Violência sexual sofrida por mulheres na adolescência precoce e tardia: Cuidado dispensado e seguimento

Torres, Alejandra Suyapa Becerra; Teixeira, Ana Luiza; Côrtes, Maria Teresa Ferreira; Alves, Ândria Cléia; Alabarse, Otávio; Azevedo, Renata Cruz Soares de; Fernandes, Arlete

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev Bras Ginecol Obstet. 44 (07) • Jul 2022 • https://doi.org/10.1055/s-0042-1743094 copiar

Violência sexual sofrida por mulheres na adolescência precoce e tardia: Cuidado dispensado e seguimento

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado.

Métodos

Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%.

Resultados

O grupo precoce (n= 242) continha maior número de estudantes (p< 0,001), que sofreram mais agressões diurnas (p= 0,031), em suas residências (p< 0,001), por agressor conhecido (p< 0,001), tiveram maior necessidade de proteção legal (p= 0,001), e demoraram mais a procurar atendimento (p= 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n= 279) houve maior consumo de álcool durante a agressão (p= 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p= 0,033), distúrbios do sono (p= 0,003), sintomas de ansiedade (p= 0,045), e sentimentos de angústia (p= 0,011); e receberam mais prescrições de psicotrópicos (p= 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos.

Conclusão

Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Palavras-chave
adolescência; mulher; violência sexual; agressão sexual; saúde mental; atendimento de emergência; estudo retrospectivo

Sociodemographic characteristics and personal history	Age groups		p-value^a a Chi-squared test.
	10–14 years	15–18 years
	n = 242	n = 279
	n (%)	n (%)
Self-reported skin color (n= 517)
White	145 (60.6)	187 (67.2)	0.119
Non-White	94 (39.3)	91 (32.7)
Intellectual disability (n= 521)			0.082
Yes	7 (2.9)	17 (6.1)
No	235 (97.1)	262 (93.9)
Years of schooling (n= 517)			< 0.001
≤ 8	193 (80.1)	67 (24.3)
> 8	48 (19.9)	209 (75.7)
Marital status (n= 521)			0.321
Single	226 (93.4)	254 (91.0)
Cohabiting with partner	16 (6.6)	25 (8.9)
Occupation (n= 491)			< 0.001
Student	222 (97.3)	197 (74.9)
Employed	1 (0.4)	30 (11.4)
No occupation	5 (2.2)	36 (13.7)
Religion (n= 480)			0.448
Protestant	81 (37.5)	118 (44.7)
Catholic	73 (33.8)	76 (28.8)
Others	13 (6.0)	15 (5.7)
Unaffiliated	49 (22.7)	55 (20.8)
Sexual activity initiated (n= 506)	44 (18.9)	108 (39.5)	< 0.001
History of sexual violence (n= 511)	29 (12.2)	58 (21.2)	0.007
Age at first episode of violence (n= 70)			0.585
4–10 years-old	13 (59.1)	25 (52.1)
11–18 years-old	9 (40.9)	23 (47.9)
History of mental disorders (n= 428)	18 (8.6)	38 (17.2)	0.008

