Sexual violence and suicidal ideation among French adults, a mediation analysis
Abstract Objectives Sexual violence against women is endemic and is linked with a host of mental health problems and suicidal behaviour. We test whether sexual violence is more prevalent and have more damaging psychological effects among women compared to men, and quantify its mediating role in the association between sex and suicidal ideation and behaviour. Methods We used data from the “Health Barometer” (Baromètre Santé) 2017 a cross-sectional phone survey, which recruited a nationally representative sample of French adults aged 18 to 75 years in 2017 (n = 25319). Data were weighted to be representative of the French adult population. Outcomes included suicidal ideation, imagery of suicide, and suicide attempts in the preceding year. We conducted mutlivariable mediation analysis using the counterfactual approach to evaluate the contribution that lifetime sexual violence has in the association between sex and suicidal ideation and behaviour. Results We found that women are five times more likely to have experienced sexual victimisation, and are more at risk of any suicidal ideation and imagery of suicide in the preceding year compared to men. Women and men had comparable rates of suicide attempts in the preceding year. We estimated that 47% of the increased risk of suicidal ideation in the preceding year women have compared to men is mediated by lifetime sexual assault. Lifetime sexual assault also explained 39% of the association between sex and having imagery of suicide. Discussion Our findings reiterate the importance of the prevention of sexual violence and an adequate care for sexual assault victims, especially women, in public health and mental health policies and initiatives. Key messages Women are five times more likely to have experienced sexual victimisation compared to men, and are more likely to suffer from suicidal ideation in the preceding year. Experience of lifetime sexual violence contributes substantially (around 50%) to women’s increased likelihood of suicidal ideation compared to men.