Predictors of post-rape medical care in a national sample of women

The Impact On Eye Movement And Desensitization Reprocessing Of Incomplete Memory In A Drug-Facilitated Rape: A Single Case Study

In a drug-facilitated sexual assault (DFSA), the person's level of intoxication may result in incomplete memory. This paper describes eye movement and desensitization reprocessing (EMDR) with client-centered adaptations to address an incomplete trauma memory in a 26-year-old woman. The client was experiencing PTSD, characterized by nightmares and derealization. Therapy followed standard EMDR procedures with three minor modifications to help the client maintain current awareness. Although the memory remained incomplete, the client-centered adaptations promoted working through of the clients' trauma responses (e.g. disorientation, physical sensations) and a sense of competence and self-confidence were restored. At the end of reprocessing, and at follow-up, the client was no longer experiencing nightmares or derealization and her wellbeing had improved.

Comparing the Demographic Characteristics of Victims of Sexual Assault in Rural Versus Urban Areas

BACKGROUND

In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed.

PURPOSE

This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2.

METHODS

Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association.

RESULTS

Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers.

CONCLUSION

Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities).

"Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence

Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.

Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization. Integrated interventions aimed at reducing PTSD and AUD symptoms following recent sexual assault are needed and should address barriers to care and early treatment termination. The proposed study will test a novel, brief (5 to 7 sessions) intervention that integrates Written Exposure Therapy for PTSD and Cognitive Behavioral Therapy for AUD, and is initiated within the first six weeks post-assault. In Phase 1, qualitative analysis of content gathered during focus groups with treatment providers will be conducted to inform intervention development. In Phase 2, a proof-of-concept pilot study (n = 10) of the intervention, Substance Use Skills Training and Exposure Post-Sexual Assault (STEPS), will be conducted. In Phase 3, a pilot randomized controlled trial (RCT) among 54 recent sexual assault survivors will be implemented using the updated manualized STEPS intervention to evaluate feasibility and preliminary efficacy in reducing PTSD and AUD symptoms. Ecological momentary assessments will be used to assess daily alcohol use, craving, affect, intrusions and avoidance. The effects of STEPS on commonly associated symptoms (e.g., depression, substance use) will be examined. The proposed study has the potential to make a significant public health impact by advancing knowledge on the link between sexual assault and co-occurring PTSD and AUD and informing early intervention efforts for this high-risk population.

Bias Crime and Victimization Among Latinx Adults: Formal and Informal Help Seeking

Latinx adults have become increasingly vulnerable to bias motivated victimization. The impact of such incidents on Latinx communities is severely understudied, particularly concerning whether or not victims will seek help as a result of such events. Evidence within other victimization contexts demonstrate Latinx populations may be less likely to seek formal help from police, medical providers, and other formal authorities, relying instead on informal support networks such as family and friends. The current study sought to understand formal and informal help-seeking behavior among Latinx adults who experienced bias motivated victimization. The Understanding and Measuring Bias Victimization against Latinos study obtained rates of bias victimization and subsequent help-seeking behavior among Latinx adults who reported experiencing bias victimization (n = 315, 34.6% of full sample of 910). Those who experience bias victimization seek formal help at much lower rates than informal forms of support. Logistic regression analyses controlling the type of victimization demonstrated that participants who experienced a victimization constituting a hate crime were more likely to seek formal help compared to experiencing non-criminal bias events. Implications include addressing barriers to Latinx bias victims seeking forms of help, in addition to understanding the potential polyvictimization histories that predict why Latinx adults may decide to seek help.

Trends in US Emergency Department Use After Sexual Assault, 2006-2019

IMPORTANCE

Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality.

OBJECTIVE

To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation's Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022.

MAIN OUTCOMES AND MEASURES

Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics.

RESULTS

Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population.

Pathway to Healing and Recovery: Alleviation of Survivor Worries in Sexual Assault Nurse Examiner-Led Sexual Assault Telehealth Examinations

INTRODUCTION

The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination.

METHODS

Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests.

RESULTS

Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing.

DISCUSSION

These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits.

Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial

IMPORTANCE

Sexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers.

OBJECTIVE

To test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks.

DESIGN, SETTING, AND PARTICIPANTS

The Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months.

INTERVENTION

SHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition.

MAIN MEASURES

Health risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review.

RESULTS

SHE did not impact women's number of health risks (all p's > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ² (1, n = 153) = 4.38, p = .036, r_s = .16), and self-report (χ² (1, n = 130) = 5.89, p = .015, r_s = .21). SHE was found to be an acceptable intervention.

CONCLUSIONS

SHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT02957747.

