Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women

ABSTRACT

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs’ social support has not previously been assessed.

Objective: This study examined the associations of past year SA and PTSD with SMW’s social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.

Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.

Results: PTSD was associated with less social support from partners, ($b$ = −0.06, SE = 0.02, p = .010, R²_change= .02), family, ($b$ = −0.06, SE = 0.03, p = .025, R²_change= .02), and friends, ($b$ = −0.07, SE = 0.02, p = .008, R²_change= .02). There was a significant interaction between PTSD and SA on social support from partners ($b$ = −0.01, SE = 0.01, p = .047, R²_change= .01). Neither non-SA nor SA trauma was associated with support from family or friends.

Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

HIGHLIGHTS

• We examined the associations of past-year sexual and non-sexual assault trauma and PTSD with sexual minority women’s social support from close significant others.

• Higher PTSD was associated with lower social support from partners, family and friends.

• In intimate partnerships, sexual assault was only associated with less social support when PTSD symptoms were more severe.

Antecedentes: Las mujeres adultas jóvenes de minorías sexuales (SMW, por sus siglas en inglés) tienen un riesgo elevado de sufrir agresión sexual (SA, por sus siglas en inglés), trastorno de estrés postraumático (TEPT) y apoyo social inadecuado. Si bien la SA y el TEPT pueden conducir a reducciones en el apoyo social de otras personas cercanas, el impacto de la SA y el TEPT en el apoyo social de las SMW no se ha evaluado previamente.

Objetivo: Este estudio examinó las asociaciones de SA y TEPT del último año con el apoyo social de SMW por parte de parejas íntimas, familiares y amigos. Se planteó la hipótesis de que la SA y el TEPT se asociarían negativamente con el apoyo de la pareja, la familia y los amigos, y que el TEPT moderaría el efecto de la SA sobre el apoyo en la edad adulta temprana.

Método: SMW adultas jóvenes en los Estados Unidos (N = 235) que tenían M = 23.93 (SD = 2.15) años, principalmente lesbianas o bisexuales (n = 186, 79.1%) y blancas (n = 176, 74,9%) completaron medidas sobre la exposición del último año a traumas SA y no SA, TEPT y apoyo social de parejas íntimas, familiares y amigos.

Resultados: El trastorno de estrés postraumático se asoció con menos apoyo social de la pareja (b = −0.06, SE = 0.02, p = .010, R²_cambio = .02), familia (b = −0.06, SE = 0.03, p = .025, R²_cambio = .02), y amigos, (b = −0.07, SE = 0.02, p = .008, R²_cambio = .02). Hubo una interacción significativa entre el trastorno de estrés postraumático y la SA en el apoyo social de la pareja (b = −0.01, SE = 0.01, p = .047, R²_cambio = .01). Ni el trauma no SA ni SA se asociaron con el apoyo de familiares o amigos.

Conclusiones: Los resultados subrayan el impacto potencial de la SA reciente en las relaciones íntimas de SMW adultos jóvenes con trastorno de estrés postraumático más grave. El trabajo futuro debería explorar cómo abordar el trastorno de estrés postraumático y mejorar la calidad del apoyo social puede ayudar a las SMW a recuperarse de experiencias traumáticas y mejorar los efectos de la SA en las parejas íntimas.

KEYWORDS:

• PTSD
• social support
• lesbian
• bisexual
• sexual minority
• sexual assault
• trauma

PALABRAS CLAVE:

• PTSD
• apoyo social
• lesbianas
• bisexuales
• minoría sexual
• agresión sexual
• trauma

