Date of Award

Summer 2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Robert J. Cramer

Committee Member

Abby L. Braitman

Committee Member

Daniel M. Russell


Females between the ages of 18 and 24 consistently experience higher rates of sexual violence compared to females in any other age group (Sinozich & Langton, 2014). Approximately one in five college women experience sexual violence victimization (SVV; Krebs, Lindquist, Berzofsky, Shook-Sa & Peterson, 2016) during the academic year. Among undergraduate female students, 23.1% are victims of sexual violence due to physical force, violence or incapacitation (Cantor et al., 2015). Sexual victimization has been associated with several short- and long-term psychological health consequences, accounting for enhanced symptoms of depression, anxiety, PTSD, and suicide risk (Basile, Smith, Breiding, Black & Mahendra, 2014). Compared with the general population, college women are consistently less likely to disclose an experience of sexual assault (Fisher, Cullen & Turner, 2000). Despite the high rates of sexual violence against college females, only 11% of rapes are reported to college authorities, making sexual victimization the most underreported violent crime among this population (Kilpatrick, Resnick, Ruggiero, Conoscenti & McCauley, 2007). College students are 13% less likely to report an incident of sexual assault to police versus nonstudents in the same age group (Sinozich & Langton, 2014) and one-third of female students never tell anyone about the victimization (Fisher et al., 2000)

The overarching purpose of this dissertation was to examine sexual violence victimization, mental health and health service utilization among college females using an emotion science framework. The first purpose of this dissertation was to perform a systematic review to examine the frequency of sexual victimization and the moderating characteristics of utilization of college-based health resources (Stoner & Cramer, 2017; Article I). The second purpose was to test a coping-mental health framework for the prevention of suicide among sexual minority and heterosexual victims of assault sexual assault victims (Article II). The third purpose was to examine rates of sexual victimization and health service utilization in a sample population, to examine how mental health symptoms impact health service use, and examine the rates of actual and willingness to use health services (Article III).

The systematic review (Article I) revealed a gross mismatch between the prevalence rates of sexual victimization and the utilization rates of health services post victimization. Findings from Article II suggested that an association exists between sexual assault and suicidality and is significantly stronger among individuals who self-identify as a sexual minority. Further, the findings supported a coping-mental health framework for the prevention of suicide among sexual assault victims. Article III uncovered higher rates of victimization among the sample population compared to rates found in other national studies. Further, this research supported prior literature on health service use, suggesting a low frequency of usage of on-campus health resources.