Victims of rape: repeated assessment of depressive symptoms

Torture and Maltreatment in Prison: A Medico-Legal Perspective

The maltreatment and torture of prisoners constitute a global problem. Methods of maltreatment are classified as the psychological and the physical, and physical methods inevitably lead to psychological sequelae. Our review offers an analysis from the medico-legal perspective of the literature on the torture and physical and sexual abuse experienced by prisoners and their psychological sequelae and aims to investigate the medico-legal issues of investigating maltreatment in prison so as to suggest methodologies and updated approaches for dealing with such cases in a forensic context. We performed a comprehensive literature search of peer-reviewed publications (articles and reviews), research reports, case studies, books, service models, protocols, and institutional documents available online using key electronic databases (Scopus, PubMed) and search engines (Google Scholar) with the following keywords: physical violence, psychological violence, torture, maltreatment, physical abuse, psychological abuse AND prison OR prisoner OR jail OR custody. In the medical literature, most of the publications on torture are based on retrospective studies of torture among survivors and often refer to asylum seekers. Forensic evaluation is crucial for assessing the determinant elements of torture and maltreatment. A multidisciplinary approach and standardized and updated methodologies are needed to support policymakers, national institutions, and public health system initiatives in this field.

The Role of Social Reactions to Disclosures in the Relationship Between Sexual Assault Acknowledgment and Psychological Symptoms

Following a sexual assault, women experience a host of negative psychological consequences. While some survivors label their sexual assault experience as such (i.e., are acknowledged survivors), other survivors do not. The effect of acknowledgment of sexual assault on postassault outcomes has yielded mixed findings. It was hypothesized that social reactions may account for the relationship between acknowledgment status and psychological symptoms. Results indicated that acknowledged survivors reported more severe posttraumatic stress disorder symptoms, which were partially accounted for by turning against social reactions. Future studies should explore the mechanisms responsible for these relationships and analyze the individual social reactions.

The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients

BACKGROUND

It is unclear what session frequency is most effective in cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression.

AIMS

Compare the effects of once weekly and twice weekly sessions of CBT and IPT for depression.

METHOD

We conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted.

RESULTS

Compared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00-2.18).

CONCLUSIONS

In clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.

The Impact of Avoidant/Disengagement Coping and Social Support on the Mental Health of Adolescent Victims of Sexual Violence in Eastern Congo

INTRODUCTION

Eastern Congo has been affected by armed conflict for decades while the rampant use of sexual violence has left many women and girls dealing with a wide range of consequences of sexual violence. For adolescent victims the psychosocial impact of sexual violence is devastating. However, the role of avoidant/disengagement coping and family support on the mental health impact of sexual violence remains unclear.

METHODS

The study design was a cross-sectional, population-based survey in which 1,305 school-going adolescent girls aged 11 to 23 participated. Mental health symptoms (IES-R and HSCL-37A), family support (MSPSS), avoidant/disengagement (Kidcope), war-related traumatic events (ACEES), experiences of sexual violence, daily stressors, and stigmatization (ACEDSS) were administered through self-report measures. Hierarchical multiple regression analysis was carried out with mental health outcomes as dependent variables for different types of sexual violence. Finally, several ANCOVA models were defined to explore possible interaction effects of avoidant/disengagement coping and family support with stigmatization, daily stressors and war-related traumatic exposure.

RESULTS

For girls who did not report sexual violence, avoidant/disengagement coping has a direct negative effect on all psychological symptoms. For victims of sexual violence, when high levels of stigma were reported, avoidant/disengagement coping possibly served as a protective factor, as shown by the interaction effect between avoidance/disengagement coping and stigmatization on mental health outcomes. In victims of sexual violence however, high levels of daily stressors combined with avoidant/disengagement strategies showed a strong increase in posttraumatic stress symptoms. Interestingly, the mental health impact of sexual violence was not mitigated by support by family members. For girls who reported a nonconsensual sexual experience without labelling it as rape and at the same time testified to have a lot of family support, there was a positive association between stressors (daily stressors, stigma, and war-related trauma) and posttraumatic stress symptoms.

