Risk and Protective Factors for Interpersonal Revictimization in People with Post-traumatic Stress Symptoms: a Systematic Review

Christin Kühner^1,2,3,4*Inez Verdaasdonk^5,6Anneke E Goudriaan^4,7,8Kathleen Thomaes^3,9Marleen De Waal^10,4

• ¹Department of Research, Arkin (Netherlands), Amsterdam, Netherlands
• ²Department of Psychiatry, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, Netherlands
• ³Sinai Center (Netherlands), Amstelveen, Netherlands
• ⁴Amsterdam Institute for Addiction Research (AIAR), Amsterdam, Netherlands
• ⁵Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
• ⁶Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam, Netherlands
• ⁷Amsterdam University Medical Center, Amsterdam, Netherlands
• ⁸Arkin (Netherlands), Amsterdam, Netherlands
• ⁹VU Medical Center, Amsterdam, North Holland, Netherlands
• ¹⁰Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands

Introduction: People suffering from a psychiatric disorder are at increased risk of being the victim of repeated interpersonal victimization (i.e., revictimization). A psychiatric disorder that has been investigated as both a risk factor and a consequence of interpersonal revictimization is post-traumatic stress disorder (PTSD). However, to date no systematic review has provided an exclusive overview of longitudinally assessed risk or protective factors for interpersonal revictimization in the context of PTSD. With this systematic review, we aim to provide an overview of a) which facets of PTSD are risk factors for interpersonal revictimization, and b) which non-PTSD factors are risk or protective factors for interpersonal revictimization? Method: Following our pre-registered systematic search of PubMed, APA PsycInfo, PTSDpubs, Web of Science, and Scopus, we screened N = 1286 and included N = 16 longitudinal studies. Results: In the majority of the studies, the overall severity of PTSD symptoms emerged as a risk factor, while the evidence remained mixed for hyperarousal and negative changes in mood and cognition. We found no evidence that intrusion, avoidance, or dissociation are risk factors for interpersonal revictimization. For the non-PTSD risk factors, a majority of studies indicated that the severity of prior victimization and drug use were associated with revictimization. The results remained mixed for problematic alcohol use, childhood maltreatment, depression and maladaptive coping. The results also remained mixed for the two protective factors under investigation, social support and adaptive coping. Discussion: The results of the current study provide an overview of the factors that could be addressed in interventions to prevent interpersonal revictimization. The study has several limitations, such as the overrepresentation of female participants and the reliance on convenience samples, particularly those involving women residing in shelters. Additionally, there was a disproportionate focus on intimate partner violence (IPV) and sexual abuse as forms of revictimization. Furthermore, we observed considerable heterogeneity in the operationalization and measurement of PTSD (symptoms) and revictimization. We call for more uniformity in the assessment of PTSD symptoms and a clear operationalization of revictimization. Implications of this study are that reducing PTSD symptoms and drug use may decrease risk for future revictimization.