Police Officers' Ability in Recognizing Relevant Mental Health Conditions

The recognition of certain mental health conditions is important as this requires police officers to communicate and behave in an adjusted manner with affected individuals. The objective of the present study was to test police officers’ knowledge about mental health symptoms as a component of their mental health literacy (MHL) and to examine if police officers’ perceived knowledge corresponds with their actual knowledge. A questionnaire was used to assess for MHL representing mental health conditions which occur frequently in police requests (schizophrenia, bipolar disorder, depression, post-traumatic stress disorders, and emotionally unstable personality disorder). Furthermore, the questionnaire assessed the frequency of police requests, the officers’ perceived knowledge regarding mental disorders and their sense of feeling sufficiently trained to deal with these kinds of requests. Eighty-two police officers participated in the study. Police officers’ actual knowledge about mental health conditions did not correspond with their perceived knowledge. Participants revealed a moderately high level of overall knowledge which differed with regard to symptoms of each of the five mental health conditions. The mental status of a paranoid schizophrenia was best identified by the police officers and the majority correctly allocated the symptoms. Post-traumatic stress disorders and manic episodes were only identified by a minority of police offers. Police training geared to prepare for requests involving individuals with mental disorders should expand this limited knowledge transfer and focus on a broader variety of mental health conditions that police officers frequently encounter in requests.

Intimate Partner Violence and Completion of Post-Sexual Assault Medical Forensic Examination Follow-Up Screening

Sexual assault is a major public health concern associated with significant mental health and medical symptoms. Follow-up screening post-sexual assault medical forensic examination (SAMFE) can be one method of determining needs and providing targeted prevention of mental health and medical symptoms among individuals who experienced a recent sexual assault. However, the factors associated with engagement in post-SAMFE follow-up screening have not been identified. The current study examined the association between intimate partner violence victimization and sexual assault-related characteristics and engagement in post-SAMFE follow-up screening. Participants were 193 individuals who received a SAMFE and indicated at the time of SAMFE that they were interested in follow-up by the hospital. It was found that individuals were less likely to engage in follow-up screening if the assault was perpetrated by an intimate partner. These findings suggest that other resources are needed to reach individuals who experience sexual assault perpetrated by an intimate partner due to the unique needs of that population.

Perceived Care Quality Among Women Receiving Sexual Assault Nurse Examiner Care: Results From a 1-Week Postexamination Survey in a Large Multisite Prospective Study

INTRODUCTION

This study examined the perspectives of female patients who had been sexually assaulted regarding the quality of care provided by sexual assault nurse examiners, including whether the patients' perspectives varied by their demographic characteristics and health status before the assault.

METHODS

A total of 695 female patients who received care from sexual assault nurse examiners at 13 United States emergency care centers and community-based programs completed standardized surveys 1 week after receiving sexual assault nurse examiners' care for sexual assault.

RESULTS

Most patients strongly agreed that the sexual assault nurse examiners provided high-quality care, including taking patients' needs/concerns seriously, not acting as though the assault was the patient's fault, showing care/compassion, explaining the sexual assault examination, and providing follow-up information. The perceptions did not vary by the patients' demographic characteristics or preassault health status.

DISCUSSION

Female patients who had been sexually assaulted and who were evaluated at 13 widely geographically distributed sexual assault nurse examiners' programs consistently reported that the sexual assault nurse examiners provided high-quality, compassionate care.

Rural Availability of Sexual Assault Nurse Examiners (SANEs)

PURPOSE

Sexual assault care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. Upon completion of SANE training, nurses can demonstrate their experience and expertise by obtaining SANE certification. Availability of nurses with SANE training or certification is often limited in rural areas, and no studies of rural certified SANEs exist. The purpose of this study is to describe rural SANE availability.

METHODS

We analyze both county-level and hospital-level data to comprehensively examine SANE availability. We first describe the geographic distribution of certified SANEs across rural and nonrural (ie, urban or suburban) Pennsylvania counties. We then analyze hospital-level data from semistructured interviews with rural hospital emergency department administrators using qualitative content analysis.

FINDINGS

We identified 49 certified SANEs across Pennsylvania, with 24.5% (n = 12) located in 8 (16.7%) of Pennsylvania's 48 rural counties. The remaining 37 certified SANEs (75.5%) were located in 13 (68.4%) of Pennsylvania's 19 nonrural counties. Interview data were collected from 63.9% of all eligible rural Pennsylvania hospitals (n = 63) and show that 72.5% (n = 29) have SANEs. Of these, 20.7% (n = 6) have any certified SANE availability. A minority of hospitals (42.5%; n = 17) have continuous SANE coverage.

CONCLUSIONS

Very few SANEs in rural Pennsylvania have certification, suggesting barriers to certification may exist for rural SANEs. Though a majority of hospitals have SANEs, availability of SANEs was limited by inconsistent coverage. A lack of certified SANEs and inconsistent SANE coverage may place rural sexual assault victims at risk of receiving lower quality sexual assault care.

How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review

INTRODUCTION

Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services.

METHODS AND ANALYSIS

To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories.

DATA ANALYSIS

A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies.

PROSPERO REGISTRATION DETAILS

CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.

Post-traumatic stress disorder and related factors among female victims of sexual assault required to attend a University Hospital in Turkey: A cross-sectional cohort study

BACKGROUND

Post-traumatic stress disorder (PTSD) is one of the most common consequences of sexual assault, but it is not invariable.

AIM

Our aim was to investigate pre-, peri- and post-traumatic factors associated with post-traumatic stress disorder among adult women who had been sexually assaulted.