CONCLUSIONS

These results of this study underwrite to the importance of looking beyond the straightforward negative impact of avoidant/disengagement coping strategies on mental health in adolescent victims of sexual violence. While avoidant/disengagement coping can have a negative impact on psychosocial well-being on adolescent victims of sexual violence, in case of high levels of stigmatization it can as well protect them from posttraumatic stress or anxiety. Furthermore these findings speak to the importance of exploring the diversified relationship between risk and protective factors, such as avoidant/disengagement coping strategies and family support, that shape the mental health impact of sexual violence in adolescent victims.

Smoking abstinence symptoms across 67 days compared with randomized controls-Moderation by nicotine replacement therapy, bupropion, and negative-affect traits

Accurate knowledge of negative affect (NA)-related smoking abstinence symptoms (SAS) severity and duration and their moderation by pharmacotherapy and NA-related personality traits is critical for efficacious treatments given that elevated state and trait NA are predictors of relapse. However, SAS severity, duration, and moderation are not well characterized. To date, the longest randomized controlled trial (RCT) of NA-related SAS using randomized delayed-quit smoking controls only examined symptoms across 45 days, despite clinical evidence that SAS may last longer. The present RCT assessed SAS across 67 days in dependent smokers (N = 95) who were randomized either to quit or to delay quitting for the course of the trial. The quit group was further randomized to receive either nicotine replacement therapy (NRT), bupropion (BUP), or placebo. Abstinence-related increases in anger-irritability, depressive, anxiety, and general NA symptoms did not resolve relative to the delayed quit group (DQG) levels across the 67 days in any of the 3 quit groups, though craving fell to below DQG and prequit levels. While NRT attenuated Day 3 SAS relative to BUP and placebo, BUP and NRT generally did not reduce SAS. High scores on trait measures of NA/neuroticism predicted greater increases in and duration of NA-related SAS, potentially indicating that smoking abstinence unmasks affective symptoms. Positive affect was not impacted by abstinence or treatment. The results support the views that (a) prequit baseline values are not a valid index of NA SAS recovery, and (b) on average, NA-related SAS take longer than 67 days to resolve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Longitudinal assessment of heavy alcohol use and incapacitated sexual assault: A cross-lagged analysis

Researchers have argued there are bidirectional associations between heavy alcohol use and sexual assault; however, research in this area is inconclusive due to methodological differences, particularly in study design. The purpose of this study is to clarify the longitudinal associations between heavy alcohol use and incapacitated sexual assault among first-year college women, accounting for hypothesized autoregressive effects within each construct over their first year of college. A sample of 483 women completed regular surveys that assessed a range of health behaviors, including alcohol use and sexual behavior, during their first year of college. We used cross-lagged analyses to examine prospective associations between incapacitated sexual assault and heavy alcohol use (frequency of heavy episodic drinking and peak blood alcohol content). There were significant autoregressive effects, such that women who were engaging in heavier alcohol use as they entered college continued to be heavier alcohol users throughout their first year, and women with a history of assault at college entry were at greater risk for assault during their first year of college. There was a significant cross-lagged effect from precollege incapacitated assault to first-semester alcohol use after controlling for pre-college alcohol use. There were no significant cross-lag paths from alcohol use to subsequent incapacitated assault. Women with a history of incapacitated sexual assault engaged in heavier drinking during their transition to college, but heavy alcohol use did not predict subsequent assault risk.

