Sexual Violence, Mental Health, and Prescription Opioid Use and Misuse

  • Anna E. Austin
    Address correspondence to: Anna E. Austin, PhD, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 421 Pittsboro Street, CB# 7445, Chapel Hill NC 27599.
    Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

    Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Nicole A. Short
    Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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      Previous research indicates that sexual violence is associated with prescription opioid use and misuse. However, this literature is limited by a lack of sex-specific analyses, an inability to establish temporality between experiences of sexual violence and prescription opioid outcomes, and little understanding of mechanisms underlying these associations.


      Data from Waves IV (2008) and V (2016–2018) of the National Longitudinal Study of Adolescent to Adult Health (N=10,685) were analyzed in March 2020. The association of sexual violence with past 30–day prescription opioid use and misuse among women and men and mediation by depression and anxiety diagnoses were examined using generalized structural equation modeling. Temporality was established using self-reported age at the first experience of sexual violence and age at first depression and anxiety diagnoses.


      Sexual violence was associated with an increased likelihood of prescription opioid use and misuse among women (OR=1.68, 95% CI=1.19, 2.39 for use; OR=1.18, 95% CI=0.95, 1.55 for misuse) and men (OR=2.37, 95% CI=1.37, 4.12 for use; OR=1.71, 95% CI=1.06, 2.75 for misuse). Among women, depression (p=0.0420) and anxiety (p=0.0450) diagnoses mediated the association with prescription opioid use, and anxiety diagnosis (p=0.0210) mediated the association with prescription opioid misuse. Among men, anxiety diagnosis (p=0.038) mediated the association with prescription opioid use, and depression diagnosis (p=0.0390) mediated the association with prescription opioid misuse.


      Secondary prevention efforts focused on evidence-based, trauma-informed behavioral health treatment among survivors of sexual violence may prevent prescription opioid use and misuse as strategies for coping with the psychological impact of these traumatic experiences.
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