October 03, 2018
4 min read

Sexual harassment, assault associated with poor CV, mental health in women

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Midlife women who report experiencing workplace sexual harassment are more than twice as likely to develop stage 1 or 2 hypertension and clinically poor sleep vs. women not experiencing such behavior, whereas women who report sexual assault are more likely to develop depression and anxiety compared with women who have not been sexually assaulted, according to findings published in JAMA Internal Medicine and presented at the North American Menopause Society annual meeting.

Rebecca Thurston
Rebecca Thurston

“It is widely understood that sexual harassment and assault can impact women’s lives and how they function, but this study also evaluates the implications of these experiences for women’s health,” Rebecca Thurston, PhD, professor of psychiatry, psychology and epidemiology at the University of Pittsburgh, said in a press release announcing the findings.

Thurston and colleagues analyzed data from 304 nonsmoking women aged 40 to 60 years who were free of cardiovascular disease at baseline, recruited from the Pittsburgh area (mean age, 54 years). Women completed the Brief Trauma Questionnaire developed for the Nurses’ Health Study II, which assessed workplace sexual harassment and sexual assault, as well as the Center for Epidemiologic Studies Depression Scale, the Spielberger State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Researchers also measured seated blood pressure, BMI, height and weight.

CV, mental health risks

Within the cohort, 58 women (19%) reported a history of workplace sexual harassment and 67 (22%) reported a history of sexual assault, whereas 30 (10%) reported a history of both harassment and assault.

Women with a history of sexual harassment had a higher systolic BP, marginally higher diastolic BP and poorer sleep history vs. women not reporting workplace sexual harassment. Among women not taking antihypertensive medications, researchers found that harassment was associated with a higher likelihood for developing stage 1 or stage 2 hypertension vs. women not reporting workplace harassment (OR = 2.36; 95% CI, 1.1-5.06), as well as poor sleep consistent with clinical insomnia (OR = 1.89; 95% CI, 1.05-3.42).

Women reporting a history of sexual assault were more than twice as likely to develop clinically elevated depressive symptoms (OR = 2.86; 95% CI, 1.42-5.77), anxiety (OR = 2.26; 95% CI, 1.26-4.06) and poor sleep (OR = 2.15; 95% CI, 1.23-3.77). Associations persisted after adjusting for age, race, education and BMI.

The researchers noted that women with a history of workplace sexual harassment tended to have a higher education level but reported more financial strain.

“Why more highly educated women in the present study were more likely to be harassed is unclear,” the researchers wrote. “These women may more often be employed in male-dominated settings, be more knowledgeable about what constitutes sexual harassment or be perceived as threatening; sexual harassment is an assertion of hierarchical power relations.”

Addressing the issue

In an interview, Thurston said it is imperative that providers initiate a conversation about sexual harassment and assault with their patients while also creating an environment of trust and respect.

“What we are learning more and more is that when you ask women about issues of sexual violence, they may or may not tell their providers,” Thurston told Endocrine Today. “It really depends on her level of comfort with her provider. Forming a good, trusting relationship is number one. Ask all women about these experiences, with no racial or economic boundaries, and then make information about this available to everybody.”

Additionally, availability of on-site mental health care can also help improve women’s health, Thurston said.

“Increasingly, we’re moving toward these integrated care models where we have behavioral health providers embedded within primary care clinics,” Thurston said. “I’m a psychologist, and I work within a gynecology clinic. It’s crucial, so women don’t have another step to go through.

“We need a societal shift,” Thurston said. “The burden should not just be on the woman who is the recipient of this violence or harassment. We need to do a better job of educating our men and boys as well. I think we’re getting there, but we have more work to do.”

JoAnn Pinkerton, MD, FACOG, NCMP, professor of obstetrics and gynecology at the University of Virginia Health system and executive director of the North American Menopause Society (NAMS), said sexual assault and sexual harassment are risk factors for women’s health and both must be assessed during history taking, recognizing that past traumatic events affect health as women age.

JoAnn Pinkerton

“We need to ask about sexual assault and sexual harassment and its occurrence needs to be taken into account for health risks of women,” Pinkerton told Endocrine Today. “The limitations of the study are the small numbers, and that lack of diversity limits generalizability about frequency and health risks which are likely to be greater in more racially diverse and economically stressed women.”

This year, NAMS will conduct a panel on trauma-informed care, Pinkerton said, to help menopause specialists know how to ask about trauma and learn how to assess potential long-term medical effects and find local resources to help women begin to deal with such issues. – by Regina Schaffer


Presented at: North American Menopause Society Annual Meeting; Oct. 3-6, 2018; San Diego.

Thurston RC, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.4886.

For more information:

JoAnn V. Pinkerton, MD, FACOG, NCMP, can be reached at Division of Midlife Health, University of Virginia Health System, Charlottesville, VA 22908; email: pinkerton@menopause.orgRebecca C. Thurston, PhD, can be reached at University of Pittsburg, Department of Psychiatry, Room 206, Pittsburgh, PA 151218; email: thurstonrc@upmc.edu.

Disclosure: Thurston reports she has consulted for MAS Innovations, Procter & Gamble and Pfizer.


Presented at: North American Menopause Society Annual Meeting; Oct. 3-6, 2018; San Diego.

Thurston RC, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.4886.

Disclosure: Thurston reports she has consulted for MAS Innovations, Procter & Gamble and Pfizer.