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

Multimethod Validation of the Beck Depression Inventory—II and Grossman-Cole Depression Inventory with an Inpatient Sample

Psychometric examination of the Beck Depression Inventory–II has been adequate and varied for outpatient and nonclinical samples, but is still comparatively scant for inpatient psychiatric samples. In particular, important factor analytic questions have not been assessed on inpatient samples at all. Given that over time alone (regardless of symptom change) test scores on depression measures can spuriously drop, a convergent psychometric analysis of the Beck Depression Inventory–II was undertaken with a new measure of depression severity, the Grossman-Cole Depression Inventory. A sample of 101 psychiatric inpatients was administered both tests. Item and scale level psychometrics were reviewed for each measure. Results were highly consistent with previous findings, providing support for the use of the Beck Depression Inventory–II with inpatient samples. Moreover, the new inventory performed quite well, suggesting it has promise as another measure for self-reported depression symptom severity. The Beck Depression Inventory–II appears appropriately considered as a single-factor hierarchical measure of depression with the current inpatient sample. Moreover, the Grossman-Cole Depression Inventory is related enough to the Beck inventory to provide adequate similarity without being so similar the measures duplicate each other.

Impact of Adulthood and Adolescent Rape Experiences on Subsequent Sexual Fantasies

This study represents the first investigation of adolescent and adulthood rape experiences on the sexual fantasies of female college student victims. Although students who reported being adulthood rape victims ( N = 44; not victimized in childhood) reported being more depressed than nonvictims who had experienced intercourse ( N = 83) and than nonvictims with no intercourse history ( N = 40), victims' sexual fantasies were generally indistinguishable from nonvictims in terms of multiple indices of fantasy [1]. Even when data analyses were restricted to only those subjects who perceived themselves as victims, significant differences did not emerge, although a number of suggestive trends were discerned. Across all subjects, fantasies were more elaborate in response to the first of two reported fantasies. Victims were generally indistinguishable from nonvictims in terms of demographic characteristics, previous sexual experiences, sex drive, sexual satisfaction, and sex guilt. In summary, the effects of sexual victimization in this sample were neither pervasive nor enduring.

A Comparison of Group and Individual Sexual Assault Victims

The experiences of 44 group sexual assault victims (multiple offenders, one victim) were compared with 44 individual sexual assault victims (one offender, one victim). Sexual assaults included various degrees of sexual victimization ranging from verbal coercion to rape. Participants were located from among a national sample of 3,187 college women. Group sexual assaults, compared to individual sexual assaults, were in general more violent, involved greater resistance from the victims, and were more likely to be perpetrated by strangers or relatives and to involve an experience which met the legal definition of rape. Group sexual assaults were less likely to involve multiple episodes by the same offender(s). Group sexual assault victims were more likely than individual sexual assault victims to seek police and crisis services, to have contemplated suicide, and to have sought therapy postassault. Despite these differences, the two groups were similar in the amount of drinking and drug use during the assault and their scores on standardized measures of psychological symptoms.

Depression and PTSD in Survivors of Male Violence: Research and Training Initiatives to Facilitate Recovery

Male violence is an enduring feature of women's lives from childhood through old age. The review covers child sexual abuse, rape, and partner violence with emphasis on the prevalence of violence, its mental health consequences, the course of recovery, and mediators and moderators of traumatic impact. The primary focus is depression and posttraumatic stress disorder, the two major diagnostic entities through which postassault emotions and behaviors have been conceptualized and measured. The effects of psychiatric conceptualizations of victimization and patterns of individual recovery are critically reviewed. The PTSD paradigm as the sole foundation for most victimization research is also debated. Following the review, mental health services for victimized women are examined. The article concludes with public policy recommendations to improve the availability and accessibility of mental health services with emphasis on reaching those survivors who are less likely to consult the formal system.

Coping with the Experience of Rape

The coping strategies that a victim of a rape engages in can have a strong impact on the development and persistence of psychological symptoms. Research provides evidence that victims who rely heavily on avoidance strategies, such as suppression, are less likely to recover successfully than those who rely less heavily on these strategies. The present study utilized structural path analysis to identify predictors of avoidance coping following rape and examined factors in the assault itself (e.g., force, alcohol use), sequelae of the assault (e.g., self-blame, loss of self-worth), and social support as potential direct and indirect predictors of avoidance coping. From a sample of 1,253 university women, the responses of 216 women who endorsed an experience of rape were examined. Results suggested that sequelae of the assault such as feelings of self-blame and negative reactions received from others are potentially important predictors of avoidance coping. Implications of the results for future rape recovery research are discussed.