METHODS

All women attending a specialist university clinic for victims of sexual assault referred by the courts for a mental health assessment were invited to participate. At the time, the Turkish penal code required such referral (the year up to September 2015). Consenting women completed a sociodemographic information form, the Traumatic Stress Symptom Checklist, the Multidimensional Scale of Perceived Social Support, the Short Form-36 reflecting perceived quality of life, the Beck Depression Scale and the Beck Anxiety Scale.

RESULTS

Sixty women were eligible and agreed to participate. Two-thirds of them (41, 68%) reported features of PTSD. In bivariate analyses, the women with PTSD also rated themselves as having a wide range of health and social disadvantages. Self-perceived poverty of social support and having suicidal thoughts were independently associated with PTSD.

CONCLUSIONS

Although the rate of mental health and social problems among the women with PTSD were high, less than a third had actually sought help for their difficulties. While a requirement in the penal code that such women should have a psychiatric assessment seems over-intrusive and has since been dropped, our findings suggest that more efforts should be made to ensure that such women have help available if they want it.

Sexually assaulted women: Results of a retrospective analysis of 850 women in Germany

OBJECTIVE

According to prevalence studies, at least 5-6 % of women in Europe experience rape in their lives. The initial treatment after a sexual assault can influence the individual healing process positively. In Germany, there are hardly any studies that investigate larger collection of cases of sexual assault treated in hospitals. However, knowledge about characteristics of cases of sexual assault is a prerequisite for the optimal processing of primary care.

STUDY DESIGN

For this study, the retrospective collection of data on cases of suspected sexual assault of patients presented for treatment at the Charité was carried out. Standardized findings sheets as part of a rape kit used in all cases were evaluated. Overall, 850 cases from the period between 01.01.2011 and 30.06.2016 were analyzed. The statistical evaluation was descriptive.

RESULTS

The median age of patient was 26 years (range 16-92). Penetration (vaginal/anal/oral) occurred in 75 % of cases. The suspect was unknown to 48,4 % of those affected, 26 % came from a circle of friends or acquaintances. 15,5 % were partners or expartners. 2/3 of the sexual assaults took place in private rooms, especially in the apartments of the victims. More than 2/3 of the women had drunk alcohol in temporal proximity to the crime. Extragenital injuries were present in 61,4 % of those affected and anogenital injuries in 25,4 %. Extragenital injuries were predominantly classified as mild (92,9 % in general physical examination and 62,4 % in eyes-nose-throat-examination). 42,1 % of the assaults took place on the weekend. 74,8 % of the patients presented themselves within 24 h of the suspected offence.

CONCLUSION

To our knowledge, this is the largest analysis of cases of sexually assaulted women treated at a hospital in Germany. The results point to important components of primary care, e.g. standardized injury recording and alcohol measurement, as these can serve as evidence in subsequent court proceedings. The structures of the first care of victims after sexual assault should consider that the majority of those affected present themselves at the weekend.

Refinement and Pilot Testing of a Brief, Early Intervention for PTSD and Alcohol Use Following Sexual Assault

Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.

Rural Location and Relative Location: Adding Community Context to the Study of Sexual Assault Survivor Time Until Presentation for Medical Care

Despite a strong empirical base linking community context and proximity to resources to individual health care access, studies examining predictors of sexual assault survivor time until presentation for medical care have not yet examined these relationships. This study addresses this gap. The data included retrospective records on a sample of 1,630 female survivors who reported their sexual assault to law enforcement and were subsequently seen by a sexual assault nurse examiner (SANE) in one of eight Alaskan communities between the years 1996 and 2006. Logistic regression models were used to determine whether delays in presentation (presentation 12 hr or more after assault) differed for women presenting in unique communities (rural location), and between those whose assault and exam occurred in different communities versus occurring in the same community (relative location). Although rural location did not seem to have a unique impact on time until presentation, differing locations (i.e., relative location) of assaults and exams increased the likelihood of delays in presentation. Non-American Indian/Alaska Native race/ethnicity and knowing one's assailant(s) also increased the likelihood of delays. These results indicate that in addition to a need for further research, there is a need for more appropriate and reliable sexual assault medical services across communities, and that survivors assaulted by known assailants should be targeted in efforts to reduce time until presentation.

Factors Related to Rape Reporting Behavior in Brazil: Examining the Role of Spatio-Temporal Factors

The reporting of rape to police is an important component of this crime to have the criminal justice system involved and, potentially, punish offenders. However, for a number of reasons (fear of retribution, self-blame, etc.), most rapes are not reported to police. Most often, the research investigating this phenomenon considers incident and victim factors with little attention to the spatio-temporal factors of the rape. In this study, we consider incident, victim, and spatio-temporal factors relating to rape reporting in Campinas, Brazil. Our primary research question is whether or not the spatio-temporal factors play a significant role in the reporting of rape, over and above incident and victim factors. The subjects under study are women who were admitted to the Women's Integrated Healthcare Center at the State University of Campinas, Brazil, and surveyed by a psychologist or a social worker. Rape reporting to police was measured using a dichotomous variable. Logistic regression was used to predict the probability of rape reporting based on incident, victim, and spatio-temporal factors. Although we find that incident and victim factors matter for rape reporting, spatio-temporal factors (rape/home location and whether the rape was in a private or public place) play an important role in rape reporting, similar to the literature that considers these factors. This result has significant implications for sexual violence education. Only when we know why women decide not to report a rape may we begin to work on strategies to overcome these hurdles.

Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault

INTRODUCTION

Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA.

METHODS

Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms.

RESULTS

Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs.

CONCLUSIONS

Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.

Responding to Delayed Disclosure of Sexual Assault in Health Settings: A Systematic Review

Few adolescent and adult women seek out formal support services in the acute period (7 days or less) following a sexual assault. Instead, many women choose to disclose weeks, months, or even years later. This delayed disclosure may be challenging to support workers, including those in health-care settings, who lack the knowledge and skills to respond effectively. We conducted a systematic literature review of health-care providers' responses to delayed disclosure by adolescent and adult female sexual assault survivors. Our primary objective was to determine how health-care providers can respond appropriately when presented with a delayed sexual assault disclosure in their practice. Arising out of this analysis, a secondary objective was to document recommendations from the articles for health-care providers on how to create an environment conducive to disclosing and support disclosure in their practice. These recommendations for providing an appropriate response and supporting disclosure are summarized.

An experimental examination of alcohol consumption, alcohol expectancy, and self-blame on willingness to report a hypothetical rape

This study experimentally examined the role of victim alcohol intoxication, and self-blame in perceiving and reporting rape to the police using a hypothetical interactive rape scenario. Participants (N = 79) were randomly assigned to consume alcohol (mean BAC = 0.07%) or tonic water before they engaged in the scenario. Alcohol expectancy was manipulated, and participant beliefs about the beverage they thought they had consumed and their feelings of intoxication were measured. Alcohol consumption and expectancy did not affect the likelihood that the nonconsensual intercourse depicted in the scenario was perceived and would be reported as rape. Participants with higher levels of self-blame were less likely to say they would report the hypothetical rape. Self-blame levels were higher for participants who believed they had consumed alcohol, and were associated with increased feelings of intoxication. The implications are discussed.

A Meta-Analysis of HIV Postexposure Prophylaxis Among Sexually Assaulted Patients in the United States

Sexual assault (SA) is a major public health problem that leaves patients at risk for HIV. The gold standard of medical treatment for SA patients includes prophylactic treatment to prevent HIV. A meta-analysis was conducted and examined the rates of nonoccupational postexposure prophylaxis (n-PEP) offered to, accepted, and completed by SA patients who presented to emergency departments in the United States. Four points of data were analyzed: (a) SA patients who met the criteria and were offered n-PEP, (b) SA patients who were offered n-PEP and accepted the medication, (c) SA patients who accepted n-PEP treatment and completed at least one follow-up appointment, and (d) SA patients who completed the entire course of n-PEP. Results of the meta-analysis indicated that approximately half of the patients who were offered n-PEP accepted the medication. However, only 25.7% of SA patients who accepted n-PEP completed the full course.

Characterizing Drug-Facilitated Sexual Assault Subtypes and Treatment Engagement of Victims at a Hospital-Based Rape Treatment Center

Variation among existing studies in labeling, defining, identifying, and subtyping cases of suspected drug-facilitated sexual assault (DFSA) poses challenges to integrating research findings for public health purposes. This descriptive study addressed methodological issues of nomenclature and DFSA operational definitions to improve case identification and was designed to distinguish assault subtypes. We studied a 2-year ethnically diverse cohort of 390 patients who presented acutely to an urban rape treatment center (RTC). We abstracted data from RTC medical and mental health records via chart review. Assault incidence rates; engagement into medical, forensic, and mental health services; injury sustained; and weapon use were calculated separately for assault subtypes and compared. DFSA accounted for over half of the total sexual assault (SA) cases. Involuntary DFSA (in which an incapacitating substance was administered to victims without their knowledge or against their will) increased from 25% to 33% of cases over the 2-year period. DFSA victims presented sooner, and more often attended medical follow-up and psychotherapy than non-DFSA victims. Incidence rates indicated increasing risk for young males. These findings indicate that DFSA continues to be a growing and complex phenomenon and suggest that DFSA victims have greater service needs. The field would benefit from innovations to address symptomatology arising from this novel type of trauma and the unique risks and needs of male victims, as well as underscoring the ongoing need for DFSA-specific prevention efforts for both victims and perpetrators.

