III		−19.450 (8.278)	0.019	0.056

Dunn’s pairwise tests were carried out for the three pairs of groups. Significance values have been adjusted by the Bonferroni correction for multiple tests (P<0.05). Sig. (2- tailed) values which are less than 0.05 (P>0.05), are statistically significant and hence put in BOLD

Although the initial analysis showed that there were significant differences between educational background and coping skills in rape survivors in skills such as active coping (H (2) = 12.276, P = 0.006), positive reframing (H (2) = 8.702, P = 0.006), and religion (H (2) = 8.744, P = 0.006) [Table 4], after the post hoc analysis of the groups, it was seen that there was very strong evidence of a difference in active coping (P < 0.05, adjusted using the Bonferroni correction) between the groups having primary education and graduation. There was no evidence of a difference in positive reframing and religion between all pairs.

Table 4.

Coping skills and educational background

Education	n	Mean rank	Kruskal–Wallis H		Asymp. sig.
Self-distraction
Primary	21	24.02
Secondary	14	33.18	7.003		0.072
Higher secondary	22	38.18
Graduation	6	34.50
Active coping
Primary	21	22.00
Secondary	14	36.32	12.276		0.006
Higher secondary	22	34.64
Graduation	6	47.25
Denial
Primary	21	28.69
Secondary	14	31.11	2.183		0.535
Higher secondary	22	33.45
Graduation	6	40.33
Substance use
Primary	21	31.93
Secondary	14	33.68	1.598		0.660
Higher secondary	22	30.32
Graduation	6	34.50
Use of emotional support
Primary	21	26.52
Secondary	14	37.86	3.727		0.292
Higher secondary	22	33.84
Graduation	6	30.75
Use of instrumental support
Primary	21	24.05
Secondary	14	39.46	7.047		0.070
Higher secondary	22	34.07
Graduation	6	34.83
Behavioral disengagement
Primary	21	28.17
Secondary	14	33.11	2.079		0.556
Higher secondary	22	35.70
Graduation	6	29.25
Venting
Primary	21	30.64
Secondary	14	33.18	1.243		0.743
Higher secondary	22	30.64
Graduation	6	39.00
Positive reframing
Primary	21	24.52
Secondary	14	37.18	8.702		0.034
Higher secondary	22	31.93
Graduation	6	46.33
Planning
Primary	21	26.76
Secondary	14	35.14	3.903		0.272
Higher secondary	22	32.41
Graduation	6	41.50
Humor
Primary	21	31.95
Secondary	14	31.32	0.177		0.981
Higher secondary	22	31.70
Graduation	6	34.83
Acceptance
Primary	21	26.67
Secondary	14	31.11	7.311		0.063
Higher secondary	22	33.02
Graduation	6	49.00
Religion
Primary	21	25.93
Secondary	14	39.96	8.744		0.033
Higher secondary	22	35.98
Graduation	6	20.08
Self-blame
Primary	21	25.98
Secondary	14	30.89	7.400		0.060
Higher secondary	22	40.02
Graduation	6	26.25
Post hoc analysis
Variable	Education	Pairwise comparison	Test statistic (std error)	Sig.	Adj. sig.
	Primary (I)	I–II	−12.655 (6.169)	0.040	0.241
Positive reframing	Secondary (II)	I–III	−7.408 (5.455)	0.174	1.000
	Higher	I–IV	−21.810 (8.277)	0.008	0.050
	secondary (III)	II–III	5.247 (6.113)	0.391	1.000
	Graduation (IV	II–IV	−9.155 (8.725)	0.294	1.000
			−14.402 (8.235	0.080	0.482
	Primary (I)	I–II	−14.321 (6.157	0.020	0.120
Active coping	Secondary (II)	I–III	−12.636 (5.444)	0.020	0.122
	Higher	I–IV	−25.250 (8.261)	0.002	0.013
	secondary (III)	II–III	1.685 (6.101)	0.782	1.000
	Graduation (IV)	II–IV	−10.929 (8.708)	0.209	1.000
		III–IV	−12.614 (8.219)	0.125	0.749
Religion	Primary (I)	I–II	−14.036 (6.243	0.02	0.147
	Secondary (II)	I–III	−10.049 (5.520)	0.069	0.412
	Higher	I–IV	5.845 (8.375)	0.485	1.000
	secondary (III)	II–III	3.987 (6.185)	0.519	1.000
	Graduation (IV)	II–IV	19.881 (8.828)	0.024	0.146
		III–IV	15.894 (8.333)	0.056	0.339

Dunn’s pairwise tests were carried out for the six pairs of groups. Significance values have been adjusted by the Bonferroni correction for multiple tests (P<0.05). Sig. (2- tailed) values which are less than 0.05 (P>0.05), are statistically significant and hence put in BOLD

The study also shows that there was no significant difference in coping skills among rape survivors based on socioeconomic class (all P values were greater than 0.05).