Long-Term Effects of labeling a Rape Experience

Research has found that approximately half of women who report an experience that meets the legal definition of rape do not label it rape. It has been assumed that labeling the experience as rape is necessary and beneficial for recovery; however, conflicting findings have been reported. In the present study, a longitudinal design was utilized to examine the long-term consequences of being a rape victim and of labeling the experience as rape. Assessments were obtained at two time points approximately 10 months apart from females in their first year of college. Participants were classified as nonvictims, victims who labeled the experience as rape, or victims who did not label the experience as rape. Results showed that there were negative effects of being raped, such as more psychological distress and increased alcohol use; however, few differences were found at either assessment based on rape victims' labeling of the experience.

A Conceptual Analysis of Rape Victimization: Long-Term Effects and Implications for Treatment

Recent prevalence studies have suggested that 15–22% of women have been raped at some point in their lives, many by close acquaintances, although few victims seek assistance services or professional psychotherapy immediately post-assault. Surveys have revealed that 31–48% of rape victims eventually sought professional psychotherapy, often years after the actual assault. These observations suggest that the primary role of clinicians in the treatment of rape victims is the identification and handling of chronic, post-traumatic responses to a nonrecent experience. However, it is concluded that most of the existing literature on rape treatment addresses only the target symptoms that represent the immediate response to rape. In this article, contemporary theoretical and empirical discussions of stress, cognitive appraisal, cognitive adaptation, and coping are used to conceptualize the long-term impact of rape and the process of resolution. Directions for future research on the clinical treatment of rape are suggested.

Crime Victimisation and Subjective Well-Being: Panel Evidence From Australia

This paper estimates the effect of physical violence and property crimes on subjective well-being in Australia. Our methodology improves on previous contributions by (i) controlling for the endogeneity of victimisation and (ii) analysing the heterogeneous effect of victimisation along the whole distribution of well-being. Using fixed effects panel estimation, we find that both types of crimes reduce reported well-being to a large extent, with physical violence exerting a larger average effect than property crimes. Furthermore, using recently developed panel data quantile regression model with fixed effects, we show that the negative effects of both crimes are highly heterogeneous, with a monotonic decrease over the distribution of subjective well-being. Copyright © 2015 John Wiley & Sons, Ltd.

Trauma and Victimization

The topics of victimization and traumatic stress have become focal issues within the last two decades. This article synthesizes theoretical and empirical findings about psychological responses to traumatization across survivors of rape, childhood sexual or physical abuse, domestic violence, crime, disasters, and the Vietnam war. Five major categories of response, emotional, cognitive, biological, behavioral, and interpersonal, are described. Based on these findings, the authors present a new theoretical model for understanding individual variations in victim responses. In this model, they propose a complex relation among traumatic experiences, cognitive schemas within the areas of safety, trust, power, esteem, and intimacy, and psychological adaptation. Implications for assessment, treatment intervention, and further research within the area of traumatic stress 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.

Revictimization and recovery from sexual assault: implications for health professionals

Twenty-seven adult females' responses from an online qualitative questionnaire were analyzed to explore their views on being recovered from an experience of sexual assault, and identify aspects of their postassault health service encounters that facilitated or impeded their recovery process. Being recovered involved accepting the experience, being freed from negative states, regaining control and trust, and receiving help from and being believed by others. Participants predominantly reported negative experiences with health services. Factors perceived as impeding the recovery process include health professionals' inexperience in dealing with survivors of sexual assault, adhering to rape myths and stereotypes, and disrespectful or inconsiderate treatment of survivors. We argue that these postassault negative experiences revictimized survivors. Addressing these factors may reduce revictimization, facilitate recovery, and decrease assaulted women's long-term use of health services.

