Sexual harassment, sexual violence, and mental health outcomes: causal inference with ambiguous exposures

Social exposures and their impact on mental health have proven hard to capture, partly owing to the complex and multifaceted nature of social reality. Sexual harassment and sexual violence (SHV) are no exceptions. Sexual harassment and sexual violence can be conceptualized as a continuum of negative sexual experiences whose severity vary depending on multiple determinants. Furthermore, SHV can be conceptualized as either discrete events or as a generally hostile sexual environment represented by latent variables. With any of these conceptualizations, SHV constitutes a broad construct containing many kinds of negative experiences. This ambiguity poses challenges for determining mental health consequences, because different forms of SHV may vary in terms of their mental health impact. We discuss different conceptualizations of SHV relative to mental health outcomes through the lens of the potential outcomes framework, with a focus on the consistency condition. The multiple versions of treatment theory is presented to show how to provide formal interpretations of causal estimates under ambiguous exposures. Last, we provide suggestions on how the increase the clarity and interpretability of the effects of SHV on mental health by increasing the precision of the causal questions and the use of more specific definitions of SHV. This article is part of a Special Collection on Methods in Social Epidemiology.