1. Introduction

Numerous studies have demonstrated that sexual minority women (SMW; lesbian, bisexual, queer, and other non-heterosexual women) are at elevated risk for sexual assault (SA) compared to heterosexual women both in the United States and internationally (Conron et al., 2010; Dworkin et al., 2021; Messinger & Koon-Magnin, 2019; Roberts et al., 2010; Rothman et al., 2011; Walters et al., 2013). Conron and colleagues (2010) demonstrated that 34.7% of lesbian women and 57.3% of bisexual women had experienced SA compared to 18.1% of heterosexual women. In addition to SA, SMW are more likely to experience other traumatic events compared to heterosexual women (Balsam et al., 2005; McLaughlin et al., 2012; Roberts et al., 2010). Unsurprisingly given their elevated exposure to trauma, SMW are at elevated risk for experiencing posttraumatic stress disorder (Kerridge et al., 2017; Roberts et al., 2010; Scheer et al., 2023). Even among the subpopulation of individuals who have experienced a traumatic event that meets Criterion A for PTSD (American Psychiatric Association, 2013), SMW are more likely to develop PTSD than heterosexual women (Roberts et al., 2010). Research with the general population and sexual minorities suggests that social support is a crucial factor in posttrauma resilience (Edwards et al., 2023; Zalta et al., 2021). However, a growing literature suggests that PTSD can exert a negative impact on the availability and quality of support that trauma survivors receive (Wang et al., 2021). Moreover, while the body of evidence for the relationship between PTSD and social support among broad population samples is large (Ozer et al., 2003; Wang et al., 2021), few studies have explored these variables among SA-exposed SMW in emerging adulthood, or the degree to which the source of support influences the strength of the relationship. This study consequently sought to explore the association of past-year SA, non-SA trauma, and PTSD with access to social support from close significant others (i.e. family, friends, intimate partners) by young adult SMW – a population at high risk for trauma exposure and its sequalae.

1.1. Sexual identity formation and relationships in young adulthood

Young adulthood (defined in the present study as age 18-25) is understood to be a critical period in sexual identity development (Bishop et al., 2020) and relational development more broadly (Hutchison et al., 2016). On average, SMW in the U.S. first disclose their sexual identity to family and friends between age 18 and 20 (Bishop et al., 2020). Some research suggests shifts in the salience of relationships with different types of close significant others during young adulthood, such that individuals become less dependent upon family relationships (Hutchison et al., 2016; Seiffe-Krenke, 2006) and increasingly rely on social support from peers and intimate partners (Lee & Goldstein, 2016). However, family support is demonstrated to play a critical role in the mental health and wellbeing of sexually minoritized young adults in several studies (Snapp et al., 2015; Travers et al., 2020; Zimmerman et al., 2015). These findings have far-reaching implications for trauma-exposed SMW, highlighting the need for research on how young adult SMW’s support networks are impacted by traumatic stress.

1.2. Protective effects of supportive relationships

Access to supportive relationships is typically conceptualized as a crucial resilience factor in the broader traumatic stress literature (Ozer et al., 2003; Ruzek et al., 2007; Zalta et al., 2021) and in sexual minority samples specifically (Snapp et al., 2015). For example, social support was associated with reduced risk of victimization and substance use in a sample of sexual minority adolescents in grades 9–12 (Button et al., 2012). A path analysis of associations between sexual identity, mental health status, and social support from family, friends and intimate partners, found that social support from family mitigated risk of PTSD in Irish college students who identified as lesbian, gay or bisexual (Travers et al., 2020). In their examination of PTSD and trauma-related difficulties in SMW and heterosexual women, Weiss and colleagues (Weiss et al., 2015) found that high levels of social support were associated with reduced PTSD symptom severity in both SMW and heterosexual women, while low levels of support were associated with more severe PTSD symptoms in SMW. A literature review of SA disclosure among sexual and gender minorities found evidence that positive reactions to disclosure promote recovery (Edwards et al., 2023). These findings are consistent with the buffering hypothesis of social support, wherein more social support buffers against the negative mental health consequences of stressful life experiences (Cohen & McKay, 1984), and highlights the importance of access to adequate social resources for SMW.

1.3. Social support deficits after trauma

Given the potential protective effects of support, it is troubling that trauma-exposed SMW are at elevated risk of inadequate support (Hsieh, 2014). Prior work suggests that reduced social support mediates the relationship between sexual orientation and psychological distress. For example, Button and colleagues (Button et al., 2012) found that sexual minority youth were more socially isolated and less likely to receive parental support than their heterosexual peers following victimization. Reduced social support has been associated with increased risk of sexual orientation-based bias victimization and more severe PTSD in young adults (Mitchell et al., 2020). In instances of SA exposure specifically, higher observed rates of PTSD in SMW compared to non-minoritized groups have been associated with both a lower quantity and quality of social support received (Long et al., 2007; Sigurvinsdottir & Ullman, 2015). The social support deficits experienced by SMW may stem from stigma associated with sexual minority status (Salim et al., 2023) and the stigma of SA (Charuvastra & Cloitre, 2008; Wachter et al., 2018).