A characterization of adult victims of sexual violence: results from the national epidemiological survey for alcohol and related conditions

Sexual violence can cause acute and persistent negative psychological outcomes among children and adults in a community. Previous studies have frequently reported high prevalence of prior child and adolescent sexual abuse among adult victims of sexual violence. This raises uncertainty over the specific contribution of sexual victimization in adulthood to the adverse psychological outcomes. The present study draws on a large nationally representative sample of adults without history of childhood sexual abuse, and applies diagnostic criteria of DSM-IV, in order to investigate the risk factors and psychiatric comorbidities correlated with sexual victimization in adulthood. In a large representative sample of U.S. adults without history of childhood sexual abuse, 2.5% reported sexual victimization in adulthood. Female gender, living alone, economic disadvantage, and a history of childhood adversities and parental psychopathology were identified as risk factors. Adult sexual victimization increased the risk of developing a variety of psychiatric disorders, especially PTSD (HR = 3.43, 95% CI [2.67, 4.41]) and drug abuse (HR = 3.38, 95% CI [2.49, 4.58]). Conversely, pre-existing psychiatric psychopathology, particularly PTSD (HR = 3.99, 95% CI [2.68, 5.94]) and dysthymia (HR = 2.26, 95% CI [1.42, 3.59]), increased the likelihood of sexual victimization in adulthood. Childhood experience and adulthood sociodemographic characteristics are important in affecting the risk of being sexually victimized in adulthood. Psychiatric disorders can act as both risk factors and outcomes of adult sexual victimization.

Sexual revictimization: double betrayal and the risk associated with dissociative amnesia

This study aimed to identify new treatment targets in order to develop more empirically informed initiatives to prevent sexual revictimization. A retrospective Web-based survey employing a mixed-methods design attracted a self-selecting sample of 481 community respondents, 183 of whom indicated a history of childhood sexual abuse. Seventy-four percent were females whose ages ranged from 16 to 69 years (mean = 31.2 years). Betrayal trauma referred to CSA committed by a trusted perpetrator (often caregivers). Disclosure experiences in childhood were reported though open-dialogue boxes. Double betrayal referred to high-betrayal trauma being combined with a negative response to a disclosure. This was associated with both higher incidences of prior psychogenic amnesia for CSA and sexual revictimization in later life. The findings have implications for educating the guardians of children about the prevalence and implications of CSA as well as the importance of early recognition and appropriate responding.

The costs of rape

The current study examined costs experienced by victims of completed rape (n=49) and attempted sexual assault (n=91) using quantitative analyses of 13 domains: health, self-esteem, self-perceived attractiveness, self-perceived mate value, family relationships,work life, social life, social reputation, sexual reputation, desire to have sex, frequency of sex, enjoyment of sex, and long-term, committed relationships. Women also provided descriptive accounts of their experiences, and we used these to illustrate the costs in the victims' own words.Compared to victims of an attempted sexual assault, victims of a completed rape reported significantly more negative outcomes in 11 of the 13 domains. The most negatively affected domains were self-esteem, sexual reputation, frequency of sex, desire to have sex, and self-perceived mate value. Although victims of rape experienced more negative effects than victims of attempted sexual assault,both groups of victims reported negative effects in every domain.Discussion focuses on the implications of the differing degrees and patterns of the costs of attempted and completed sexual victimization.

Older women survivors of physical and sexual violence: a systematic review of the quantitative literature

BACKGROUND

This systematic review synthesizes the quantitative empirical literature concerning older women survivors of physical and sexual assault.

METHODS

A literature search was conducted using a range of scholarly databases. Information is presented here on the prevalence, correlates, and consequences of these types of interpersonal violence in older women. Additionally, age-related differences in prevalence, psychiatric distress, and characteristics of violence, including information on perpetrators, are reviewed.

RESULTS

Overall, older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women. Additionally, older women who experienced interpersonal violence report greater psychiatric distress, including posttraumatic stress disorder (PTSD), than older women who have not experienced such events.

CONCLUSIONS

Some women who have been physically or sexually assaulted decades earlier in life continue to report significant levels of PTSD well into older adulthood. Gaps in the literature, including lack of information on ethnicity and culture, are presented, and future research directions are proposed.

