Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms

Nord J Psychiatry. 2021 Jul;75(5):370-377. doi: 10.1080/08039488.2020.1868573. Epub 2021 Jan 11.

Abstract

Background: Sexual abuse is associated with severe health consequences, and the European Union has, through the Istanbul Convention, urged its member countries to provide specialist care for victims of sexual abuse.

Aim: This aim of this study was to investigate patient- and abuse-related characteristics among patients seeking help at a specialist clinic in Sweden, with focus on disclosure, mental health and appropriate healthcare access.

Methods: This is a descriptive study where journal data from 100 consecutive patients January 2017 to February 2018 were analyzed. All adult individuals (women n = 80, men n = 8) who had taken part in the standardized semi-structured intake interview at the clinic were included (n = 88).

Results: At admission, mean age was 40.3 (SD 11.9), mean number of psychiatric diagnoses 6.3 (2.6), and 93% of the patients scored above cut-off (≥34) on IES-R for PTSD. A majority of the patients (87%) had been exposed to childhood sexual abuse (CSA), and mean time to first disclosure was 15.9 (SD 15.3) years. In total, 82% of the patients had, despite disclosure, experienced difficulties accessing appropriate healthcare before coming to the specialist clinic.

Conclusion: Adult victims of sexual abuse have difficulties accessing appropriate healthcare. This constitutes a gender-based equality problem. A model of gatekeeping mechanisms with two dimensions (external and internal) and three categories (Competence related, Organizational and Emotional) is proposed to understand these difficulties.

Keywords: PTSD; Sexual abuse; disclosure; gatekeeping; healthcare access.

MeSH terms

  • Adult
  • Child
  • Child Abuse*
  • Child Abuse, Sexual*
  • Crime Victims*
  • Female
  • Gatekeeping
  • Health Services Accessibility
  • Humans
  • Male
  • Sweden