A study published Wednesday suggests sexual harassment and assault can have extended health consequences, including depression, anxiety, poor sleep and high blood pressure.

Among 304 women ages 40 to 60, 19 percent told the researchers they had experienced workplace sexual harassment, 22 percent said they had experienced sexual assault and 10 percent said they experienced both.

Those who had experienced harassment were twice as likely to have high blood pressure and poor sleep, according to the research, which was published in JAMA Internal Medicine. Those who had experienced sexual assault were three times as likely to show symptoms of depression and twice as likely to have anxiety. Women who said they survived a sexual assault also experienced poor sleep.

Insomnia, depression and anxiety have been shown in turn to have negative health implications. High blood pressure can lead to cardiovascular disease, a top cause of death among women.

Rebecca Thurston, a professor at the University of Pittsburgh and the lead author on the study, said predatory behavior can cast a long shadow. “Experiencing sexual harassment and/or assault not only has implications for your quality of life, social functioning and job performance, but also for your mental and physical health,” she said.

The researchers also examined the women’s socioeconomic status and level of education, finding that women who reported being sexually harassed were both highly educated and under financial duress:

Financially stressed women can lack the financial security to leave abusive work situations. Why more highly educated women in the present study were more likely to be harassed is unclear; these women may more often be employed in male-dominated settings, be more knowledgeable about what constitutes sexual harassment, or be perceived as threatening; sexual harassment is an assertion of hierarchical power relations.

This is not the first research into the correlation between sexual violence and health, although it makes an attempt to differentiate itself from past research by relying less on self-reporting and more on hard medical data.

A British study published in June found that four in five teenage girls who experienced sexual assault, many of whom were living in poverty, had depression, anxiety and post-traumatic stress disorder four to five months after the assault. A study published in 2012 established a link between women who experienced intimate partner violence and high blood pressure. A 2008 study that looked at low-income workplace abuse also found a correlation between women who had experienced sexual harassment and high blood pressure.

While women are often encouraged to move on emotionally from traumatic experiences, this research shows that sexual assault and harassment should be taken seriously by medical professionals—and everyone else.

“These are often events from long ago, but they are clinically important right now,” said JoAnn Pinkerton, executive director of the North American Menopause Society.

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