It was found that there were significant correlations between different coping skills and QOL among rape survivors [Table 5]. It was observed that those victims who employed active coping as a skill had significantly better QOL in the domains of physical health (P = 0.007), psychological health (P = 0.002), and environment (P = 0.023). We also found here a strong positive correlation between positive reframing and QOL in all the domains: physical health (r = 0.391, P = 0.002), psychological health (r = 0.480, P = 0.000), social relationship (r = 0.361, P = 0.004), and environment (r = 0.411, P = 0.001). Therefore, positive reframing significantly increases the QOL of rape survivors in all the four domains.

Table 5.

Correlation between coping skills and quality of life domains

	Physical health	Psychological health	Social relationship	Environment
Self-distraction
Correlation coefficient	0.174	0.200	0.141	0.169
Sig. (two tailed)	0.173	0.117	0.271	0.185
Active coping
Correlation coefficient	0.337**	0.385**	0.039	0.286*
Sig. (two tailed)	0.007	0.002	0.764	0.023
Denial
Correlation coefficient	−0.027	0.214	0.073	0.172
Sig. (two tailed)	0.831	0.092	0.570	0.177
Substance use
Correlation coefficient	−0.064	0.115	0.110	0.125
Sig. (two tailed)	0.619	0.368	0.391	0.327
Use of emotional support
Correlation coefficient	0.277*	0.164	0.129	0.266*
Sig. (two tailed)	0.028	0.199	0.313	0.035
Use of instrumental support
Correlation coefficient	0.408**	0.212	0.140	0.305*
Sig. (two tailed)	0.001	0.096	0.275	0.015
Behavioral disengagement
Correlation coefficient	0.137	0.153	0.275*	0.220
Sig. (two tailed)	0.284	0.231	0.029	0.083
Venting
Correlation coefficient	0.215	0.190	0.231	0.289*
Sig. (two tailed)	0.091	0.136	0.069	0.022
Positive reframing
Correlation coefficient	0.391**	0.480**	0.361**	0.411**
Sig. (two tailed)	0.002	0.000	0.004	0.001
Planning
Correlation coefficient	0.073	0.232	0.207	0.271*
Sig. (two tailed)	0.569	0.067	0.104	0.032
Humor
Correlation coefficient	−0.159	0.074	0.261*	0.106
Sig. (two tailed)	0.214	0.564	0.039	0.409
Acceptance
Correlation coefficient	0.330**	0.158	0.145	0.382**
Sig. (two tailed)	0.008	0.216	0.258	0.002
Religion
Correlation coefficient	0.164	0.223	−0.185	0.198
Sig. (two tailed)	0.199	0.078	0.148	0.119
Self-blame
Correlation coefficient	−0.140	−0.123	−0.072	−0.113
Sig. (two tailed)	0.275	0.336	0.575	0.377

*Correlation is significant at the 0.05 level (two tailed); **Correlation is significant at the 0.01 level (two tailed). Sig. (2- tailed) values which are less than 0.05 (P>0.05), are statistically significant and hence put in BOLD

Use of emotional support and use of instrumental support were positively correlated with QOL in the domains of physical health and environment. Analysis showed that use of planning as a skill was positively correlated with the domain of environment (r = 0.271, P = 0.032). Moreover, there was also a significant positive correlation of acceptance with the domains of physical health (r = 0.330, P = 0.008) and environment (r = 0.382, P = 0.002).

DISCUSSION

There has been a dearth of studies in India regarding rape victims, and there is hardly any study which dealt with the coping styles and QOL of rape victims. Thus, this study is of special significance in advancing our scientific knowledge in the psychological management and rehabilitation of rape victims. In our study, the mean age of the victims was 16.33 years, with the most affected age group being 15–18 years (37%). This is in contrast to the study conducted in Delhi by Suri, where the age group most affected by rape was 11–15 years.[12] Other studies have indicated that 40.70% of victims of sexual assault are in the age group of 13–20 years.[13,19] The educational background of the victims in our study revealed that most of them were educated till higher secondary, which is interesting to note as Kerala is one among the most literate states of India, in comparison to studies conducted in Delhi where the majority of the victims were illiterate or had an education below 10^th standard.[12,13]

Most of the victims were from the lower socioeconomic background, which is in accordance with that seen in other states also.[12]

To our knowledge, there has been no previous study on the coping methods employed by rape victims and their association with their QOL. We were able to discover that most of the victims employed more of adaptive coping skills (active coping, use of emotional support, use of instrumental support, positive reframing, planning, acceptance) and they showed significantly better QOL than those with maladaptive or avoidant skills.