Characteristics and context of the episode of sexual violence	Age groups		p-value
	10–14 years	15–18 years
	n (%)	n (%)
Type of abuse			0.998^a a Chi-square test.
Acute	229 (94.6)	264 (94.6)
Chronic	13 (5.3)	15 (5.4)
Time of approach (n= 512)			0.031^a a Chi-square test.
18:01–00:00 hours	82 (34.6)	94 (34.2)
00:01–07:00 hours	50 (21.1)	84 (30.5)
07:01–18:00 hours	105 (44.3)	97 (35.2)
Place of approach (n= 511)			< 0.001^b b Fisher's test.
Victim's residence	81 (34.4)	57 (20.6)
Family residence	13 (5.5)	5 (1.8)
Perpetrator's residence	12 (5.1)	10 (3.6)
Acquaintance's residence	3 (1.28)	6 (2.1)
Street	79 (33.6)	114 (41.3)
Bus stop	5 (2.1)	13 (4.7)
Other public places	3 (1.3)	11 (3.9)
School	12 (5.1)	4 (1.4)
Work	0	1 (0.3)
Party	12 (5.1)	31 (11.2)
Does not know	11 (4.7)	23 (8.3)
Referred consent	4 (1.7)	1 (0.3)
Known abuser (n= 521)	154 (63.6)	126 (45.1)	< 0.001^a a Chi-square test.
Relationship with the aggressor (n= 521)			0.003^a a Chi-square test.
Father	14 (5.8)	5 (1.8)
Stepfather	14 (5.8)	8 (2.8)
Other family member	16 (6.6)	12 (4.3)
Friend	38 (15.7)	31 (11.1)
School/work colleague	15 (6.2)	8 (2.8)
Neighbor	9 (3.7)	10 (3.6)
Intimate partner	8 (3.3)	10 (3.6)
Other acquaintances	40 (16.5)	42 (15.0)
Unknown	88 (36.3)	153 (54.8)
Number of aggressors (n= 516)			0.896^a a Chi-square test.
1	208 (87.0)	239 (86.3)
2	21 (8.8)	24 (8.6)
3–10	10 (4.2)	14 (5.0)
Presence of intimidation (n= 491)	188 (81.7)	230 (88.1)	0.002^a a Chi-square test.
Verbal threats (n= 472)	37 (16.7)	58 (23.1)	0.085^a a Chi-square test.
Use of physical force (n= 472)	120 (54.3)	132 (52.6)	0.710^a a Chi-square test.
Use of firearm (n= 472)	12 (5.4)	20 (7.9)	0.274^a a Chi-square test.
Use of cutting weapon (n= 472)	7 (3.1)	23 (9.1)	0.008^a a Chi-square test.
Forced inhalation (n= 472)	9 (4.0)	7 (2.8)	0.452^a a Chi-square test.
Type of sexual violence (n= 521)
Vaginal aggression	156 (64.4)	175 (62.7)	0.681^a a Chi-square test.
Oral aggression	27 (11.6)	56 (20.0)	0.006^a a Chi-square test.
Anal aggression	34 (14.0)	42 (15.0)	0.746^a a Chi-square test.
Frustrated attempt	21 (8.7)	9 (3.2)	0.008^a a Chi-square test.
Undetermined aggression^* * Undetermined aggression: the adolescent had memories of what happened, but could not distinguish the type of violence.	6 (2.5)	3 (1.1)	0.315^b b Fisher's test.
Does not know^ Does not know: the adolescent was unable to answer because she couldn't remember what happened.	47 (19.4)	76 (27.2)	0.036^a a Chi-square test.
Alcohol consumption (n= 469)	22 (9.8)	47 (19.1)	0.005^a a Chi-square test.
Consumption of other psychoactive substances (n= 420)	6 (2.9)	11 (5.1)	0.247^a a Chi-square test.
“Blackout” during the aggression (n= 515)	43 (18.0)	70 (25.3)	0.044^a a Chi-square test.