1.4. Negative effects of PTSD on social relationships

In each of the aforementioned studies, there was a demonstrated relationship between social support and the traumatic experiences themselves, which were in turn hypothesized to increase PTSD risk. However, a growing body of research suggests that inadequate social support may, in some instances, stem not from the traumatic event, but from the impact of the survivor’s consequent PTSD symptoms on relationships (Shallcross et al., 2016). Longitudinal evidence suggests that the relationship between social support and PTSD is bidirectional, such that social support can buffer against the development of PTSD, but can also erode when PTSD symptoms are persistent and/or severe (Long et al., 2007). PTSD includes symptoms of relational impairment (e.g. feeling emotionally cut off from others, increased irritability and aggression) (American Psychiatric Association, 2013) that may make effective use of social support challenging for trauma survivors, even when support is available. In addition, close significant others of those suffering from PTSD report a broad range of negative consequences, including reduced relationship satisfaction, increased caregiver burden and burnout, and increased risk of physical and emotional abuse (Monson et al., 2009). In a study of 513 romantic partners of traumatic injury survivors, survivor nonrecovery post-trauma was associated with greater difficulty offering social support, and lower relationship satisfaction (van Stolk-Cooke et al., 2023). These findings underscore the importance of understanding the near-term relational context in which PTSD unfolds.

1.5. The present study

To our knowledge, the direct effects of PTSD on SMW’s support from partners, family and friends have not been assessed. Studies highlighting the negative effects of PTSD on social support do not consider the socially stigmatized nature of SA compared to other trauma types. Given that SMW report differential access to support from their various social networks (Frost et al., 2016), an examination of how support may be impacted by trauma sequalae is warranted. The aim of the present study was to identify the direct effects of PTSD, past-year SA exposure, and past-year non-SA trauma exposure on SMW’s access to social support from (1) intimate partners, (2) family and (3) friends, and to establish whether there was a moderating effect of PTSD on the relationship between past-year SA and social support. It was hypothesized that PTSD would be negatively associated with social support in all types of relationships. It was hypothesized that past-year SA would be negatively associated with social support, while non-SA traumas would not. Finally, it was hypothesized that PTSD would moderate the effect of SA on social support, such that SMW with more severe PTSD would experience more negative impacts of SA on their ability to access support from intimate partners, family, and friends.

2. Methods

2.1. Procedures

The present study constituted a secondary analysis of data collected in a longitudinal parent study of health risk behaviours among emerging adult SMW (Kaysen et al., 2014; Rhew et al., 2017). The University of Washington Institutional Review Board approved study procedures. Participants were recruited via online advertisements. 1057 eligible participants provided informed consent and completed up to four annual assessments. Participants received $25 for the baseline survey, $30 for assessments at months 12, 24 and 36, and a bonus $35 if all four surveys were completed. Retention rates were 77%, 71%, and 70% for months 12, 24 and 36. To reduce participant burden, select measures of secondary interest – including the social support measure – were only administered at one-time point to two-thirds of participants who completed that wave. Thus, of the 719 (68%) participants who initiated the month 36 survey, nearly two-thirds (n = 421) were randomly assigned to complete the social support measure.

2.2. Participants

Eligible participants for the parent study were U.S. residents, aged 18–25 at recruitment, who identified as lesbian or bisexual at baseline,¹ had a valid email address, and were assigned female gender at birth. Additional inclusion criteria for the present study were a positive endorsement of three yes or no items about having (1) a spouse or partner, (2) family or relatives, and (3) friends on the Life Stressors and Social Resources Inventory (Moos & Moos, 1997) in order to enable an examination of differences in the associations between SA, PTSD and social support by relationship type.²

Participant demographics are presented in Table 1. Participants (N = 235) had an average age of 23.93 years (SD = 2.2). At the time of assessment, participants identified as bisexual (46.4%), lesbian (32.8%), queer (8.1%), straight/heterosexual (4.7%) or other (8.1%). The decision to include women whose sexual identity had changed since baseline was made in part to account for the sexual fluidity that is often observed among SMW, particularly bisexual women (Diamond, 2000; 2008). Participants were mostly White (74.9%), with others identifying as Black/African American (11.1%), Asian American (4.3%), multiracial (4.7%), and American Indian or Alaskan Native (1.7%). Fourteen and a half percent of the sample had experienced at least one SA in the last year, while 63.8% had experienced at least one non-SA traumatic event in the last year.

Table 1. Participant demographics (N = 235).

