Ontario doctors and emergency departments saw 52,780 cases of sexual assault between 2002 and 2016, according to a new study.
The study, conducted by researchers at the Ottawa Hospital Research Institute and ICES, used hospital reporting data and physician billing codes to count how often sexual assaults were treated by doctors in Ontario. It was published Thursday in the American Journal of Public Health.
“This is a global health crisis. This is something that is vastly under-recognized,” said co-author Dr. Kari Sampsel, an emergency physician and medical director of the sexual assault and partner abuse care program at The Ottawa Hospital.
Although the vast majority of victims were female, the researchers found sexual assault cases among all genders, income levels and regions of the province.
“What this is showing is lending more evidence to the fact that this is a huge social, societal problem, and that our extreme cases in the hospital, we’re still picking it up across all sexes and ages,” said co-author Katherine Muldoon, senior research associate at The Ottawa Hospital and fellow at ICES.
“It’s a general social problem and it’s not distinct to groups that get a lot of attention, but it is affecting everyone.”
Most cases in the researchers’ data appeared in emergency departments. Around 86 per cent of cases involved a female victim. The highest frequency of assaults for female victims was among people aged 15 to 19 years, followed by 20 to 24 years old. For males, the highest frequency of assault was for boys aged 0 to 4 years old.
The researchers also found 896 cases of sexual assault among people aged 60 and older.
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This fits with what Amina Doreh, public education and media co-ordinator with the Sexual Assault Support Centre of Ottawa, has seen in her years of work with assault victims.
“Sexual violence and sexual assault is something that happens in every single community,” she said.
According to the study, there were 1458 revictimization cases, with some individuals assaulted more than six times in a single year.
Sexual assault rates are notoriously difficult to calculate. This study counted people who visited a doctor or emergency room. Other studies count victims who report their assault to police. Some studies survey the population to ask whether they have ever experienced an assault — one recent Statistics Canada survey found that there were 22 incidents of sexual assault for every 1,000 Canadians aged 15 and older in 2014.
The problem is that these different databases don’t necessarily overlap, Sampsel said.
“There is a subset of people who are going to present to a hospital for care,” she said. “There is a subset of people who are going to present to police or justice outlet for care. There are people who are not going to go to either of those institutions and would rather talk to a community agency. And then there’s a huge number of people who just don’t tell anybody.”
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Many people choose not to report an assault, Doreh said, or aren’t ready to seek help.
“I do support work in supporting people who’ve experienced sexual assault, and they come in and say, ‘I’ve been holding onto this story for years because I wasn’t ready to disclose to somebody or when I did disclose to somebody they didn’t believe me. So therefore I kept it to myself.’”
People who have had negative experiences with the police and justice systems, or who face other social barriers, are also less likely to report their assaults to others, she said.
Even this study, which looked at people who sought medical attention, had to take a unique approach to ensure it captured all the cases, said Muldoon.
Hospitals can label sexual assault cases in various ways, she said.
One database code clearly indicates that an assault happened, but it’s not necessarily always used. Other codes indicate that examinations were done following an “alleged rape” – a way of indicating what the exam was for without clearly stating that an assault happened. This analysis had to capture all these different ways of labelling cases, she said, to deal with how physicians approach a medical chart that deals with sexual assault.
“Sexual assault has legal implications in it that other types of assault and other injuries don’t,” she said.
“Physicians who are nervous to write down on a chart that sexual assault happened, they would be more comfortable to say that they did an examination and didn’t conclude. They didn’t make a decision whether they thought a sexual assault happened or not.”
Since medical records can be brought up in legal cases, she said, many doctors don’t want to complicate their patients’ lives by writing something that could contradict what the victim may have told police, she said.
Sampsel would like to change that. “It becomes an invisibility problem,” she said.
“When you write down neck pain or situational crisis or whatever, you know you can have neck pain because you got into a car accident. You can have neck pain because you slept funny and your neck is all stiff. That’s very different than being sexually assaulted and strangled.
“And so we need to recognize that sexual assault and intimate partner violence are problems of the emergency room and majorly common within emergency room populations.”
Funding for support services like her program in Ottawa can also depend on being able to demonstrate the scope of the problem, she said. Her program helps between 700 and 780 victims of sexual assault each year by providing counselling, directing people to support services and police if so desired, and providing medical treatment, testing for sexually transmitted infections, giving emergency contraception and whatever other services the patient wants, she said.
There are 35 programs in hospitals around the province doing similar work.
“The general public has no idea what the depth of the issue is,” Sampsel said.