Understanding Disparities in Service Seeking Following Forcible Versus Drug- or Alcohol-Facilitated/Incapacitated Rape

Victims of drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) are substantially less likely to seek medical, rape crisis, or police services compared with victims of forcible rape (FR); however, reasons for these disparities are poorly understood. The current study examined explanatory mechanisms in the pathway from rape type (FR vs. DAFR/IR) to disparities in post-rape service seeking (medical, rape crisis, criminal justice). Participants were 445 adult women from a nationally representative household probability sample who had experienced FR, DAFR/IR, or both since age 14. Personal characteristics (age, race, income, prior rape history), rape characteristics (fear, injury, loss of consciousness), and post-rape acknowledgment, medical concerns, and service seeking were collected. An indirect effects model using bootstrapped standard errors was estimated to examine pathways from rape type to service seeking. DAFR/IR-only victims were less likely to seek services compared with FR victims despite similar post-rape medical concerns. FR victims were more likely to report fear during the rape and a prior rape history, and to acknowledge the incident as rape; each of these characteristics was positively associated with service seeking. However, only prior rape history and acknowledgment served as indirect paths to service seeking; acknowledgment was the strongest predictor of service seeking. Diminished acknowledgment of the incident as rape may be especially important to explaining why DAFR/IR victims are less likely than FR victims to seek services. Public service campaigns designed to increase awareness of rape definitions, particularly around DAFR/IR, are important to reducing disparities in rape-related service seeking.

A Strategy for Increasing Postrape Medical Care and Forensic Examination

Despite the physical and emotional damage of sexual assault, most raped women do not receive postassault medical care. This article describes a social marketing strategy to sell sexual assault nurse examiner (SANE) services available on a college campus directly to matriculated students (potential victims and allies). Significant results found in postcampaign surveys were that the majority of students saw posters and generally retained the information in them, students exposed to more sources of information had more accurate knowledge of services, and students' recommendations concerning SANE usage reflected their exposure to information and their perception of assault risk. The article concludes with policy recommendations.

Rape Survivors' Experiences With the Legal and Medical Systems

This study used a naturalistic quasi-experimental design to examine whether rape survivors who had the assistance of rape victim advocates had more positive experiences with the legal and medical systems compared to those who did not work with advocates. Eighty-one survivors were interviewed in two urban hospitals about what services they received from legal and medical system personnel and how they were treated during these interactions. Survivors who had the assistance of an advocate were significantly more likely to have police reports taken and were less likely to be treated negatively by police officers. These women also reported less distress after their contact with the legal system. Similarly, survivors who worked with an advocate during their emergency department care received more medical services, including emergency contraception and sexually transmitted disease prophylaxis, reported significantly fewer negative interpersonal interactions with medical system personnel, and reported less distress from their medical contact experiences.

Patterns of Assault in a Sample of Recent Rape Victims

Intimate partner assault patterns are not well understood in recent rape victims. In an effort to examine these patterns, 47 rape victims seeking care from a forensic medical examination facility were sampled across three assessment points (6 weeks postassault, 3 months postassault, and 6 months postassault). Index rape, prior rape and physical assault, and new rape and physical assault were classified by victims’ relationships to their perpetrators. At the initial medical exam, 17 women had been past victims of domestic violence. Six women were victims of intimate partner violence during the 6 months after the index rape.

Sexual Assault History and Health-Related Outcomes in a National Sample of Women

This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization ( N = 627) identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.

Longitudinal Relationships of Social Reactions, PTSD, and Revictimization in Sexual Assault Survivors

Sexual assault survivors receive various positive and negative social reactions to assault disclosures, yet little is known about the directionality of associations of social reactions to posttraumatic stress disorder (PTSD) symptoms over time. Data from a large, diverse sample of women who had experienced adult sexual assault was analyzed with hierarchical linear modeling (HLM) to examine how negative and positive reactions relate to PTSD symptoms over 3 years and to test the hypothesis that the relationship between negative social reactions and PTSD symptoms is reciprocal. We found that, as predicted, social reactions predicted subsequent PTSD symptoms, and in turn PTSD symptoms predicted subsequent social reactions. We also investigated the role of sexual revictimization by comparing women who suffered (vs. not) additional sexual victimization during the course of our study. Revictimized women had greater PTSD symptoms and more negative social reactions, but associations of social reactions with PTSD symptoms did not vary according to revictimization status. Implications for practice and suggestions for future research are discussed.

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. Inperson interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.

IMPORTANT BUT INCOMPLETE: PLAN B AS AN AVENUE FOR POST-ASSAULT CARE

Many survivors of rape do not seek post-assault care. The recent change in status of emergency contraception (EC), such as Plan B, to an over-the-counter (OTC) product may be further changing post-assault care-seeking. This descriptive study will quantify OTC EC use in the post-assault period and elicit survivors' desires for care. Data were collected from women purchasing OTC EC at university pharmacies (n=55) and students in an undergraduate university class (n=165). Quantitative results indicate annual prevalence rates of post-assault OTC EC use as 5.4%-7.3%. Qualitative analyses indicate OTC EC is an important but incomplete form of post-assault care. Future work should focus on intervention development to provide all OTC EC users with information about post-assault resources to prevent long-term sequelae.

Post-sexual assault health care utilization among OEF/OIF servicewomen

BACKGROUND AND OBJECTIVES

Few who experience sexual assault seek health care immediately. Yet many become heavy users of health care resources in the years postassault because sexual violence has been linked with both acute and chronic health consequences. Our objective was to investigate servicewomen's medical and mental health (MH) care utilization after sexual assault in-military (SAIM) and identify reasons for not seeking care.