Variable	N	%
Gender Identity
Woman	224	68.9
Gender nonbinary	8	3.4
Transgender man	2	0.9
Sexual Orientation
Lesbian	77	32.8
Bisexual	109	46.4
Queer	19	8.1
Straight/heterosexual	11	4.7
Other	19	8.1
Ethnicity
Latino	27	11.5
Non-Latino	206	87.7
Race/Ethnicity
White	176	74.9
African American	26	11.1
Asian	10	4.3
AIAN	4	1.7
Multiracial	11	4.7
Relationship Status
Dating	36	15.3
In a committed relationship	151	64.2
Married/civil union/domestic partnership	39	16.6
Other	9	3.8
Education
Some high school	5	2.1
High School Diploma	20	8.5
Vocational degree	7	3.0
Some college	96	40.9
Associate’s degree	20	8.5
Bachelor’s degree	72	30.6
Graduate or professional degree	15	6.4
Income
<$20,000	144	61.3
$20,001–$29,999	46	19.6
$30,000–$39,999	26	11.1
$40,000–$49,999	11	4.7
>$50,000	8	3.4
Past year exposure to trauma
SA	34	14.5
Non-SA	150	63.8
Total	154	65.5
Likely PTSD (PCL > 33)	37	15.7
	M	SD
Age	23.93	2.15

2.3. Measures

Non-SA Trauma Exposure. Exposure to non-SA trauma within the last year was measured via the Traumatic Life Events Questionnaire (Kubany et al., 2000). This measure assesses past-year exposure to 18 traumatic events a scale of 0 (never) to 6 (more than 5 times). All items related to sexual assault were excluded, as a more detailed measure of sexual assault was utilized. A sum of all non-SA traumatic events experienced was calculated and utilized in analyses.

Sexual Assault Exposure. Exposure to SA within the last year was measured via the revised Sexual Experiences Survey (Koss et al., 2007). This measure uses behaviour-based prompts to assess exposure to different types of unwanted sexual behaviours (e.g. non-consensual touching, oral sex, vaginal and anal penetration). For each type of sexual contact, participants are asked which types of coercion were used in the assault (e.g. alcohol incapacitated sexual assault, threatening harm, physical force). For each item, participants were asked to indicate how often this has happened to them in the last year on a scale from 0 (0 times) to 3 (3 or more times). A sum of all experiences of sexual assault was calculated and utilized in analyses.

PTSD Symptoms. The PTSD Checklist (Weathers et al., 1991) was adapted to assess past-month DSM-5 PTSD symptoms. As this study was ongoing prior to publication of the PCL-5 (Weathers et al., 2013), we made the following modifications to capture the proposed DSM-5 symptom changes: four new items assessed the new DSM-5 symptoms (three in Criterion D and one in Criterion E), six items included wording changes in symptom descriptions (three in Criterion B, one in Criterion C, one in Criterion D, and one in Criterion E), and the foreshortened future item was removed. The new and modified items were administered paralleling the DSM-5 diagnostic criteria (Kaysen et al., 2021). Participants were prompted to choose their ‘most distressing’ traumatic event from their TLEQ and SES responses and answer the PCL questions regarding that event. The 20-item DSM-5 PCL had strong internal consistency in this sample (α = .94). Items used the PCL for DSM-IV 5-point Likert-type scale. For analyses, items were recoded to a severity scale of 0 (not at all) to 4 (extremely). Summed scores range from 0-80, with a score of 33 or greater indicating likely PTSD. Participants were asked to anchor their responses to the most stressful event they had experienced in the past year. Internal consistency was high (Cronbach’s α = .95).

Social Support. Three subscales from the LISRES (Moos & Moos, 1997) assessed participants’ relationships with intimate partners, family, and friends. For each relationship type, participants complete six items assessing social supports (e.g. ‘How often can you count on them to help you when you need it?’) on a scale from 0 (not at all) to 4 (extremely). Summed scores range from 0 to 24 for each relationship, with higher scores reflecting more social support. Internal consistency was high (Cronbach’s α = .93) for all three subscales.

2.4. Data analyses

Analyses were conducted in R version 4.2.3 (R Core Team R, 2013). Hierarchical multiple regressions were conducted to test the effects of socioeconomic variables, past year SA and non-SA trauma and PTSD on social support from intimate partners, family, and friends. In addition, regressions examined whether there was a significant interaction of PTSD symptom severity by SAs on support from each relationship.

