The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women.

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Published in final edited form as: J Interpers Violence. 2021 Jul 6;37(19-20):NP17325–NP17343. doi: 10.1177/08862605211028006 The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women Kate Walsh 1 , Amanda K Gilmore 2 , Simone C Barr 3 , Patricia Frazier 4 , Linda Ledray 5 , Ron Acierno 6 , Kenneth J Ruggiero 7 , Dean G Kilpatrick 7 , Heidi S Resnick 7 Author information Article notes Copyright and License information 1 University of Wisconsin-Madison, WI, USA 2 Georgia State University, Atlanta, GA, USA 3 Ralph H. Johnson VA Medical Center, Charleston, SC, USA 4 University of Minnesota, Minneapolis, MN, USA 5 SANE SART Resource Service, Minneapolis, MN, USA 6 University of Texas Health Science Center, Houston, TX, USA 7 Medical University of South Carolina, Charleston, SC, USA ✉ Corresponding Author: Kate Walsh, University of Wisconsin-Madison, WI 53706, USA., klwalsh2@wisc.edu Issue date 2022 Oct. PMC Copyright notice PMCID: PMC13221724  NIHMSID: NIHMS2171347  PMID: 34229508 The publisher's version of this article is available at J Interpers Violence Abstract Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures. Keywords: race/ethnicity, rape, discrimination, post-traumatic stress disorder, depression Introduction Nearly 20% of women in the United States will experience a rape during her lifetime, and 36.3% will report contact sexual violence ( Smith et al., 2017 , 2018 ). Rape refers to unwanted or nonconsensual oral, anal, or vaginal penetration obtained due to force or drug or alcohol facilitation whereas contact sexual violence also includes sexual coercion (e.g., verbal coercion/pressure) and unwanted or nonconsensual sexual touching ( Smith et al., 2017 , 2018 ). Meta-analyses highlight strong associations between exposure to sexual violence and mental health and substance use problems and disorders, including post-traumatic stress disorder, depression, and substance use disorders ( Dworkin et al., 2017 ). When victim medical costs, lost work productivity for victims and perpetrators, and criminal justice costs are considered, sexual violence exacts a U.S. population economic toll in excess of $3 trillion over the course of victims’ lives ( Peterson et al., 2017 ). Programming to prevent sexual violence and treat survivors when exposed is of paramount importance. Women of color are at high risk for sexual violence ( Smith et al., 2017 ). Indeed, nearly half of multiracial women (49.5%), 45.6% of American Indian women, and more than one-third (35.5%) of non-Hispanic Black women report lifetime exposure to sexual violence ( Smith et al., 2017 ). Women of color may experience high rates of sexual violence due to their multiple, marginalized identities. Specifically, the concept of intersectionality, coined by Kimberle Crenshaw (1989 , 1991 ) and explicated by Black feminist groups including the Combahee River Collective (1977) , is germane to the study of violence against women of color, who are targeted based on both gender and race. Drawing on Patricia Hill Collins’ (2017) work on violence and intersectionality, Armstrong et al. (2018) highlighted sexual violence as a mechanism of inequality and oppression wherein the experiences of women of color are often silenced, marginalized, and ignored. Loya (2014) also described how income- and asset-poverty increased risk for sexual violence among Latina and Black women, and sexual violence in turn increased poverty via psychological consequences and disruptions in income. Indeed, women of color with sexual violence histories experience a higher prevalence of post-traumatic stress disorder (PTSD), depression, and substance use problems and disorders compared to White women (e.g., Bryant-Davis et al., 2010 ; Lindquist et al., 2013 ; Wadsworth & Records, 2013 ; Walsh et al., 2014 ). The Self-medication Hypothesis of Substance Use, which suggests that people use substances to cope with psychological distress ( Khantzian, 1997 ), has frequently been cited to understand the link between mental health and substance use disorders in trauma-exposed populations (e.g., Brady et al., 2004 ). Partly consistent with this theory, recent evidence suggests that sexual violence is associated with physical health and drinking problems among Black women through PTSD and depression, respectively; these same pathways do not emerge for white women ( Pegram & Abbey, 2019 ). Intergenerational trauma, racism, sexism, and poverty have been shown to heighten mental health and substance use problems following sexual violence ( Bryant-Davis et al., 2009 , 2010 ), and racial and ethnic minority women face greater barriers to help-seeking ( Loya, 2014 ; Tillman et al., 2010 ; Ullman & Lorenz, 2020 ; Weist et al., 2014 ). For example, Black women are blamed more for their assaults and are less likely to disclose their assault experiences, which may preclude