Sexual assault was more closely associated with PTSD symptoms than a slew of other stressful life experiences.
On paper, Iceland should be a haven for women.
The high-income Nordic country has topped the World Economic Forum’s global gender equality rankings for 15 years in a row, and for the past half-century, women and men have been equally likely to lead the country.
But the island nation’s international reputation comes with a striking caveat, a major new analysis shows: about 40 per cent of Icelandic women have been sexually or physically assaulted, and many are grappling with post-traumatic stress disorder (PTSD).
“What you would expect is that in a country with high gender equality, you would see lower victimisation rates,” Rannveig Sigurvinsdóttir, an associate professor of psychology at Reykjavik University who was not involved with the study, told Euronews Health.
“And that’s absolutely not what we’re seeing”.
The study, published in the journal JAMA Network Open, surveyed about 28,200 women ages 18 to 69 in Iceland, asking whether they had experienced 23 “life stressors” such as stillbirth, having a child taken away, divorce, or discrimination and humiliation.
Two in three women said they had either witnessed or were a direct victim of unwanted sexual experiences, making it the most common life stressor followed by life-threatening illness or injuries (58.1 per cent), and accidents, fires, or explosions (51.1 per cent).
The researchers behind the study at the University of Iceland also assessed the respondents’ PTSD symptoms and found that overall, 15.9 per cent of women had probable PTSD.
The link between sexual violence, trauma, and health
Women who had been sexually assaulted or held captive were more likely to have probable PTSD than women who experienced any other life stressor, including having a child taken away, a sudden violent death, or experiencing a natural disaster.
Sigurvinsdóttir cautioned that the prevalence data may be slightly inflated because people with a history of sexual violence could be more likely to complete the survey, but said the study underscores that sexual violence appears to be a significant contributor to PTSD.
“That’s been replicated across the western world many, many times,” she said. “The big two groups that suffer the most PTSD, just from the literature, are women who’ve been victimised sexually and veterans”.
Sexual violence was more traumatic for women who were first attacked when they were younger than 12 years old and for those who were assaulted by a partner or relative, such as a parent, the study found.
“We found a substantial proportion of women who experienced PTSD decades after the last assault, lending support to the chronicity of PTSD after exposure to such trauma,” the study authors said.
It follows a smaller study published last year that identified similar trends but included both men and women.
Women were nearly four times as likely as men to be victims of sexual violence, and women were also more likely to experience other unwanted sexual encounters, the study found.
Another analysis in Iceland found that women who had experienced sexual violence in the workplace were more likely to have depression, anxiety, attempt suicide, have sleep problems, and binge drink.
The Nordic gender paradox
Taken together, the results call Iceland’s reputation for gender equality into question, but it isn’t the only high-income Nordic country to have a problem with this kind of violence.
Finland, Denmark, and Sweden all report higher lifetime levels of sexual or physical assault compared with the rest of Europe, the study noted.
However, there are some nuances to the Nordic paradox, with Sigurvinsdóttir explaining that people there may be more willing to disclose their assaults, partly explaining the higher rates.
Further, when Spanish researchers dug into current rates of intimate partner violence in European countries, the disparity between Nordic and other countries narrowed substantially.
“It seems that actually, the Nordic paradox only applies when you look at lifetime victimisation,” Sigurvinsdóttir said.
That could be because people in the Nordics tend to have more partners over their lifetimes, effectively creating more opportunities for abusive relationships to occur, not because men there are inherently more violent, the researchers from the Centre d’Estudis Demogràfics (CED) and the Universitat Pompeu Fabra concluded.
“That might tell us that gender equality doesn’t really relate to violence happening, but it relates to how society responds to it,” Sigurvinsdóttir said.
In other words, violence against women happens regardless of whether society prioritises gender equality, suggesting that stamping out violence is a distinct cultural and policy challenge.
How to combat sexual violence
In recent years, the Icelandic government has increased funding for a women’s shelter, funded public awareness campaigns, and made amendments to the criminal code to clarify digital sexual violence and stalking.
It also amended the definition of rape in 2018 to emphasise consent, according to the human rights committee of the United Nations.
Sigurvinsdóttir said more work is needed to address the problem; for example, a speedier criminal justice process for victims of violence, more public services to support victims, and efforts to bridge gaps between the country’s public health care system and mental health care.
Also key, she added, is the social support that victims get – or don’t get – in the wake of violence.
Her research in Iceland shows that when someone receives a negative reaction after disclosing their sexual assault, they are much more likely to have poor mental health.
But she also found that people who shared their experiences with a friend, family member, or someone else were significantly more likely to get a positive reaction than a negative one.
“I think people are slowly realising… how common trauma is, and how serious the implications can be,” Sigurvinsdóttir said.
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