Longitudinal research with sexual assault survivors: a methodological review

Longitudinal research designs are relatively rare in the academic literature on rape and sexual assault despite their tremendous methodological rigor and scientific utility. In the interest of promoting wider use of such methods, we conducted a methodological review of projects that have used prospective longitudinal designs to study the occurrence of sexual victimization throughout the lifespan and/or the process of change during rape recovery (N = 32 projects). Five questions were examined: (a) What were the substantive foci of these longitudinal studies? (b) How were survivors recruited? (c) What participation rates were typical? (d) How long were participants followed over time and with what success rates? and (e) What incentives were used to increase participation? Most studies focused on postassault sequelae and recruited survivors from hospital emergency departments and other first-response help-seeking sites with highly variable participation rates. Retention rates were comparable across studies (approximately 70%).

The relationship between women's response effectiveness and a history of sexual victimization

This study evaluated the effects of a sexual victimization history and the contextual features of sexual activity and alcohol use on the effectiveness of women's responses to 44 written vignettes describing diverse dating and social situations. One hundred and one undergraduate women reported their history of sexual victimization and provided written descriptions of how they would respond to each vignette. Experts in the sexual violence research area then evaluated the effectiveness of these responses in decreasing risk of having an unwanted sexual experience, meaning one in which the woman is verbally or physically coerced into having sexual contact of any kind with a man. Results revealed that past victimization moderated the influence of the situations' contextual features on women's response effectiveness. Specifically, as the presence of sexual activity increased in the situations, the response effectiveness of more severely victimized women increased less than nonvictimized women. In addition, as the presence of alcohol increased in the situations the response effectiveness of more severely victimized women decreased more than that of nonvictimized women.

Sequelae of sexual trauma in women treated for non-trauma-related psychiatric disorders in a psychiatric hospital in Switzerland

OBJECTIVE

We sought to explore the impact of sexual trauma on symptom severity, sense of coherence, and control orientation in female psychiatric inpatients diagnosed with and admitted for non-trauma-related mental disorders.

METHODS

A sample of 31 female inpatients with a reported history of sexual trauma (two thirds abused in childhood, one third raped in adulthood) were compared with 31 female inpatients with similar sociodemographic backgrounds, matched for age and psychiatric diagnosis.

FINDINGS

Compared with the sexually nontraumatized patients, the patients with a reported history of sexual trauma were neither more symptomatic nor did they have a more severe course of illness. No significant differences were found between the two groups with regard to sense of coherence and control orientation. Patients who had been raped in adulthood rated lower than all other patients in the Meaningfulness subscale of the Sense of Coherence Scale, indicating that their belief that there is good reason to care about what happens has been affected.

CONCLUSION

Based on the dimensions assessed, female psychiatric inpatients with a reported history of sexual trauma were not found to be significantly different from female inpatients without such a history. The burden of a mental disorder ensuing from the severity of illness symptoms and illness course is probably so high that the potential impact of a sexual trauma cannot manifest.

The impact of criminal justice involvement on victims' mental health

The aftermath of violent crime can leave victims with persistent emotional and mental health problems. Although research has shown the potential benefits of prosecuting cases through the courts, there is also a substantial literature that suggests that common features of the criminal justice system can exacerbate the impact of the initial crime, leading to a secondary victimization. The authors present a review of the research on the positive and negative impact of criminal justice involvement, and common points of failure in the efforts of justice institutions to meet the needs of victims. They conclude with recommendations for future work, including the need for research on restorative justice, victim impact statements, court notification systems, victim services, and victim advocates.

