Young, vulnerable , and with lasting effects.

Psychiatrist profiles victims of sexual violence based on medical records of 1.133 women treated at Unicamp

Brazil recorded a rape every six minutes in 2023, according to the Brazilian Public Security Forum – a violation with serious implications for the physical, social and psychological health of victims. The city of Campinas has a structured network to handle cases of sexual violence that includes the Special Care Outpatient Clinic of the Hospital da Mulher Prof. Dr. José Aristodemo Pinotti (Caism) at Unicamp. The medical records of 1.133 women treated between 2011 and 2018 were evaluated at the facility, which was the subject of a master's degree research by the School of Medical Sciences (FCM). The study identified the sociodemographic profile of the patients, the classification of the cases of violence and the symptoms presented.

Descriptive and quantitative statistical analysis of the data showed that most patients in the period were under 26 years old, white, single and childless, and had between 9 and 11 years of schooling and regular employment. This corroborates the fact that younger women also make up the most vulnerable group – 39% of them were teenagers.

The research also found that around one fifth of the patients (20,4%) had already suffered another type of violence and that 66% of the adolescents had no sexual experience before the crime. “What does it mean for this girl to start her sexual life in this way?”, asks the research supervisor, professor and psychiatrist Renata Cruz Soares de Azevedo.

For Maria Teresa Ferreira Côrtes, also a psychiatrist and author of the work, this reality implies thinking about a differentiated structure to serve this public and the victims' families, their support network.

Regarding the characteristics of the cases of sexual violence, the dissertation concludes that they occurred predominantly in an acute form (isolated, non-chronic event), in public environments and perpetrated by an unknown aggressor. The characteristics reveal a panorama of violence, since 88,3% of the patients reported having suffered some type of intimidation, with the use of physical force, with a firearm or a bladed weapon being common.

“We also found very high rates of anal assault [26,4%] and 13,9% of gang rapes. These are very high numbers, but unfortunately they are within the national averages,” says Côrtes.

In this context, immediate care (up to 72 hours after the occurrence) is essential for carrying out prophylaxis, preventing sexually transmitted infections (STIs) and pregnancies. “Most of our patients arrive within the first 48 hours, which is great,” reveals Azevedo.

However, some of the victims, around 20% of the adolescents, sought the service five days after the violent act, when preventive measures are not as effective. The counselor explains that the victim can go directly to the emergency room at Caism (Rua Alexander Fleming, nº 101, Cidade Universitária “Zeferino Vaz”, Campinas), which operates 24 hours a day, without the need for a medical referral or police report.

Affirmative mental health,

Since 2006, the outpatient clinic has been offering psychiatric care, which also allows for the study of the consequences of abuse on the mental health of victims. Specialized care begins at the first outpatient visit and continues for a maximum period of six months. Of the total number of patients who went to the emergency room, 65,5% underwent psychiatric evaluation. Of this group, half presented symptoms of anxiety and depression. Cases of sleep disturbance and feelings of guilt or shame resulting from the violence were also common. In addition, a quarter of the patients reported having experienced blackout, the partial or total forgetting of the violent event.

The study analyzed only the first psychiatric consultations and found that adolescents tend to present fewer symptoms than adult victims, which can lead to the mistaken perception that they are not suffering. “When we look at risk behaviors, which are a way of externalizing suffering, such as suicidal behavior, we see no difference between the groups. This raises the need to be very careful with adolescents. We need to guide families about the possibility that victims may demonstrate suffering in other ways,” explains Côrtes.

The use of legal and illegal psychoactive substances was also analyzed in the dissertation. There was no record of a statistically significant difference when comparing adolescent and adult victims, showing an increase in the use of substances by minors, particularly among women.

According to Azevedo, victims of attacks that occur after the use of psychotropic substances are usually held responsible, a factor that, in a way, reduces the burden of guilt on the aggressor and delays the search for medical care. “When the aggressor intends [to drug the victim], the vehicle is almost always alcohol. So, the patient did not necessarily drink a lot. We make an effort not to blame the victims, but to make them understand that they are more vulnerable in certain situations.”

Another unprecedented issue in Brazil is the study of the correlation between the use of digital media and rape cases. Cases were assessed in which contact with the aggressor occurred first via digital media – be it a dating app, social network or other means – and later culminated in the act of sexual violence. Rape facilitated by the use of technology was three times more common among adolescents than among adults.

“This is a number that we will monitor because it tends to increase, and this requires us to discuss more security on the networks, especially when it involves adolescents,” said Azevedo, citing other situations, such as when the act of sexual violence is recorded and distributed over the internet, increasing the suffering of the victims.

Considering the eight years analyzed, two situations caught the researchers' attention: the drop in immediate care rates and the decrease in attendance for outpatient treatment.

“This worries us because more women are arriving late and are not undergoing serological follow-up [after collecting material for tests] nor receiving mental health care – at least in our service,” argues Côrtes.

These unexpected results require further studies to determine their causes. According to Azevedo, the way in which the first contact with the patient occurs increases or decreases the chance of her returning. “We have to think of other mechanisms so that the patient understands the importance of continuing [with the follow-up],” he concludes.