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Teenagers may bear the burden of poor mental health if they've had to deal with sexual assault or unwelcome sexual advances, U.K. researchers said.

In a U.K. population-based study, sexual violence was linked with a slew of poor mental health outcomes among both teenage girls and boys, according to Francesca Bentivegna, MSc, and Praveetha Patalay, PhD, of University College London.

Compared with no exposure, youth who experienced sexual violence in the previous 12 months had significantly higher mean psychological distress scores at age 17 years as measured by the Kessler Psychological Distress Scale (mean difference 2.09 for girls; 2.56 for boys), they reported in the .

Experiences of sexual violence also were tied to significantly higher risks for other poor mental health outcomes:

• High psychological distress: risk ratio 1.65 (95% CI 1.37-2.00) for girls; 1.55 (95% CI 1.00-2.40) for boys
• Self-harm: RR 1.79 (95% CI 1.52-2.10); RR 2.16 (95% CI 1.63-2.84)
• Attempted suicide: RR 1.75 (95% CI 1.26-2.41); RR 2.73 (95% CI 1.59-4.67)

These models were fully adjusted for several potential confounders, including previous mental illness like depressive symptoms and self-harm up to age 14.

When broken down by sexual violence type, youth who experienced sexual assault saw the worst psychological distress. But even experiences of unwelcome sexual approach -- without sexual assault -- took a toll on mental health, according to the authors.

Bentivegna and Patalay set up a hypothetical scenario using the study's data and population attributable fractions, and determined that the prevalence of poor mental health at age 17 could be reduced by as much as 10.5% in boys and 18.7% in girls if there was no sexual violence.

Patalay noted in a statement that "From these findings, we are able to calculate, for instance, that 4,900 in every 100,000 girls would be less likely to self-harm if sexual assault and harassment among this age group could be prevented. It is critical that we better understand the impact of sexual violence on mental health problems, particularly among girls, who are disproportionally more likely to experience both these things."

"Our findings suggest sexual assault and harassment could be an important driver of the gender gap in mental ill health that emerges in adolescence," she stated.

In an , Fiona Mensah, PhD, and Stephanie Brown, PhD, both of Murdoch Children's Research Institute in Australia, suggested violence prevention start with the family, schools, and communities.

But healthcare providers also need to step up. "Practitioner awareness of the prevalence and effects of sexual violence is also vital in settings where mental health care is sought by adolescents," they pointed out, adding that practitioners in health, social, and education settings involving young people can benefit from trauma-focused training for dealing with these scenarios.

Data for the longitudinal study came from the U.K. Millennium Cohort Study of children born from 2000 to 2002. This sample had 5,119 girls (1,035 of whom experienced sexual violence) and 4,852 boys (251 of whom experienced sexual violence); 80% of the same were white. Sexual violence was self-reported and was determined via two questions on a questionnaire regarding sexual assault and unwelcome sexual approach in the past 12 months.

Study limitations included the collection of information on mental health and past experiences of sexual violence at the same time in the assessment at age 17, and the low self-reported prevalence of sexual violence versus Bentivegna said in the statement that "We need to ensure law enforcement and the legal system provide stronger deterrents and consequences for perpetrators," adding that "a startling tolerance to sexual violence across society" has fostered "low conviction rates for perpetrators" and continued victim blaming.

She also called for " better tailored and targeted support for victims, to try to mitigate the potential long-term mental health impacts from sexual assault and harassment."

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