Reactions and feelings after violence	Age groups		p-value
	10–14 years	15–18 years
	n (%)	n (%)
Perception of sexual violence (n= 521)	210 (86.8)	255 (91.4)	0.301^a a Chi-squared test.
Disclosure of the episode of sexual violence (n= 414)	129 (65.8)	151 (69.2)	0.454^a a Chi-squared test.
Person to whom the adolescent disclosed
Mother (n= 414)	48 (24.5)	48 (22.0)	0.552^a a Chi-squared test.
Father (n= 414)	17 (8.6)	22 (10.1)	0.622^a a Chi-squared test.
Other relative (n= 326)	15 (10.0)	13 (7.4)	0.401^a a Chi-squared test.
Intimate partner (n= 326)	4 (2.6)	12 (6.8)	0.084^a a Chi-squared test.
Friend (n= 414)	9 (4.6)	17 (7.8)	0.179^a a Chi-squared test.
Other people (n= 414)	4 (2.0)	12 (5.5)	0.068^a a Chi-squared test.
Received support from someone (n= 361)	123 (71.9)	145 (76.3)	0.341^a a Chi-squared test.
Physical and/or psychosocial disorders (n= 364)	155 (89.1)	173 (91.0)	0.529^a a Chi-squared test.
Physical disorders (n= 364)	73 (41.9)	101 (53.1)	0.033^a a Chi-squared test.
Sleep disorders	58 (33.3)	93 (48.9)	0.003^a a Chi-squared test.
Appetite disorders	37 (21.2)	44 (23.1)	0.664^a a Chi-squared test.
Gastrointestinal disorders	6 (3.4)	8 (4.2)	0.706^a a Chi-squared test.
Urogenital disorders	2 (1.1)	3 (1.6)	1.000^b b Fisher exact test.
Changes in physical well-being	12 (6.9)	12 (6.3)	0.824^a a Chi-squared test.
Mental Disorders (n= 364)	106 (60.9)	132 (69.4)	0.087^a a Chi-squared test.
Symptoms of anxiety	67 (38.5)	93 (48.9)	0.045^a a Chi-squared test.
Symptoms of depression	25 (14.3)	39 (20.5)	0.123^a a Chi-squared test.
Suicidal ideations	14 (8.0)	17 (8.9)	0.758^a a Chi-squared test.
Suicide attempt	6 (3.4)	7 (3.7)	0.904^a a Chi-squared test.
Cutting	5 (2.8)	2 (1.0)	0.266^b b Fisher exact test.
Fear of the consequences of the episode of sexual violence	21 (12.0)	26 (13.7)	0.646^a a Chi-squared test.
Fear of suffering sexual violence again	18 (10.3)	22 (11.6)	0.707^a a Chi-squared test.
Flashbacks	24 (13.8)	41 (21.6)	0.053^a a Chi-squared test.
Social changes (n= 364)	135 (77.6)	160 (84.2)	0.107^a a Chi-squared test.
Social isolation	38 (21.8)	55 (28.9)	0.120^a a Chi-squared test.
Changes in daily routine	36 (20.7)	39 (20.5)	0.969^a a Chi-squared test.
Changed address	14 (8.0)	17 (8.9)	0.758^a a Chi-squared test.
Changed schools	13 (7.4)	4 (2.1)	0.015^a a Chi-squared test.
Feelings expressed/perceived during health care (n= 364)
Shame	97 (55.7)	111 (58.4)	0.607^a a Chi-squared test.
Guilt	77 (44.2)	82 (43.1)	0.833^a a Chi-squared test.
Crying	14 (8.0)	23 (12.1)	0.201^a a Chi-squared test.
Humiliation	8 (4.6)	16 (8.4)	0.142^a a Chi-squared test.
Apathy	11 (6.3)	7 (3.7)	0.246^a a Chi-squared test.
Anguish	2 (1.1)	12 (6.3)	0.011^a a Chi-squared test.
Rage	4 (2.3)	5 (2.6)	1.000^b b Fisher exact test.
Insecurity	3 (1.7)	8 (4.2)	0.166^a a Chi-squared test.

Characteristics of care	Age groups		p-value
	10–14 years	15–18 years
	n (%)	n (%)
Emergency care
Time until search for medical care (n= 514)			0.048^b b Fisher exact test.
≤ 24 hours	108 (45.7)	154 (55.4)
> 24–72 hours	44 (18.6)	54 (19.4)
> 72 hours–5 days	19 (8.0)	23 (8.2)
> 5 days until 6 months	63 (26.7)	44 (15.8)
> 6 months	2 (0.8)	3 (1.0)
Emergency contraception (n= 462)	134 (62.9)	188 (75.5)	0.003^a a Chi-square test.
Prophylaxis against sexually-transmitted infections (n= 511)	167 (75.5)	234 (87.3)	< 0.001^b b Fisher exact test.
HIV prophylaxis (n= 508)	135 (57.7)	197 (71.9)	< 0.001^a a Chi-square test.
Collection of biological sample (n= 487)	98 (44.5)	156 (58.4)	0.002^a a Chi-square test.
Six-month multidisciplinary follow-up
Assistance from social worker and/or legal aid (n= 521)	181 (74.8)	172 (61.6)	0.001^a a Chi-square test.
Filing of police report (n= 450)	112 (52.8)	127 (53.3)	0.910^a a Chi-square test.
Prescription of psychotropics (n= 371)	42 (23.3)	70 (36.6)	0.005^a a Chi-square test.
Completed the 6-month follow-up (n = 337)	128 (79.0)	144 (82.3)	0.447^a a Chi-square test.

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