them from accessing health care services ( Donovan & Williams, 2002 ). Additionally, although American Indian survivors of sexual violence have high rates of help-seeking, they are more likely to seek traditional Native healing (77.4%) than counseling (50.9%; Evans-Campbell et al., 2006 ), suggesting that culturally sensitive services for survivors are critically important. Moreover, financial barriers to health care access have been associated with poorer physical and mental health among African American and Latina women with sexual assault experiences ( Fedina et al., 2020 ; Loya, 2014 ). The minority stress hypothesis posits that experiences of prejudice and discrimination, socioeconomic disparities, and limited access to health care are chronic and cumulative stressors experienced by people of color that result in long-term health disparities (e.g., Williams, 1999 ). Discrimination refers to unfair treatment experienced on the basis of one’s marginalized identity or identities including race, ethnicity, culture, gender, sexual orientation, or ability. Although discrimination experiences have been associated with poorer mental and physical health and diminished well-being more broadly ( Clark et al., 2015 ; Jackson et al., 2012 ; McClendon et al., 2019 ; see Vines et al., 2017 , for review), recent data have shown that a higher frequency of discrimination experiences was specifically associated with PTSD diagnostic status, but not with other mood and anxiety disorder diagnoses, in African American and Latinx adults with anxiety disorders ( Sibrava et al., 2019 ). Pretrauma exposure to racial discrimination also has been found to predict the development of PTSD symptoms following traumatic injury ( Bird et al., 2021 ). Additionally, discrimination frequency has been indirectly associated with PTSD symptom severity via emotion dysregulation ( Mekawi et al., 2020 ). To our knowledge, however, associations between discrimination and mental health symptoms and substance use problems have not been examined among recent rape victims. Racial and ethnic minority groups are more likely to drop out of trauma treatment (e.g., Lester et al., 2010 ), and as noted previously, sexual violence survivors of color experience greater barriers to accessing services in the aftermath of an assault ( Loya, 2014 ; Tillman et al., 2010 ; Ullman & Lorenz, 2020 ; Weist et al., 2014 ). Despite increased attention to personalized medicine approaches for the treatment of PTSD (e.g., Nicholson et al., 2020 ), there is limited understanding of how secondary prevention programming could be tailored for sexual violence survivors of color. Understanding whether and how discrimination experiences are associated with postrape adjustment among survivors of color can inform culturally sensitive early intervention and treatment programming. This secondary analysis of existing data ( Gilmore et al., 2021 ; Walsh et al., 2017 ) examined racial and ethnic differences in discrimination experiences and frequency and associations with mental health and substance use problems among female recent rape survivors presenting to the emergency department (ED) for a Sexual Assault Forensic Medical Exam (SAMFE). Based on prior literature ( Krieger et al., 2005 ), it was hypothesized that Black women would report the highest frequency of discrimination experiences relative to other groups. Additionally, it was hypothesized that more frequent exposure to discrimination would be associated with greater PTSD and depression symptoms and greater alcohol and drug problems (see Vines et al., 2017 , for review). Methods Participants Participants were 139 Black, American Indian, Hispanic, or mixed race girls and women age 15 and older drawn from a larger sample of girls and women who presented to the ED for a SAMFE and completed follow-up phone interviews about mental health symptoms, substance use, and discrimination experiences six months after the assault. The current study focused on racial and ethnic minority women because we were specifically interested in the relations between racial discrimination and PTSD, depression, and substance use symptoms. Data from the six-month interview were analyzed here because the discrimination measure was only administered at this time point. The mean age of the sample was 26.78 ( SD = 9.85) years. Approximately 48.2% ( n = 67) identified as non-Hispanic Black, 18.7% ( n = 26) as American Indian, 17.3% ( n = 24) as non-Hispanic mixed race, and 15.1% ( n = 21) as Hispanic. The majority of women (72.7%; n = 64) were single, although 15.9% ( n = 14) were married/cohabitating, and 11.4% ( n = 10) were divorced, separated, or widowed. Most participants (73.6%) made less than $25,000 annually, 33.1% were employed outside the home, and 66.9% had completed high school and at least some college. Intervention conditions As described elsewhere ( Gilmore et al., 2021 ; Walsh et al., 2017 ), the parent study recruited and randomly assigned 