Exposure to work-related sexual violence and health

Sexual violence or harassment (henceforth referred to as sexual violence) is an important work environment problem. There has also been a substantial growth in publications focusing on associations between exposure to sexual violence and health outcomes over the past decade. In this issue of The Lancet Public Health, Svava Dogg Jonsdottir and colleagues1Jonsdottir SD Thordardottir EB Valdimarsdottir UA et al.Sexual violence in the workplace and associated health outcomes: a nationwide, cross-sectional analysis of women in Iceland.Lancet Public Health. 2024; 9: e365-e375Summary Full Text Full Text PDF Google Scholar contribute to this literature by reporting findings on exposure to sexual violence in work-related settings and a range of mental and physical health outcomes from Iceland. The study addresses health outcomes not previously examined in the literature including social phobia and self-harm, and underscores the potential pervasiveness of the problem. A strength is also that the study is based on a nationwide sample, in contrast to many previous studies which have been based on specific occupational groups or convenience samples. This work fits within the growing literature indicating associations between workplace sexual harassment and poor mental health. It also adds to previous work suggesting increased risk for sickness absence and alcohol consumption or alcohol-related morbidity and mortality.2McGinley M Richman JA Rospenda KM Duration of sexual harassment and generalized harassment in the workplace over ten years: effects on deleterious drinking outcomes.J Addict Dis. 2011; 30: 229-242Crossref PubMed Scopus (24) Google Scholar, 3Blindow KJ Thern E Hernando-Rodriguez JC Nyberg A Magnusson Hanson LL Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality: a prospective cohort study.Scand J Work Environ Health. 2023; 49: 395-404Crossref PubMed Scopus (3) Google Scholar Furthermore, Jonsdottir and colleagues suggest an association with general physical health complaints. Considering that the literature is limited regarding physical health outcomes,4Cortina LM Areguin MA Putting people down and pushing them out: sexual harassment in the workplace.Annu Rev Organ Psychol Organ Behav. 2021; 8: 285-309Crossref Scopus (77) Google Scholar a remaining question is whether experiences of sexual violence or harassment can lead to specific somatic health problems. Although some studies have linked workplace sexual harassment to cardiovascular risk factors such as high blood pressure,5Thurston RC Chang Y Matthews KA von Känel R Koenen K Association of sexual harassment and sexual assault with midlife women's mental and physical health.JAMA Intern Med. 2019; 179: 48-53Crossref PubMed Scopus (82) Google Scholar it is unclear whether workplace sexual harassment is linked to diseases such as cardiovascular disease and diabetes. More research is needed to investigate different somatic health outcomes. A key question is to what extent associations are likely to be causal. The study by Jonsdottir and colleagues is, as are many previous studies, cross-sectional and unable to determine if the assumed cause was experienced before the outcome of interest, a necessary condition for causal inference. Prospective or longitudinal studies are needed to help to establish causality. It is also possible that associations between sexual violence and many health outcomes or life style factors could be partly explained by factors such as heredity and personality traits. For example, personality traits such as neuroticism have been related to some forms of workplace harassment and associated with emotional responses in individuals exposed to stressful experiences.6Nielsen MB Glasø L Einarsen S Exposure to workplace harassment and the five factor model of personality: a meta-analysis.Personal Individ Differ. 2017; 104: 195-206Crossref Scopus (79) Google Scholar, 7Lahey BB Public health significance of neuroticism.Am Psychol. 2009; 64: 241-256Crossref PubMed Scopus (1241) Google Scholar Additionally, future work should seek to discern such potential confounding when assessing health risks, and limit selection, for understanding of causality. In interpreting the findings from Jonsdottir and colleagues it is also important to consider that the study assesses both exposure in school and work environments. Although it is valuable to assess exposure over a considerable part of the life course, associations with health outcomes might depend on the context. Work-related sexual violence appears be linked to power dynamics,8McDonald P Workplace sexual harassment 30 years on: a review of the literature.IJMR. 2012; 14: 1-17Google Scholar which could have implications for the type and duration of sexual violence experienced, and might also be addressed using workplace interventions that take such dynamics into account. For advancement in the field, there is also need for more attention to definition and operationalisation of exposure to work-related sexual violence or harassment. In the study by Jonsdottir and colleagues sexual violence is in line with certain legal definitions described as verbal or physical violence of a sexual nature.9European Institute for Gender EqualitySexual harassment.https://eige.europa.eu/thesaurus/terms/1376Date: 2024Date accessed: May 14, 2024Google Scholar This could encompass exposure to sexual coercion as highlighted by the authors, but also common conduct such as unwanted touching and repeated unwelcome requests for dates, conduct that could be categorised as unwanted sexual attention.4Cortina LM Areguin MA Putting people down and pushing them out: sexual harassment in the workplace.Annu Rev Organ Psychol Organ Behav. 2021; 8: 285-309Crossref Scopus (77) Google Scholar As in many other studies the exposure is operationalised with a self-labeling approach without a definition of sexual violence or harassment, thereby relying on the respondent's interpretation of what constitutes sexual violence or harassment. This means that several behaviours in circumstances related to work that would be considered as sexual violence from an academic perspective might not be reported as such by the respondents.10Nielsen MB Bjørkelo B Notelaers G Einarsen S Sexual Harassment: prevalence, outcomes, and gender differences assessed by three different estimation methods.J Aggress Maltreatment Trauma. 2010; 19: 252-274Crossref Scopus (76) Google Scholar By contrast to several other studies that merely focused on the workplace, Jonsdottir and colleagues focused on the work environment. They were therefore likely to capture behaviours that the respondents were exposed to in other places or circumstances such as work-related trips, travel, training, events or social activities, and work-related communications. More research should address work-related behaviours of a sexual nature, or dimensions of behaviours, that are expected to be intimidating, hostile, degrading, humiliating or offensive. Future research should also assess sexual violence or harassment in any circumstances related to work, given new widespread work arrangements and practices in working life. Non-sexual, gender-based harassment due to a person's sex or gender, or harassment that disproportionally affects a person of a particular gender, which is a common form of work-related exposure, also merit specific attention within this research field. These factors, together with increased knowledge about primary targets for prevention, might allow for workplace interventions addressing workplace violence and other gender-based harassment that are effective in maintaining health and wellbeing of the workforce. For more on equal treatment of men and women in matters of employment and occupation see http://data.europa.eu/eli/dir/2006/54/oj For more on equal treatment of men and women in matters of employment and occupation see http://data.europa.eu/eli/dir/2006/54/oj I declare no competing interests. Sexual violence in the workplace and associated health outcomes: a nationwide, cross-sectional analysis of women in IcelandIn this cross-sectional study self-reported experiences of sexual violence in the workplace were associated with several self-reported health outcomes. The findings suggest a need for targeted interventions to promote workplace safety and to mitigate adverse health implications among people who have experienced workplace sexual violence. Future research should explore factors such as the frequency, duration, and relationship dynamics of workplace sexual violence, as well as the effect on different genders and sexual orientations, to deepen our understanding of these experiences and inform effective prevention strategies. Full-Text PDF Open Access