An ecological model of the impact of sexual assault on women's mental health

This review examines the psychological impact of adult sexual assault through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology contribute to post-assault sequelae. Using Bronfenbrenner's (1979, 1986, 1995) ecological theory of human development, we examine how individual-level factors (e.g., sociodemographics, biological/genetic factors), assault characteristics (e.g., victim-offender relationship, injury, alcohol use), microsystem factors (e.g., informal support from family and friends), meso/ exosystem factors (e.g., contact with the legal, medical, and mental health systems, and rape crisis centers), macrosystem factors (e.g., societal rape myth acceptance), and chronosystem factors (e.g., sexual revictimization and history of other victimizations) affect adult sexual assault survivors' mental health outcomes (e.g., post-traumatic stress disorder, depression, suicidality, and substance use). Self-blame is conceptualized as meta-construct that stems from all levels of this ecological model. Implications for curbing and/or preventing the negative mental health effects of sexual assault are discussed.

Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.

[Social support and psychological consequences of sexual assault: a literature review]

Sexual assault results in important consequences for victims. An inadequate social support may have an impact on the victim's psychological condition and interfere with her adjustment. The purpose of the present article is to describe different support reactions linked to sexual assault and their impact on the psychological condition of the victims, the posttraumatic symptoms and the recovery. The specific contribution of the spouse living with the victim is exposed. The impact of the consequences resulting from the sexual assault on the quality of the support is also presented. Finally, clinical implications and research approach are proposed.

Cognitive approaches to posttraumatic stress disorder: the evolution of multirepresentational theorizing

The evolution of multirepresentational cognitive theorizing in psychopathology is illustrated by detailed discussion and analysis of a number of prototypical models of posttraumatic stress disorder (PTSD). Network and schema theories, which focus on a single, explicit aspect/format of mental representation, are compared with theories that focus on 2 or more explicit representational elements. The author argues that the latter theories provide a more complete account of PTSD data, though are not without their problems. Specifically, it is proposed that at least 3 separate representational elements-associative networks, verbal/propositional representations, and schemas-are required to generate a comprehensive cognitive theory of PTSD. The argument that the development of multirepresentational cognitive theory in PTSD is a paradigm case for the development of similar theories in other forms of psychopathology is elaborated, and a brief agenda is proposed promoting 2 levels of theorizing-deep, formal theory alongside more localized, applied theory.

Childhood and adult sexual abuse, rumination on sadness, and dysphoria

OBJECTIVE

The study addressed the hypothesis that adults reporting sexual abuse are more likely to exhibit a general tendency to ruminate on sadness. The relations between reported abuse, rumination on sadness, and dysphoria were also examined.

METHOD

Undergraduate students (101 women and 100 men) reported on childhood and adult sexual abuse and instances of intimidation, as well as completing the Rumination on Sadness Scale [Journal of Personality Assessment 75 (2000) 404] and the Beck Depression Inventory [Depression: Clinical, Experimental, and Theoretical Aspects, Harper & Row, New York].

RESULTS

Participants who reported more abuse were more likely to report rumination on sadness. Both reports of abuse and of rumination were linked to dysphoria. Overall, causal modeling indicated that two models were equally effective in accounting for the data: (a) victimization leads to dysphoria, with this relation being partly mediated by rumination and (b) victimization leads to dysphoria, which in turn leads to rumination. Both models are consistent with prior research. For men considered separately, both models were equally effective. For women, model a best accounted for the data.

CONCLUSION

One of the pathways by which victimization may lead to depression in adulthood is by encouraging the development of a tendency to ruminate on sadness. Alternatively, victimization may lead to depression by other means, and the experienced depression or dysphoria may foster rumination.

An acute post-rape intervention to prevent substance use and abuse

The trauma of rape is routinely associated with extreme acute distress. Such peri-event anxiety increases risk of developing psychopathology and substance use or abuse post-rape, with the degree of initial distress positively predicting future problems. Unfortunately, the nature of post-rape forensic evidence collection procedures may exacerbate initial distress, thereby potentiating post-rape negative emotional sequelae. Consequently, substance use may increase in an effort to ameliorate this distress. To address this, a two-part video intervention was developed for use in acute post-rape time frames to (a) minimize anxiety during forensic rape examinations, thereby reducing risk of future emotional problems, and (b) prevent increased post-rape substance use and abuse. Pilot study data with 124 rape victims indicated that the low-cost, easily administered intervention was effective in reducing risk of marijuana abuse at 6 weeks. Nonstatistically significant trends also were evident for reduced marijuana use. Trends were also noted in favor of the intervention in the subgroup of women who were actively using substances pre-rape (among pre-rape alcohol users, 28% viewers vs. 43% nonviewers met criteria for post-rape alcohol abuse; among pre-rape marijuana users, the rates of post-marijuana use were 17% vs. 43%).