233 girls and women to one of three conditions at the ED: Prevention of post-rape stress (PPRS), pleasant imagery and relaxation information (PIRI), and treatment as usual. The PPRS is a 9-minute video designed to reduce avoidance and promote healthy coping behaviors, the PIRI is a 9-minute relaxation video used as an active control, and treatment as usual involved typical care by a nurse examiner. There were no significant differences in racial/ethnic composition across the study conditions, χ 2 (8, N = 139) = 5.53, p = .70; however, all multivariate analyses controlled for study condition to ensure that it did not influence findings. Demographics Participants were asked about age (years), race (Black, White, Asian, Native American [American Indian throughout the manuscript to reflect preferred terminology], mixed race) and ethnicity (Hispanic, non-Hispanic), marital status (married/cohabitating vs. single/divorced/ separated/widowed), years of education (<high school (HS) diploma, HS diploma/some college, college or beyond), household income (<$25,000, $25–50,000, >$50,000), and employment outside the home (yes/no). PTSD symptoms Past two-week PTSD symptoms were assessed in response to the rape for which participants sought a medical exam using the Post-traumatic Diagnostic Scale (PDS; Foa et al., 1997 ). The PDS assesses the frequency of symptoms using 17 items rated from 0 ( not at all or only one time ) to 3 ( 5 or more times a week/almost always ); total scores range from 0 to 51. Scores on the PDS have shown good internal consistency in past research ( Foa et al., 1997 ) and in the current sample (α = .92). Depression symptoms The 10-item Center for Epidemiologic Studies Depression Scale (CES-D; Andersen et al., 1994 ; Radloff, 1977 ) was used to assess past-week symptoms of depression. The CES-D has good psychometric properties, including strong internal consistency (α = .89) and good sensitivity in screening for depression ( Björgvinsson et al., 2013 ). Cronbach’s alpha was .91. Alcohol use problems The 10-item Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993 ) assessed drinking problems since the index rape. The AUDIT has good psychometric properties ( de Meneses-Gaya et al., 2009 ). Cronbach’s alpha was .91. Drug use problems The 10-item Drug Abuse Screening Test (DAST) ( Skinner, 1982 ) quantified drug use problems since the index rape. The DAST has moderate to high levels of reliability, validity, sensitivity, and specificity ( Yudko et al., 2007 ). Cronbach’s alpha was .86. Experiences of discrimination The Experiences of Discrimination scale (EOD; Krieger et al., 2005 ) consists of the stem question “Have you ever experienced discrimination, been prevented from doing something, or been hassled or made to feel inferior in any of the following situations because of your race, ethnicity, or color?” followed by nine situations: getting hired or getting a job; at work; getting housing; getting medical care; getting service in a store or restaurant; getting credit, bank loans, or a mortgage; on the street or in a public setting; from the police or in the courts. For each “yes” response, a follow-up item was administered asking how many times this happened (“once,” “two or three times,” or “four or more times”). The measure yields a count score of situations in which the respondent has experienced discrimination (α = .81) and a frequency score of discrimination experiences (α = .79-.86) and has been found to have strong validity ( Krieger et al., 2005 ). Kuder-Richardson-20 was .83 for the count score and Cronbach’s alpha was .84 for the frequency score. Procedures The larger trial from which these data are drawn is registered at clinicaltrials.gov under the registration number ( NCT01430624 ) and includes protocol information. Procedures were approved by two University and two affiliated hospital Institutional Review Boards. Between May 2009 and December 2013, girls and women who presented for a SAMFE were approached by a trained about participation in the study. Eligible and interested individuals provided written informed consent to participate in the study and allow access to both medical records and self-report data collected via follow-up phone interviews. Participants were randomly assigned to one of three intervention conditions during their ED visit and notes from their SAMFE records were used as baseline data for the larger study. All data for the current analysis was collected during three structured telephone follow-up phone interviews targeted at 1.5, 3, and 6 months post-SA conducted by Counseling Psychology doctoral students who were masked to study condition. Analytic Plan Data screening and descriptive analyses were conducted in SPSS, version 27 and multivariate analyses were conducted in Mplus, version 8.0. Preliminary analyses revealed that PTSD, depression, alcohol, and drug problems were not above thresholds for skew and kurtosis and thus were treated as normally