The hypothesis that past year SA exposure and PTSD would be negatively associated with access to social support from intimate partners, family and friends was tested in three multiple regressions. Indicator variables included PTSD and past year SA. Covariates included income and education (i.e. indicators of socioeconomic status) and past year exposure to non-SA trauma. Relationships were evaluated hierarchically. For each relationship type, the effects of socioeconomic covariates were examined at step 1, SA and non-SA trauma were evaluated at step 2, PTSD was examined at step 3, and the interaction of SA trauma and PTSD was examined at step 4. Interactions were probed at ±1 SD above and below the mean on SA exposure.

3. Results

While no outliers were detected, several variables violated assumptions of normality, and were log transformed or square-root-transformed according to the recommendations of Tabachnick and Fidell (2007). Analyses were conducted with and without transformed variables to determine the effect of transformation on the results. There were no substantive differences in outcomes, and so results with the original data are presented. Means, standard deviations and correlations for SA and non-SA trauma exposure, PTSD symptom severity, and relational health with intimate partners, family and friends are presented in Table 2.

Table 2. Means, standard deviations & correlations of past year SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends (N = 235).

	Mean (SD)	1	2	3	4	5	6
1. SA Trauma	1.18 (4.35)	—
2. Non-SA Trauma	2.77 (4.84)	.23***	—
3. PTSD	15.81 (17.23)	.13	.38***	—
4. Partner Support	18.88 (5.29)	-.21**	-.10	-.21**	—
5. Family Support	11.91 (6.55)	-.06	-.06	-.17**	.40***	—
6. Friend Support	16.21 (5.90)	-.02	.00	-.17*	.34***	.40***	—

Note: *p < .05, **p < .01, *** p < .001.

A series of ANOVAs determined if demographic covariates should be included in the primary analyses. Variables assessed included race, ethnicity, sexual orientation, education, and income. No differences were found in variables of interest across demographic factors. However, income and level of education were included in regression analyses due to the role that socioeconomic status plays in trauma-related pathology (Brattström et al., 2015).

Results suggested a significant main effect of PTSD symptom severity on social support from intimate partners, ($b$ = −0.06, SE = 0.02, p = .010, R²_change= .02), family members, ($b$ = −0.06, SE = 0.03, p = .025, R²_change= .02), and friends, ($b$ = −0.07, SE = 0.02, p = .008, R²_change= .02), such that more severe PTSD was related to less support from each relationship. Results also indicated a significant effect of past year SA trauma on support from intimate partners, ($b$ = −0.24, SE = 0.09, p = .006, R²_change= .02), such that more exposure to SA was associated with less support in intimate partnerships.

In the regression on intimate partnerships, results were qualified by a significant interaction between PTSD and SA, such that the strength of the relationship between SA and support from intimate partners depended on the severity of PTSD symptoms, $b$ = −0.01, SE = 0.01, p = .047, R²_change= .01 (Table 3). The interaction between PTSD and SA was not significant in models assessing social support from friends and family, and the main effect of PTSD on these relationships remained significant. The interaction effect of SA and PTSD on social support from intimate partners was decomposed at high (+1 SD), average (mean) and low (−1 SD) rates of SA exposure. Simple slopes analyses indicated that PTSD was not associated with intimate partner social support when past-year exposure to SA was low ($b$ = −0.01, SE = 0.03, t = −0.32, p = .750), but that the strength of the relationship became significant at mean ($b$ = −0.05, SE = 0.02, t = −2.46, p = .010) and high rates of past-year SA exposure ($b$ = −0.09, SE = 0.03, t = −3.28, p < .001). Simple slopes of the effect of PTSD by SA exposure for social support from intimate partners, family, and friends were plotted and are presented in Figure 1. Results indicate that those with low PTSD symptoms reported generally high access to support from intimate partners, regardless of past year SA exposure. However, as PTSD increases, the negative association between SA and intimate partner support becomes stronger.

Figure 1. Interaction of PTSD symptom severity and past year SA trauma exposure on social support from intimate partners, family, and friends.

Table 3. Hierarchical regressions of past year non-SA and sa trauma exposure, and PTSD symptom severity as predictors of social support from intimate partners, family and friends (N = 235).

