An Exploratory Mediation Analysis of Sexual Assault Experiences, Depression, and Heavy Substance Use

Abstract Background The experience of sexual assault has been demonstrated to be associated with numerous adverse outcomes, including depressive disorders and heavy substance use. The present study sought to examine the relationship between heavy substance use and depression among sexual assault victims. Methods We used nationally representative data from the German Health and Sexuality Survey (GeSiD) with N = 4,955 women and men aged 18-75 years. We assessed (i) the potential effect of sexual assault experience on depression mediated by hazardous alcohol, heavy tobacco, and frequent cannabis use and (ii) sexual assault experience on heavy substance use mediated by depression using logistic regression analysis to estimate proportion mediated (PM). Results We found some evidence of mediation between lifetime sexual assault and depression by heavy tobacco use (PM = 1.6%) and frequent cannabis use (PM = 14.7%) among women. We also observed mediation by hazardous alcohol use (PM = 35.5%) and heavy tobacco use (PM = 48.6%) among men who experienced childhood sexual assault. Focusing on depression as a potential mediator, we found some evidence of mediation between lifetime sexual assault and heavy tobacco use among women (PM = 17.6%) and men (PM = 13.3%), and between lifetime sexual assault and frequent cannabis use among women (PM = 26.9%). Conclusions The findings of this study suggest that public health specialists, clinicians, and therapists should develop early interventions to prevent addiction and the development of depression after experiencing sexual assault. Key messages • The study reveals that sexual assault is linked to depression and heavy substance use, with alcohol and tobacco use identified as significant mediators, especially among men and women. • Early interventions are vital for clinicians and therapists to prevent addiction and depression in sexual assault survivors, highlighting the need for targeted support in this vulnerable group.