distributed. There were no differences in six-month follow-up completion by race/ethnicity, χ 2 (1, N = 139) = 8.88, p = .06, nor by age, marital status, years of education, income, or employment (all p s > .05). To test the first hypothesis that Black women would report discrimination in more situations and a greater frequency of discrimination compared to other racial and ethnic groups, a regression analysis simultaneously predicting the discrimination count and frequency scores from the three dummy coded race variables (with Black participants as the reference group) was conducted in Mplus version 8.0. The discrimination count variable was treated as a count outcome variable and allowed to covary with discrimination frequency. To test the second hypothesis that discrimination frequency would be positively associated with PTSD, depression, and alcohol and drug problems, a regression model simultaneously predicting mental health and substance use problems from discrimination frequency was estimated. To account for missing data in our intent-to-treat analyses, Full Information Maximum Likelihood estimation, which is asymptotically equivalent to multiple imputation ( Graham, 2009 ), was used. Demographic characteristics that were significantly associated with the dependent variables at the bivariate level were included as covariates in multivariate models. Dependent variables were allowed to covary in models. Results Table 1 depicts bivariate correlations between demographic characteristics, discrimination count and frequency scores, PTSD symptoms, depression, alcohol problems, and drug problems for racial or ethnic minority women. Age was significantly positively associated with PTSD, depression, and alcohol problems, education was significantly negatively associated with PTSD and depression, and employment was significantly negatively associated with drug problems. Age, education, and employment were thus included in multivariate models below. The discrimination count and discrimination frequency scores were both positively associated with PTSD and depression and nearly perfectly correlated with one another ( r = .95, p < .001); however, neither was associated with alcohol or drug problems. PTSD was also positively associated with alcohol problems. Table 1. Correlations Among Study Variables for Racial and Ethnic Minority Women ( N = 139). 2 3 4 5 6 7 8 9 10 11 1. Age −.26 ** −.04 .07 .12 .13 .15 .24 * .26 ** .21 * .09 2. Married – −.07 −.08 −.03 −.01 −.01 .02 .14 −.04 −.004 3. Employed – .23 * .25 ** −.09 −.13 −.17 −.13 −.06 −.20 * 4. Education – .33 ** −.001 −.04 −.21 * −.20 * −.15 −.07 5. Income – −.18 .10 −.09 −.16 −.08 −.13 6. Discrimc – .95 *** .22 * .23 * .03 .14 7. Discrimf – .29 ** .28 ** .01 .10 8. PTSD – .78 *** .23 * .07 9. Depression – .17 .07 10. Alcohol prob – .42 *** 11. Drug prob – Open in a new tab Note . * p < .05 ** p < .01 *** p < .001 married/cohabitating (yes = 1; no = 0); employed (yes = 1; no = 0); education (high school education or beyond = 1, less than high school education = 0); income (<$25,000 = 1, $25,000–50,000 = 2, >$50,000 = 3); discrimc = discrimination count; discrimf = discrimination frequency. Figure 1 shows mean discrimination count and frequency scores for each racial/ethnic group. Regression analyses revealed that compared to Black women, American Indian (estimate = −.39, SE = .12, p = .001) and Hispanic (estimate = −.26, SE = .09, p = .005) women experienced discrimination in significantly fewer situations. Similarly, American Indian (estimate = −.33, SE = .12, p = .006) and Hispanic (estimate = −.28, SE = .09, p = .002) women reported a significantly lower frequency of discrimination than Black women; there were no significant differences between Black and mixed race women for discrimination count or frequency. Figure 1. Open in a new tab Mean differences in discrimination count and frequency scores reported by Black ( n = 67), American Indian ( n = 26), mixed race ( n = 21), and Hispanic ( n = 24) women. Table 2 depicts the results of a simultaneous regression analysis predicting PTSD, depression, alcohol, and drug problems from frequency of discrimination experiences, controlling for demographic characteristics, race, and intervention condition. Even after controlling for these covariates, frequency of discrimination was positively associated with both PTSD and depression. The only significant positive predictor of alcohol problems was American Indian (vs.) Black race, with American Indian women reporting more alcohol problems. When the discrimination count score was substituted for the discrimination frequency score, a nearly identical pattern of findings emerged (analyses available upon request). Table 2. Standardized Estimates From Simultaneous Multiple Regression Analyses Predicting PTSD, Depression, Alcohol, and Drug Problems From Discrimination Frequency. PTSD β ( SE ) Depression β ( SE ) Alcohol Problems β ( SE ) Drug Problems β ( SE ) Age .17 (.11) .17 (.14) .35 (.11) ** −.02 (.13) Education status −.37 (.12) ** −.35 (.12) ** −.08 (.18) .25 (.15) + Employed .10 (.13) .16 (.13) .02 (.16) −.13 (.15) Race/ethnicity American Indian vs. Black −.05 (.14) −.05 (.14) .33 (.16) * .13 (.18) Mixed race vs. Black . 