Mental health of students in higher education

College Report CR166the first, the victim is physically forced into a sexual act. In the second, sheis incapacitated by being intoxicated with drugs or alcohol. The substancemay be taken voluntarily or administered surreptitiously by the perpetrator.It is well known that sexual assault in childhood or adolescence is associatedwith a higher risk of sexual assault in adult life (van der Kolk, 1989). Thisstudy was based on an online survey of over 5000 women undergraduates.The researchers found that experience of physically forced sexual assaultbefore starting college was associated with a substantially increasedrisk (nearly sevenfold) of forcible assault while at college. Incapacitatedassault before starting college was similarly associated with a higher riskof incapacitated assault as a student. Use of marijuana and getting drunkincreased the risk of incapacitated assault but not forcible assault. It wasfurther revealed that 16.5% of women students had been threatened orhumiliated and 5.7% had been physically hurt by an intimate partner. Insome of these women, forced sexual assault was a repeated event.McCauley et al (2009) carried out a survey of 1980 women studentsaged 18–34 years. In 11.3% of the sample a lifetime history of rape wasreported. As in the Krebs et al study, incapacitated rape, but not forciblerape, was associated with drug use and binge drinking. Messman-Mooreet al (2005) found that the presence of symptoms of post-traumaticstress disorder (PTSD) was associated with an increased risk of rape. Theysuggested that one reason why women with a history of sexual abuse orassault may be at risk is because they use alcohol or drugs as a way ofalleviating the distress caused by PTSD symptoms.Amar & Gennaro (2005) studied the prevalence of violence perpetratedby intimate partners in a cohort of college women aged 18–25 years in theUSA and the relationship between this and psychiatric morbidity. ‘Violence’embraced psychological abuse, intimidation, threats and coercion as wellas physical violence. Seventy per cent of the sample was Black, althoughthere was no difference in race between victims and non-victims of violence.Psychiatric morbidity was assessed by the SCL-90. Some form of violencehad been experienced by 48% of the cohort and of these, a third reportedphysical injury. In 13% of those reporting physical injury, this was describedas ‘severe’. Scores on the SCL-90 were higher in victims of violencecompared with non-victims and higher still in those who had been subject tomultiple forms of violence.Stepakoff (1998) surveyed a cohort of female undergraduate students.Participants completed self-report measures of sexual victimisation,hopelessness, suicidal ideation and suicidal behaviour. Adult sexualvictimisation predicted current hopelessness and suicidal ideation. Bothchildhood sexual abuse and adult sexual victimisation predicted suicidalbehaviour. One in four victims of rape, in contrast to approximately one in20 women who had not been victims, had engaged in a suicidal act.Changes over timeAs mentioned earlier, there is a widespread perception that levels ofdisturbance exhibited by clients at student counselling services haveincreased in recent decades. This has been noted both in the UK and theUSA. This observation raises a number of important questions. The first iswhether the prevalence of psychiatric disorders is increasing or whetherthere is a change in the numbers of students seeking help from counsellingand other services. If the latter, the question then arises as to whether this30 http://www.rcpsych.ac.uk