Sexual assault is a major public health crisis, with national epidemiological studies reporting that approximately one-in-five women will be sexually assaulted in their lifetime. Experiential and empirical data indicate that sexual assault causes significant distress for those who experience it, with approximately one-third of sexual assault survivors evidencing lifetime posttraumatic stress disorder (PTSD). In recent years, there have been increasing calls to expand recognition of PTSD beyond its binary framing and to incorporate contextual variables into the study of PTSD so that understandings of posttraumatic stress are more fully situated within the context of trauma survivors' lives. The current study responds to these stated needs. This study utilized two waves of a longitudinal data set in which sexual assault survivors were surveyed annually about their posttraumatic stress symptoms and social support. Using this data, I conducted a latent transition analysis (LTA) to identify latent classes of posttraumatic stress experiences and model the probability of transitioning between latent classes over time. With the goal of highlighting existing strengths in survivors' communities and better understanding optimal utilization of those resources, I also incorporated structural and functional social support as predictors of class membership and class transition. Four latent classes emerged at each time point and were named the High Severity, Depressed & Anxious, Avoidant & Reactive, and Low Severity classes. These classes demonstrated both quantitative (i.e., overall severity) and qualitative (i.e., symptom cluster severity) differences. Transition probabilities illustrated a general pattern of de-escalation. As would be expected, de-escalation was more likely when both types of social support were high compared to when both types of social support were low. Notable differences between the latent classes emerged, however, when one type of social support was high and the other was low. Specifically, while participants assigned to the High Severity class at Time 1 were more likely to de-escalate when structural support was high and functional support was low than the reverse, the opposite pattern was true for participants assigned to the Depressed & Anxious class. The intermediate classes identified in this latent class analysis highlight the limitations of categorical understandings of posttraumatic stress in which one either "has" or "does not have" PTSD. These findings support the calls that have been made by researchers and clinicians to introduce a "subclinical" level of PTSD to the Diagnostic and Statistical Manual, while also encouraging nuance beyond what even a subclinical designation would provide. Specifically, while a subclinical designation would reflect some amount of quantitative variation between the latent classes, it would be unlikely to reflect the qualitative differences found in the current study. These qualitative differences were especially relevant to understanding the longitudinal relationship between posttraumatic stress and social support, with functional support appearing to be especially relevant to those in the High Severity class and structural support especially relevant to those in the Depressed & Anxious class. The findings indicate that sexual assault survivors' social support needs may vary based on the specific symptoms that define their experience of posttraumatic stress at a given point in time. These findings also provide guidance for clinical and non-clinical practitioners regarding how to help survivors engage their support networks most effectively in the aftermath of trauma.
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