25 (.13) + .24 (.12) + .15 (.15) −.06 (.10) Hispanic vs. Black .04 (.10) −.06 (.10) .16 (.11) .09 (.13) PPRS vs. TAU −.13 (.13) −.18 (.12) −.01 (.15) .04 (.14) PIRI vs. TAU −.04 (.13) −.14 (.14) −.13 (.13) .20 (.12) Discrimination frequency .34 (.14) * .31 (.15) * .12 (.16) .12 (.16) Open in a new tab Note . * p < .05 ** p < .01 + p < .10. Employed (yes = 1; no = 0); education status: high school education or beyond = 1; less than high school education = 0; PPRS = prevention of post-rape stress; PIRI = pleasant imagery and relaxation information; TAU = treatment as usual; PTSD = post-traumatic stress disorder measured by the Post-traumatic Diagnostic Scale; depression measured by the Center for Epidemiologic Studies Depression Scale; alcohol problems measured by the Alcohol Use Disorders Identification Test; drug problems measured by the Drug Abuse Screening Test. Patterns were similar when the discrimination count score was examined in place of the discrimination frequency score. Discussion The current study examined the role of race and discrimination frequency in PTSD, depression, and substance use problems among a racially diverse, primarily low-income sample of women who presented to the ED for a SAMFE and were assigned to an intervention, active control, or TAU and followed up over a six-month period. Consistent with recent work suggesting that racial discrimination is associated with PTSD ( Bird et al., 2021 ; Mekawi et al., 2020 ; Sibrava et al., 2019 ), findings revealed positive associations between the frequency of discrimination experiences and both PTSD and depression symptoms six months postrape after controlling for race, intervention condition, and other significant demographics. Contrary to our study hypotheses and to the self-medication model of substance abuse ( Khantzian, 1997 ), discrimination frequency was not associated with alcohol or drug problems in the current sample. Only identifying as American Indian was associated with reporting more alcohol problems, independent of discrimination frequency. Consistent with hypotheses, Black women reported significantly more situations in which they experienced discrimination and more frequent discrimination experiences than American Indian and Hispanic/Latina women, but they did not differ significantly from mixed race women in discrimination situations or frequency. These findings are consistent with other work finding more discrimination experiences among Black ( Krieger et al., 2005 ) and multiracial ( Jackson et al., 2012 ) community members and suggest that sexual assault programming for these groups may benefit from careful attention to and consideration of experiences of racial trauma and discrimination ( Comas-Diaz et al., 2019 ). Elements of treatment models that have been proposed to address racial trauma (e.g., Comas-Diaz, 2016 ) could be incorporated into standard trauma treatments for racially and ethnically diverse sexual assault survivors as has been done for African American adults ( Williams et al., 2014 ) and youth ( Metzger et al., 2020 ) with trauma exposure. Additionally, early interventions like the PPRS could be modified for survivors of color to address the intersection of sexual violence and discrimination experiences to maximize the effectiveness of early intervention programming. For instance, the video could describe through a feminist lens of intersectionality how discrimination and sexual violence are both tools of oppression that especially target people of color and may increase symptoms. Via collaborative work with survivors of color, culturally appropriate coping strategies could be incorporated into the video. Consistent with our hypotheses and with a larger body of research (see Vines et al., 2017 , for review), the current study found support for the role of discrimination frequency in both PTSD and depression symptoms. PTSD and depression were strongly positively correlated in our sample, which is consistent with other work among recent rape victims ( Walsh et al., 2013 ) and makes similarities in associations between discrimination frequency and both outcomes unsurprising. Prior work with African American adults suggests both indirect effects of discrimination frequency on PTSD symptoms via emotion dysregulation ( Mekawi et al., 2020 ) as well as direct effects on PTSD when examined prospectively ( Bird et al., 2021 ). Similar to this latter study, the current study observed direct relations between discrimination frequency and both PTSD and depression, suggesting that discrimination experiences may have direct associations with mental health more broadly among recent rape survivors. These results underscore a burgeoning literature documenting