Background
Boys and men experience sexual abuse and assault (collectively termed “sexual trauma” throughout this thesis) but are rarely prioritised in research, public health messaging, or service provision. Despite evidence of low disclosure rates, long disclosure delays, and risk of suicidality among this population, further targeted research is needed to better understand boys’ and men’s disclosure experiences and mental health outcomes following sexual trauma.
Aims and objectives: This thesis aimed to contribute to the emerging evidence base regarding boys’ and men’s experiences following sexual trauma, seeking to inform research, clinical practice, and policy in trauma and men’s mental health. Objectives included (i) examining factors impacting sexual trauma disclosure and experiences of disclosing; and (ii) examining mental health outcomes following sexual trauma exposure. Study 1 examined barriers, facilitators, and correlates of disclosure, drawing on global evidence to contextualise low rates of disclosure and long disclosure delays reported among this population. Study 2 examined the lived experiences of disclosing CSA in therapeutic contexts, with a focus on how those disclosures were navigated and experienced. Study 3 examined the longitudinal relationship between exposure to sexual trauma within intimate partner relationships and depressive symptoms in men, addressing a gap in evidence previously limited by over- reliance on cross-sectional designs and small, non-representative samples.
Methods
This thesis employed a mixed-methods approach; it incorporated a rigorous evidence synthesis, quantitative analysis of a longitudinal dataset, and in-depth qualitative analysis. Study 1 comprised a systematic review that consolidated global evidence regarding barriers and facilitators for sexual trauma disclosure in boys and men and correlates of disclosure outcomes (i.e., whether disclosure occurred and when disclosure occurred). Barriers and facilitators were conceptualised according to the socioecological model, considering factors impacting disclosure at individual, relational, systemic, and sociocultural levels. Study 2 involved in-depth qualitative interviews with 14 men exposed to CSA, exploring men’s experiences of disclosure in therapeutic contexts. Interviews were analysed using interpretative phenomenological analysis to generate rich understandings of men’s experiences of approaching and navigating these disclosures. Using multi-wave data from a large cohort of men from the Australian general community (n = 13,328) 1 , Study 3 used generalised estimating equations with logistic regression to examine risk of depressive (PHQ- 9)symptoms in men following exposure to sexual trauma occurring within intimate partner relationships. Possible moderators were also assessed, including demographic characteristics, alcohol use, illicit substance use, social support, and sexual functioning.
Results
Study 1 highlighted significant barriers to disclosure exist across all levels of the socioecological system, such as shame, unsupportive responses to disclosure from social supports, a dearth of tailored services, and widespread silence and stigma surrounding sexual trauma in boys and men. Factors facilitating disclosure were underexamined and few studies focused on specific disclosure contexts. Quantitative evidence was constrained by small samples, non-validated measurement tools, and methodological inconsistency, limiting the synthesis and generalisability of findings. In Study 2, men often approached therapy after years of avoidance and distress, seeking to understand and address the root of their mental ill- health. Prior disclosure experiences were frequently characterised by minimisation and dismissal and shaped men’s hesitancy disclosing CSA to therapists. Disclosures were framed as dynamic and iterative processes, shared incrementally across therapeutic interactions as trust was established. Some described embodied responses during disclosure reminiscent of fight-or-flight, highlighting the enduring presence of trauma during the disclosure process. Men who experienced validation, deep listening, and emotionally attuned therapists described these disclosures as profoundly transformative, while some described therapist responses that compounded their confusion, silence, and distress. Study 3 found 2.5% of Australian men in the general community reported experiencing intimate partner sexual violence, which was associated with 68% greater odds of depressive symptoms across study waves. None of the assessed moderators were significant, suggesting similar risk of depressive symptoms across demographic and psychosocial profiles.
Conclusions
Findings from this thesis advance understanding of boys’ and men’s experiences following sexual trauma. Findings are synthesised across three discussion themes: (i) mental ill-health stemming from boys’ and men’s sexual trauma exposure and disclosure experiences, (ii) barriers to internal recognition of sexual trauma in boys and men, and (iii) gendered presentations of sexual trauma in boys and men. Mental ill-health in this population endures across the lifespan and is shaped by the original trauma, the extent to which boys and men feel permitted to acknowledge their victimisation, and how others respond to the trauma. Addressing mental ill-health among this population requires intervention at the practitioner and community levels, where greater capacity to recognise and respond to sexual trauma among boys and men is urgently needed. Dedicated practitioner training, public health messaging, and sustained empirical attention are needed to improve outcomes for this underserved population of trauma survivors.
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