METHODS

In a retrospective cross-sectional Midwestern community sample of OEF/OIF Active Component and Reserve/National Guard servicewomen, currently serving and veterans, computer-assisted telephone interviews were conducted with 207 servicewomen who experienced SAIM.

RESULTS

A quarter (25%) received post-SAIM MH care and 16% medical care. Utilization of medical care tended to be sooner (within the first month) and MH care later (6 mo to 1+ y). Most sought care on a military base, a third from civilian providers, and 10% sought MH from Veterans Health Administration. Servicewomen were more likely to have utilized medical care if they had experienced a completed SAIM and made a Department of Defense SAIM report and MH care if they were white, experienced on-duty SAIM, and made a Department of Defense SAIM report. The most common reason for not seeking medical care was due to belief that care was not needed. Reasons for not utilizing medical or MH care included embarrassment, confidentiality concerns, and fear of adverse career consequences.

CONCLUSIONS

Few servicewomen utilized post-SAIM care, thus assault-specific health consequences were likely unaddressed. Given the severe and chronic consequences of sexual assault, our findings emphasize need for military, Veterans Health Administration, and civilian providers to query SAIM history to provide timely and optimal care.

Current practice of HIV postexposure prophylaxis treatment for sexual assault patients in an emergency department

BACKGROUND

Comprehensive data that address current HIV nonoccupational postexposure prophylaxis (nPEP) practices in the emergency care of sexual assault patients are limited. The U.S. Centers for Disease Control and Prevention released HIV nPEP guidelines in 2005 and updated guidelines for Sexually Transmitted Disease Treatment in 2006 and 2010, each of which support providing nPEP to sexual assault patients. This study examined the offer, acceptance, and adherence rates of nPEP among sexual assault patients treated at an emergency department (ED).

METHODS

We conducted a retrospective review between January 1, 2008, and December 31, 2011, of women, aged 16 years and older, treated for sexual assault in an academic ED that participates in the sexual assault nurse examiner program.

FINDINGS

One hundred seventy-one female patients were treated in the ED for 179 sexual assault events. nPEP was not indicated in 19 cases and was offered to all 138 of patients for whom nPEP was appropriate. Five patient cases that exceeded the 72-hour exposure window were offered nPEP. Of the 143 patient cases offered nPEP, 124 (86.7%) initiated nPEP. Of the 124 who accepted PEP, 34 (27.4%) had documented completion of the 28-day course.

CONCLUSIONS

nPEP was offered in all 138 cases where patients were eligible for treatment. Of patients who accepted nPEP, a minority are documented to have completed a course of treatment. Systems to improve postassault follow-up care should be considered.

Silenced suffering: the need for a better understanding of partner sexual violence

This article has two overall goals. First, to examine the current state of sexual violence research to highlight several shortcomings in the knowledge on partner sexual violence. Second, to describe several factors to consider in future research to facilitate a more in-depth understanding of partner sexual violence. Shortcomings of the research on partner sexual violence include (1) overreliance on dichotomous yes/no representations of sexual violence experiences; (2) lack of, or inadequate documentation of the scope and nature of partner sexual violence; (3) inadequate ways to account for impairment of consent under different circumstances; (4) difficulties in discriminating unwanted from nonconsensual sexual activities; and (5) limited information about the role sexual violence plays in the larger context of coercive control. In order to facilitate a more in-depth understanding of partner sexual assault, there is a need (1) to better understand the scope and nature of partner sexual assault and (2) to better understand the role partner sexual violence plays in coercive control. By improving the measurement of this phenomenon, victims, researchers, practitioners, and those involved in the justice system might be better equipped to respond to sexual violence among intimate partners.

Factors Associated With Follow-Up Attendance Among Rape Victims Seen in Acute Medical Care

OBJECTIVE

Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies.

METHOD

Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department.

RESULTS

Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21-0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13-0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28-0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86-4.91), a completed Sexual Assault Nurse Examiner's (SANE) examination (OR = 2.97, 95% CI = 1.84-4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76-7.11) were associated with an increased odds of attending the follow-up.

CONCLUSIONS

Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.

Are sexual assault victims presenting to the emergency department in a timely manner?

Social workers regularly assist sexual assault victims and would benefit from a greater understanding of causes for delayed presentation to seek medical care. Delays in presentation of sexual assault victims affect the legal value of collected evidence. The authors of this study sought to characterize the nature and frequency of delayed presentation among victims. To do so, they performed a chart review from 2001 to 2007 of the Sexual Assault Forensic Examiner program at their institution. Delayed presentation was defined as presentation more than 12 hours after the assault. Chi-square test was used to contrast frequencies, and multivariate regression was used to control for confounders. Among 482 victims, more than half presented delayed. Of the victims who documented whether they knew the perpetrator, 63 percent knew the perpetrator, with 58 percent of these presenting delayed. Knowing the perpetrator was significantly associated with delayed presentation. Age, ethnicity, and gender were not associated with delayed presentation.