that discrimination experiences are cumulative stressors that can exacerbate mental health symptoms (for review, see Vines et al., 2017 ). The finding that identifying as American Indian was the only significant predictor of alcohol problems fits with work suggesting high persistent rates of alcohol use in American Indian communities as a consequence of colonialism ( Blume, 2021 ) and highlights a critical need to both address systems of oppression that perpetuate these disparities and create substance use interventions in partnership with American Indian communities that emphasize interdependent, communal values. Contrary to the self-medication model of substance use ( Khantzian, 1997 ), discrimination frequency was not associated with increased alcohol or drug problems in the current sample. Although sample sizes for within racial and ethnic group analyses were too small to examine associations separately within groups, it is possible that different racial and ethnic groups may evidence distinct relationships between discrimination experiences and mental health and substance use problems. However, it also is possible that discrimination frequency does not directly impact substance use problems but rather operates on substance use problems indirectly through mental health symptoms ( Pegram & Abbey, 2019 ). In addition to tailoring secondary prevention programming to be culturally appropriate and responsive to the ways that discrimination might impact mental health symptoms among sexual violence survivors of color, it also is important to note that nearly three-quarters of this sample made less than $25,000 annually and only one-third of the sample reported being employed outside the home, which fits with other work highlighting the role of income-poverty in risk for sexual violence ( Loya, 2014 ). These findings highlight a critical need to attend to the financial necessities of low-income sexual violence survivors of color. Policy changes suggested by Loya (2014) , including expanded victim compensation and employment protections, remain as critical today as they were when first proposed. Several limitations of the current study should be acknowledged. First, the sample size for analyses was small and comparisons between racial and ethnic subgroups should be interpreted with caution and replicated in future work. Second, aside from race/ethnicity, the current study did not collect additional information on cultural identify and significant heterogeneity may exist within particular racial or ethnic groups ( Vaeth et al., 2017 ). Third, discrimination is only one form of adversity experienced by people of color; microaggressions and other experiences of racism, oppression, and identity invalidation were not measured here and should be included in future work. We also did not assess other forms of discrimination (e.g., gender, sexuality, disability), which may be important to consider in future work. Fourth, the discrimination measure was only administered at six months postassault, which precluded a longitudinal understanding of the ways that discrimination experiences may have influenced risk for assault and coping or adjustment in the immediate aftermath of assault. Finally, although recent rape survivors represent a unique sample in which to understand these associations, findings may not generalize to all recent rape survivors as many survivors, particularly those who identify as racial or ethnic minorities, do not seek postrape services ( Lindquist et al., 2013 ; Tillman et al., 2010 ; Weist et al., 2014 ). Despite these limitations, the current study adds to a growing literature documenting the role of discrimination in risk for PTSD and extends this work by suggesting discrimination experiences may compound risk for PTSD and depression among racially and ethnically diverse women with recent rape experiences. Results also highlighted that Black women experience discrimination in more situations and with greater frequency than women from other racial and ethnic groups, with the exception of mixed-race women. Finally, this study underscores a critical need to tailor postrape early interventions designed to reduce alcohol problems to better address the needs of American Indian rape survivors. These patterns suggest that racial and ethnic minority women with recent rape experiences have heterogeneous patterns of experiences and symptoms and future work should consider how to adapt evidence-based therapies to be maximally effective at combating both racial and interpersonal trauma exposures. Acknowledgments The authors would like to thank the women who participated in the current study. Dr Kate Walsh had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The National Institute on Drug Abuse (DA023099; PI: Resnick) funded data collection for the parent project and supported the second author’s writing time (K23DA042935; PI: Gilmore). Biographies Kate Walsh , PhD, is an associate professor in the