Coping skills are necessary to deal with human crisis, and an analysis of the different skills employed by rape victims helps us to understand how they recover from a life-changing event. The psychological work includes liberating oneself from the fears caused by the rape, acknowledging and bearing the pain caused by the rape, and attaining control of one’s life again. Hence, coping skills and adequate social support systems are also required. Lack of support can lead to self-destructive behavior.

Sexual assault is a neglected public health issue in most of the developing countries, and those that get reported account for an even smaller percentage.[19]

In our study, we found that most of the rape victims employed adaptive coping skills, which also was significantly related to their QOL. This is in stark contrast to the study from USA by Dickinson et al.[20] According to this study done in South Alabama, USA, where sexual assault victims were assessed for their health-related QOL and sexual assault, it was found that a history of sexual abuse was associated with substantial impairment in health-related QOL and a greater number of somatized symptoms, medical and psychiatric problems, and diagnoses. In their study, sexual abuse was a significant predictor of high negative scores on the health survey, social functioning, and QOL indicators.[20] Female participants with a history of sexual abuse had more physical and psychiatric diagnosis with lower QOL than those who did not have a history of sexual abuse.

This difference could be from the fact that a lot of work has been done at the grassroot level in the society for rehabilitation of rape victims in Kerala, segregating them from their abusive circumstances and taking care of their basic needs and education. Women and child care homes (formerly known as Nirbhaya homes) were created under the services of the Department of Women and Child Development of the Government of Kerala in 2013, with the first home being started in the district of Thiruvananthapuram. There are a total of 13 such homes in the state of Kerala to provide shelter to the victims of sexual abuse and human trafficking.[21] Children less than 12 years of age who experience sexual abuse are rehabilitated in save our souls (SOS) model shelter homes. Victims of sexual assault whose cases have been registered under the Protection of Children from Sexual Offences Act, 2012 and those children who have been assessed by the Child Welfare Committee members to have an unsupportive and abusive environment at home, based on complaints received by the police, are brought to these child care homes. All the basic needs including the education of the children are taken care of by the care homes. Moreover, every home is equipped with the services of a psychologist and a legal counselor, who provide counseling and life skill training. This helps in increasing their resilience and instilling hope in them after their trauma.

What we observed is that when these victims are given opportunities to thrive, they fare better than what their circumstances would allow them to. A comprehensive, integrated, and multidisciplinary approach to help these victims is mandatory for their rehabilitation and reintegration into the society.

Rape survivors do have long-term consequences of their trauma, and we, the Indian society, should be better equipped for their seamless integration back to the society. This can only happen if we collectively acknowledge their struggles and give them proper intervention to address the trauma they face.

We hope this study paves the way for future research from other districts of Kerala and other states of India too, where the relationship between specific risk factors and long-term consequences of abuse, different symptom patterns that emerge consequently, and possible mediating factors can be studied.

This current system of child care homes where rape survivors are stabilized away from their homes after the trauma is beneficial in terms of their physical, social, and psychological health, as evidenced by our study. With proper support and participation, these victims can lead better, bright lives, becoming highly competent in their professional and personal lives, not dictated by their past trauma.

Limitations

Since this study involves rape survivors in Thiruvananthapuram district, Kerala, it is limited to a particular section and state, and hence, there is a limitation in generalizing the study findings to the population. Replication of the study in different states all over India could lead to a better generalizability. No control group was included, so a comparison with age- and sex-matched individuals was not possible. Since causal association cannot be inferred from a descriptive study, longitudinal studies are required to overcome this limitation.

CONCLUSION

This study showed that coping skills employed by the rape victims are correlated to the QOL, with those who employed adaptive coping skills (active coping, use of emotional support, use of instrumental support, positive reframing, planning, acceptance) showing significantly better QOL than those who employed maladaptive skills. Although the sample size is only 63, it is a significant number considering the difficulties in accessing and communicating with rape victims in India. This study gives valuable insights into the psychological sequelae of rape in our country.

Suggestions

This study provides some valuable implications and suggestions for future research, which are as follows:

• Study sample size can be increased to include all the other districts of Kerala, to be able to generalize the findings.

• A follow-up study can be done focussing on their progress over the years and comparing their QOL.

• A comparison study with age- and sex-matched controls would help in exploring the differences in coping skills employed.

• Different specific variables can be studied, like aspects of mental and social health, including the long-term consequences of the trauma, such as posttraumatic stress disorder.

• A better appreciation of the long-term effects of several types of abuse on the psychological and physical health could lead to productive interventions aimed at improving the QOL of these victims.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.