Sexual assaults in Singapore: a comparative study of rapists and molesters

Sexual assaults vary in terms of severity from molestation, which involves touching, stroking, fondling or grabbing of any part of the victim's body, to rape, where victims have been known to suffer severe emotional trauma. The aim of the study is to compare molesters with rapists using hypotheses that molesters and rapists commit their offences at different times of the day, at differing locations and with differing relationships with their victims. The influence of alcohol on both groups was also studied. Convicted molesters and rapists were given a semi-structured interview in prison. Demographic information and details of each offence were obtained from prison records. Comparisons were made of the demography, time, place, reasons for assault, relationship of offender to victims and the role of alcohol and drugs consumed by the perpetrators. Molesters and rapists were of similar age and ethnicity, but differed in that rapists had attained a lower educational level and were more likely to be single. Rapists were more likely to report having drunk alcohol, committing rape after midnight and in secluded places. Molesters struck in the afternoon hours and usually in crowded places. Victims of molesters tended to be relatives whereas victims of rapists were more likely to be ex-spouses or ex-lovers. Molesters tended to give other reasons for their offences. Differences between molesters and rapists could lead to intervention strategies chiefly targeting the issues of poor socialisation skills in molesters and alcohol counseling for rapists.

A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims

The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred seventy-one female rape victims were randomized into 1 of the 3 conditions, and 121 completed treatment. Participants were assessed with the Clinician-Administered PTSD Scale, the PTSD Symptom Scale, the Structured Clinical Interview for DSM-IV, the Beck Depression Inventory, and the Trauma-Related Guilt Inventory. Independent assessments were made at pretreatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highly efficacious and superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales.

A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault

The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.

Patterns of recovery from trauma: the use of intraindividual analysis

Patterns of recovery from sexual and nonsexual assault were examined. Two studies containing data from female victims of these assaults were analyzed. In Study 1, victims (N = 101) underwent 12 weekly assessments with measures of posttraumatic stress disorder (PTSD), depression, and state anxiety. In Study 2, victims (N = 108) underwent monthly assessments on the same measures. The authors examined the effects of type of trauma and time of peak reaction on long-term recovery using intraindividual analysis of change. In both studies, initial and peak reactions of rape victims were more severe than were those of nonsexual assault victims on all measures of psychopathology. Victims with delayed peak reaction exhibited more severe pathology at the final assessment than did victims with early peak reaction. Results of Study 2 indicated a slower recovery rate from sexual than nonsexual assault; in Study 1 a similar pattern of recovery emerged. The advantages of an individual-focused, longitudinal approach to recovery from a trauma are discussed.

Emergency evaluation and intervention with female victims of rape and other violence

Given the high prevalence of crime within the general population and the increased rates of victimization among those seeking medical care, professionals who work in emergency departments, primary care medical facilities, or mental health settings need to be prepared to address physical and psychological problems related to sexual and physical assault. In this paper, interpersonal violence prevalence studies are reviewed in terms of study design and findings for sexual assault and physical assault. Common injuries following both forms of assault are documented, followed by a review of long-term medical outcomes. In addition to a review of physical health outcomes, primary psychological effects of violence are also reviewed. Strategies with which to screen for interpersonal violence in the medical setting are offered, and issues related to mandatory reporting are summarized. Interventions for assault victims that can be implemented in the medical setting are outlined, and a new hospital-based treatment for victims of rape is described.

Victimization of women and its impact on assessment and treatment in the psychiatric emergency setting

An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.