Predictors of delayed disclosure of rape in female adolescents and young adults

BACKGROUND

Delayed disclosure of rape has been associated with impaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency. The purpose of this study was to compare various demographics, post-rape characteristics, and psychological functioning of early and delayed disclosers (i.e., more than 1-week post-rape) among rape victims, and to determine predictors for delayed disclosure.

METHODS

Data were collected using a structured interview and validated questionnaires in a sample of 323 help-seeking female adolescents and young adults (12-25 years), who were victimized by rape, but had no reported prior chronic child sexual abuse.

RESULTS

In 59% of the cases, disclosure occurred within 1 week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12-17 years [odds ratio (OR) 2.05, confidence intervals (CI) 1.13-3.73], penetration (OR 2.36, CI 1.25-4.46), and closeness to assailant (OR 2.64, CI 1.52-4.60) contributed significantly to the prediction of delayed disclosure.

CONCLUSION

The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services.

Sexual assault: a descriptive study of 2500 female victims over a 10-year period

OBJECTIVE

To describe the victims of sexual assault and the circumstances in which the assaults occur.

DESIGN

Descriptive case study.

SETTING

Centre for Victims of Sexual Assault (CVSA), Rigshospitalet, Copenhagen, Denmark.

POPULATION OR SAMPLE

A total of 2541 women attending CVSA from 2001 to 2010.

METHODS

All women attending CVSA underwent a standardised data collection procedure. Descriptive bivariate analysis and logistic regression analysis were performed.

MAIN OUTCOME MEASURES

Associations between different assault characteristics and (1) the age of the victim and (2) the relationship between victim and perpetrator.

RESULTS

Two-thirds of the victims were aged 15-24 years. Seventy-five percent had met the perpetrator before the sexual assault and 70% reported the assault to the police. A physical injury was found in 53, and 27% sustained an anogenital lesion. Alcohol was involved in 60% of the cases. One-third of the victims had experienced a previous sexual assault(s). Women were more likely to report to the police when they were assaulted by a stranger (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.3-2.6) and sustained a physical injury (OR 1.7, 95% CI 1.4-2.2) or anogenital lesion (OR 1.5, 95% CI 1.1-2.0). Women aged 45 years or older were more likely to sustain a physical injury (OR 2.0, 95% CI 1.2-3.2) or an anogenital lesion (OR 2.1, 95% CI 1.4-3.2).

CONCLUSIONS

Our results challenge the typical stereotype of a violent rape attack by a stranger, which is important in creating an environment where women are not reluctant to seek help after a sexual assault. Young age and drinking alcohol were risk factors for sexual assault, and we need to address this when considering preventive strategies.

Community perceptions of rape and child sexual abuse: a qualitative study in rural Tanzania

BACKGROUND

Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences.

METHODS

A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis.

RESULTS

The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents.

CONCLUSIONS

In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.

Predictors of using mental health services after sexual assault

Sexual assault increases the risk for psychopathology. Despite the availability of effective interventions, relatively few victims who need treatment receive care in the months following an assault. Prior work identified several factors associated with utilizing care, including ethnicity, insurance, and posttraumatic stress disorder (PTSD) symptoms. Few studies, however, have examined predictors of treatment utilization prospectively from the time of assault. The present study hypothesized that White racial status, younger age, being partnered, having health insurance, having previously received mental health treatment, and having more PTSD and depression symptoms would predict utilization of care in the 6 months postassault. This was examined in a sample of 266 female sexual assault victims with an average age of 26.2 years, of whom 62.0% were White and 38.0% were African American assessed at 1.5 and 6 months postassault. Available information on utilizing care varied across assessments (1.5 months, n = 214; 3 months, n = 126; 6 months, n = 204). Significant predictors included having previously received mental health treatment (OR = 4.09), 1 day depressive symptoms (OR = 1.06), and having private insurance (OR = 2.24) or Medicaid (OR = 2.19). Alcohol abuse and prior mental health care were associated with a substantial increase in treatment utilization (OR = 4.07). The findings highlight the need to help victims at risk obtain treatment after sexual assault.

Social reactions to sexual assault disclosure and problem drinking: mediating effects of perceived control and PTSD

Sexual assault survivors receive various positive and negative social reactions to assault disclosures, yet little is known about mechanisms linking these social reactions to posttraumatic stress disorder (PTSD) symptoms and problem drinking. Data from a large, diverse sample of women who had experienced adult sexual assault were analyzed with structural equation modeling to test a theoretical model of the relationships between specific negative social reactions (e.g., controlling, infantilizing) and positive reactions (e.g., tangible support), perceived control over recovery, PTSD, and drinking outcomes (N = 1,863). A model disaggregating controlling reactions from infantilizing reactions showed that infantilizing reactions in particular related to less perceived control, which in turn was related to more PTSD and problem drinking, whereas controlling reactions were not related to perceived control, PTSD, or problem drinking. Tangible support was related to increased perceived control over recovery, yet it was not protective against PTSD or problem drinking. Finally, PTSD and drinking to cope fully mediated the effect of perceived control on problem drinking. Implications for practice and suggestions for future research are discussed.

