New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging

Grace B. McKee · Kathy Gill-Hopple · Daniel W. Oesterle · Leah E. Daigle · Amanda K. Gilmore

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Intimate Partner and Family Violence Sexual Assault and Victimization Studies Restraint-Related Deaths

Abstract

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants ( N = 882) ranged in age from 18 to 81 ( M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

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2017National Intimate Partner and Sexual Violence Survey (NISVS) : 2010-2012 state report 2007Non-fatal Strangulation is an Important Risk Factor for Homicide of Women 2004Physical injury after sexual assault: Findings of a large case series 2016Non-fatal strangulation in sexual assault: A study of clinical and assault characteristics highlighting the role of intimate partner violence 2016Prevalence of strangulation in survivors of sexual assault and domestic violence 2016Improving Identification of Strangulation Injuries in Domestic Violence: Pilot Data From a Researcher–Practitioner Collaboration 1983Forensic Science Aspects of Fatal Sexual Assaults on Women 2019Examining trends in non‐fatal strangulation among sexual assault survivors seeking Sexual Assault Nurse Examiner care from 2002 to 2017

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