Intimate Partners	$b$	SE	t	$\mathrm{\Delta }{R}^2$	p
Step 1				.00	.254
Income	0.027	0.25	0.11		.915
Education	0.169	0.26	0.66		.511
Step 2				.04	.017
Non-SA Trauma	−0.014	0.08	−0.18		.859
SA Trauma	−0.016	0.14	−0.11		.912
Step 3				.02	.002
PTSD	−0.041	0.02	−1.80		.074
Step 4				.01	.001
SA × PTSD Interaction*	−0.011	0.01	−2.00		.047
Family	$b$	SE	t	$\mathrm{\Delta }{R}^2$	p
Step 1				.02	.055
Income	0.410	0.32	1.28		.203
Education	0.410	0.33	1.24		.216
Step 2				.00	.162
Non-SA Trauma	0.007	0.10	0.07		.945
SA Trauma	−0.016	0.10	−0.16		.872
Step 3				.01	.037
PTSD*	−0.062	0.03	−2.25		.025
Friends	$b$	SE	t	$\mathrm{\Delta }{R}^2$	p
Step 1				.00	.546
Income	0.208	0.29	0.72		.475
Education	0.135	0.30	0.45		.652
Step 2				.00	.848
Non-SA Trauma	0.078	0.09	0.88		.380
SA Trauma	0.053	0.09	0.58		.565
Step 3				.02	.132
PTSD**	−0.066	0.02	−2.66		.008

Note: *p < .05; **p < .01; ***p < .001.

4. Discussion

The present study examined the associations of past-year SA exposure, past-year non-SA trauma exposure, and PTSD with SMW’s access to social support from intimate partners, family and friends. Results supported the hypothesis that PTSD was negatively associated with SMW’s social support from all three types of relationships. There was no support for the hypothesis that there would be a significant main effect of past-year SA trauma on social support. As expected, non-SA trauma was not associated with access to support in any relationship type. There was partial support for the hypothesis that PTSD would moderate the effect of SA on social support. There was a significant interaction between SA and PTSD on intimate partner support, such that SMW with low PTSD reported high intimate partner support regardless of past-year SA, while higher PTSD symptoms and more past-year SAs had a greater negative impact on intimate partnerships. This interaction was not significant for family or friends.

These results highlight the negative association between PTSD and social support across different types of potentially supportive relationships. This finding is highly relevant given that the association between social support and PTSD has largely been examined using global measures that do not identify the source of support (Zalta et al., 2021). While support from all relationship types was associated with PTSD in the present sample, the strength of the association between PTSD and support varied by relationship type. As indicated by the R² values in each model, effects were small across analyses. Examining effect sizes by relationship type, the effect size of the association between PTSD and support was stronger for partners than it was for family and friends. A large developmental literature suggests that young adulthood is a key period for romantic relationship development both broadly (Arnett, 2000; Masarik et al., 2013), and for sexual minority youth specifically (Bishop et al., 2020). It is a time during which partnered individuals tend to rely more heavily on their intimate partners than they do on family members or friends (Trinke & Bartholomew, 1997). It is posited that more frequent and intimate interactions between romantic partners may translate to greater caregiver burden on partners when compared to the burdens placed on family and friends. Further, nascent learning about how to effectively navigate intimate partnerships during young adulthood may allow PTSD to take a larger toll on partner support in this young sample. Additional work is needed to better understand this difference in effects between support sources, what elements of PTSD may specifically contribute to the loss of support, and whether these findings are specific to SMW samples or fit a more general pattern.

For intimate partner relationships, PTSD also moderated the association between SA and social support. This effect was not found for the association between non-SA trauma and support. This difference in association is consistent with a recent meta-analysis that suggested that types of trauma exposure moderated the association between social support and PTSD (Zalta et al., 2021). This meta-analysis combined all types of interpersonal trauma into a single category, which limited the extent to which differences between SA and non-SA traumas could be evaluated. The findings for the current study suggest that SA may be uniquely impactful on intimate partnership relationships relative to other types of social support.

There are several explanations for why PTSD moderated the association between SA and social support from intimate partners, but not from family or friends. PTSD includes symptoms of behavioural avoidance (i.e. avoiding activities, people or places that cue memories of a traumatic experiences), and may lead SA survivors to avoid intimate physical or sexual activities that would otherwise be a source of pleasure and satisfaction within their relationships. SA is associated with a high degree of stigma and shame relative to other types of traumatic events (Kennedy & Prock, 2018; Lanthier et al., 2023), particularly for sexual minority individuals (Kanefsky et al., 2022). Elevated shame or stigma felt by the trauma survivor may contribute to a withdrawal from aforementioned aspects of intimate relationships. Women who reported a history of sexual assault also reported reduced sexual desire and arousal (Pulverman & Meston, 2020), with shame mediating the association between an assault history and desire. Reductions in the frequency of pleasurable or intimate activities within the romantic relationship may result in an objective or perceived withdrawal of support by intimate partners. The moderation effect may also be attributed, in part, to communication related to the assault. A recent study with a community of sexual assault survivors showed the direct effect between PTSD and relationship satisfaction was mediated in part by positive and negative communication (DiMauro & Renshaw, 2019). Those with elevated PTSD may have increased challenges with communication, which in turn further diminish the overall relationship. Future work should explore these potential mechanisms of the effect of PTSD on the relationship between SA and intimate partner support.