Perceptions of Similarity and Responsibility Attributions to an Acquaintance Sexual Assault Victim

Individuals view similar rape victims as less responsible for the rape than victims perceived as dissimilar. However, it is unclear if individuals hold victims they perceive as similar less responsible for the assault, or if individuals view themselves as more similar to victims they do not view as responsible for the assault. The current study, therefore, examined the temporal relationship between these constructs. A total of 167 college women listened to a date narrative that ended in sexual assault, consensual sex, or no sexual activity (these last two served as controls). Results supported that participants viewed themselves as less similar to the woman in the narrative when the date ended in sexual assault. Only similarity ratings made following learning that the woman was sexually assaulted predicted responsibility attributions suggesting that viewing a victim as responsible for the assault results in decreased perceptions of similarity toward her. Implications and suggestions for future research are discussed.

Predicting sexual assault kit submission among adolescent rape cases treated in forensic nurse examiner programs

Following a sexual assault, victims are usually advised to have a medical forensic exam and sexual assault forensic exam kit (SAK). Once completed, the SAK is to be transported by law enforcement to the crime lab for analysis. However, many kits are never transported to the crime lab, thereby preventing forensic evidence obtained in the kit to be used during the prosecutorial process. The current study examined rates of SAK submission for 393 adolescent sexual assault cases in two Midwestern communities and explored what factors predicted law enforcement officers' submission of SAKs to the crime lab for analysis. Findings reveal that more than 40% of the adolescent cases did not have their SAK submitted, and several factors, including the age and race of the victim, the number of perpetrators in the assault, and the number of assaultive acts, predicted SAK submission. Implications for SAK community protocols are discussed.

Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time

BACKGROUND

Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression.

METHODS

Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of the three follow-ups.

RESULTS

Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol.

CONCLUSIONS

Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up.

Does Encouragement by Others Increase Rape Reporting? Findings from a National Sample of Women

Our study explores the role of victims' consultation with others about whether or not to report their rape to police. Three groups were observed within this sample of 435 rape victims from a national telephone household probability sample of women: those who did not consult with anyone about reporting (n = 364), those who consulted with someone and were encouraged to report to police (n = 40), and those who consulted with someone and were not encouraged to report (n = 31). Descriptive analyses indicated that the encouraged group was more likely to report to police than either of the other two groups (which did not differ from each other). Because there were no differences between the two consulting groups on demographic or rape-related variables, they were combined in subsequent analyses. Consulting with others about whether to report, peri-traumatic fear of injury or death, assault perpetration by a stranger, and concerns about contracting a sexually transmitted disease were significant predictors of reporting to police after controlling for other significant predictors in a multivariate regression analysis. Implications of these findings are discussed, including the benefits and consequences of formal rape reporting for victims, and the role that disclosure recipients may have in assisting victims post-rape (e.g., encouragement of reporting, emotional support).

Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: results from a national telephone household probability sample

OBJECTIVE

To examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape.

METHOD

Using a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident.

RESULTS

One-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use.

CONCLUSIONS

Substance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed.

Prior substance abuse and related treatment history reported by recent victims of sexual assault

To inform intervention approaches, the current study examined prevalence and comorbidity of recent use and history of abuse of alcohol, marijuana, and other illicit drugs as well as history of substance treatment among a sample of female victims of sexual assault seeking post-assault medical care. Demographic variables and prior history of assault were also examined to further identify factors relevant to treatment or prevention approaches. Participants were 255 women and adolescent girls seeking post sexual assault medical services who completed an initial follow-up assessment on average within 3 months post-assault. The majority (72.9%) reported recent substance use prior to assault, approximately 40% reported prior substance abuse history, and 12.2% reported prior substance treatment history. Prior history of assault was associated with recent drug use and history of drug abuse as well as substance treatment. Among those with prior histories of substance abuse and assault, assault preceded substance abuse onset in the majority of cases. Almost all those with prior treatment history reported recent drug or alcohol use. A portion of sexual assault survivors seen for acute medical services may benefit from facilitated referral for substance abuse treatment in addition to counseling at the time of screening. Assessment and intervention approaches should target alcohol, marijuana, and other illicit drug use and abuse. Substance use and associated impairment may serve as a rape tactic by perpetrators of assault. Substance use at the time of assault does not imply blame on the part of assault victims. Previous findings indicate that rape poses high risk of PTSD particularly among women with prior history of assault. Screening and intervention related to substance abuse should be done with recognition of the increased vulnerability it may pose with regard to assault and the high risk of PTSD within this population.

Risk assessment as a paradox: when actions of an IRB become incompatible with ethical principles

As anecdotal evidence mounts up of Institutional Review Boards becoming an impediment to research, I share a personal experience in this article to argue how the conduct of an Institutional Review Board was incompatible with a number of ethical principles such as Respect for Persons, Deception, Informed Consent, and Justice. I conclude by promoting Evidence-Based Ethical Problem Solving to facilitate and enhance risk assessments through empirical evidence.