Psychology and Gender & Women’s Studies Departments at the University of Wisconsin-Madison and director of the UW-Madison Sexual Violence Research Initiative. Her interdisciplinary research program focuses on risk factors for and outcomes of sexual violence, with a focus on translating findings into effective prevention and treatment programming. Amanda K. Gilmore , PhD, is an assistant professor in the Department of Health Policy & Behavioral Sciences and the Mark Chaffin Center of Healthy Development in the School of Public Health at Georgia State University. Her research focuses on prevention of alcohol use and sexual assault, as well as secondary prevention of substance use and mental health symptoms after sexual assault. Simone C. Barr , PhD, is a staff psychologist on the Mental Health Service at the Ralph H. Johnson VA Medical Center. Patricia Frazier , PhD, is a Distinguished McKnight University Professor in the Department of Psychology at the University of Minnesota. Her research interests include using technology to develop innovative interventions for trauma survivors. Linda Ledray , PhD, founded one of the first Sexual Assault Nurse Examiner (SANE) programs at Hennepin County Medical Center in Minneapolis, MN, in 1977 and she was the program director until 2009. This model was based on both process and outcome research and is a model for hundreds of programs throughout the United States and a number of foreign countries. Dr Ledray is a retired Army Colonel and continues to work as a consultant for RTI in Raleigh, NC, on the Sexual Assault Kit Initiative funded by BJA. Ron Acierno , PhD, is a professor and vice chair of Veterans Affairs in the Department of Psychiatry and Behavioral Sciences. He also serves as the executive director of the UTHealth Trauma and Resilience Center (TRC). Dr Acierno has two related but distinct research foci: epidemiological studies of elder mistreatment and treatment outcome studies, focusing on victims of trauma, disaster, combat, or loss. He has served as Principal Investigator on grants from NIA, NIMH, NIJ, the Department of Defense, The Department of Veterans Affairs, the South Carolina Department of Public Safety, the Archstone Foundation, and the Retirement Research Foundation. Thus, Dr Acierno mixes epidemiological research with treatment outcome research, and keeps close to the clinical world as a clinician-administrator for treatment programs serving both civilian and military traumatized populations. Kenneth J. Ruggiero , PhD, is professor and SmartState endowed chair at the Medical University of South Carolina, where he serves as director of the Technology Applications Center for Healthful Lifestyles and the Trauma Resilience and Recovery Program. His work centers on improving access and quality of mental health care to vulnerable and underserved populations, particularly children and adults who have been affected by traumatic events such as disasters, serious injury, child abuse, and occupational incidents. This includes research on self-help apps for disaster victims and technology-enhanced treatments for survivors of traumatic injury. He also works with community agencies to help mental health providers improve quality of care with children. Dean G. Kilpatrick’s , PhD, primary research interests include measuring the prevalence of rape, other violent crimes, and other types of potentially traumatic events, as well as assessing PTSD and other mental health impacts of such events. Dr Kilpatrick and colleagues have conducted numerous studies on these topics, using national household probability samples of adults and adolescents. This research has been funded by the Centers for Disease Control and Prevention, NIMH, NIDA, NICHD, National Institute of Justice, and the VA. He is also the director of a large recently established National Mass Violence and Victimization Center that is designed to study and improve the nation’s capacity to respond to victims and survivors of mass violence incidents. Heidi S. Resnick , PhD, was a professor emerita at the National Crime Victims Research and Treatment Center within the Department of Psychiatry at the Medical University of South Carolina. Dr Resnick led or served as a coinvestigator on federally funded research investigating prevalence and risk factors for PTSD and other adaptations following exposure to traumatic events, with an emphasis on sexual assault. She and colleagues conducted research to develop and evaluate secondary prevention approaches that might reduce PTSD or other difficulties following exposure to traumatic events. She was an exemplary mentor and researcher and her work moved the field forward by addressing the acute needs of individuals after a sexual assault. Footnotes Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. References Andersen EM, Malmgren JA, Carter WB, & Patrick DL (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. 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