The present study had several limitations. While the project’s focus on a sexual minority sample constitutes a major strength, other restrictions on sample characteristics (i.e. female gender assignment at birth, young adult age) limit the generalizability of findings to sexual minority men, transgender women, and older SMW. The absence of a heterosexual comparison group precludes any direct examination of how the findings of the present study might differ for SMW versus heterosexual women. This study excluded SMW who were not romantically partnered, since these individuals did not complete the intimate partner support items of the LISRES. As such, the support experiences of SMW who had been in romantic relationships over the last year that had since ended were not accounted for. While exploratory analyses revealed no significant differences between single and partnered SMW on rates of past-year SA or non-SA trauma exposure or PTSD, future work would benefit from examining access to intimate partner support even for those who do not endorse being in an ongoing relationship. Facets of the trauma recovery context that have previously been linked to the quality and availability of posttrauma social support were not assessed (e.g. relationship satisfaction, partner accommodation, responses to SA disclosure, survivor coping, self-blame, shame, and self-efficacy) (Campbell et al., 2017; Littleton, 2010; Salim et al., 2022; van Stolk-Cooke et al., 2023). The measures included in the present study did not account for instances where the close significant other may have perpetrated a participant’s interpersonal trauma. Future research on social support for trauma-exposed SMW should include these and other variables that may moderate the relationship between social support and PTSD. Finally, social support was assessed cross-sectionally, limiting the conclusions that can be drawn about the dynamic relationship between social support and trauma sequelae in this SMW sample. Given that longitudinal research suggests bidirectionality between PTSD and social reactions, including both social support (Wang et al., 2021) and negative reactions to SA disclosures (Littleton, 2010; Ullman & Relyea, 2016), future work should prioritize studying these variables longitudinally in SMW trauma survivors. Indeed, meta-analytic work has found that negative reactions to SA disclosure exert greater effects on psychopathology than positive social support in broader SA survivor samples (Dworkin et al., 2019), underscoring a critical need for future work examining disclosure reactions among at-risk young adult SMW.

To our knowledge, this study presents the first examination of the effects of PTSD, past-year SA exposure, and past-year non-SA trauma exposure on SMW access to social support from close significant others across relationship types. This work has several clinical implications, the foremost of which is the importance of intervening on PTSD to mitigate its negative impacts SMW’s ability to access and benefit from social support. Targeting PTSD may further reduce the negative effects of recent SA exposure on SMW’s intimate partnerships. Moreover, findings highlight the need to explore SMW’s posttrauma social support dyadically following existing models of dyadic research on trauma survivors and their support providers (Davis & Brickman, 1996; Lorenz et al., 2018; Ullman et al., 2018), and the potential for couples-focused PTSD treatments, in which PTSD is targeted within the context of an intimate partnership (Edwards et al., 2021; Sijercic et al., 2022). Given the larger contextual barriers affecting SMW, findings highlight the potential benefits of adapting couples-based interventions to be more culturally appropriate to non-heterosexual couples.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institute of Mental Health [grant number T32MH019938]; National Institute on Alcohol Abuse and Alcoholism [grant number R01AA018292].

Notes

1 While we refer to participants as SMW due to the fact that all participants identified as lesbian or bisexual women at the time of study enrolment, this sample includes some individuals whose gender or sexual identity changed from baseline to 36 months. These cases were inspected and no outliers were observed. In addition, no significant differences in outcomes based on gender identity or sexual identity were observed.

2 Each subscale of the LISRES was distributed only to participants who endorsed access to the corresponding relationship type. The majority (95.1%) of respondents reported family and friend connections, while 58.2% reported an intimate partnership. In determining eligibility criteria for the present analyses, data were inspected for differences between romantically partnered versus single participants on outcomes of interest. No significant differences were identified.