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Hahn C, Tilstra-Ferrell E, Salim S, Goodrum N, Rheingold A, Gilmore AK, Barber S, Moreland A. Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study. JMIR Form Res 2024; 8:e49557. [PMID: 38358791 PMCID: PMC10905344 DOI: 10.2196/49557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. OBJECTIVE This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. METHODS Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). RESULTS Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. CONCLUSIONS Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.
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Affiliation(s)
- Christine Hahn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Emily Tilstra-Ferrell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Selime Salim
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Nada Goodrum
- Department of Psychology, University of South Carolina, Charleston, SC, United States
| | - Alyssa Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Sara Barber
- South Carolina Coalition Against Domestic Violence and Sexual Assault, Columbia, SC, United States
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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Hardeberg Bach M, Ahrens C, Olff M, Armour C, Krogh SS, Hansen M. EHealth for Sexual Assault: A Systematic Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:102-116. [PMID: 36632639 DOI: 10.1177/15248380221143355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.
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Affiliation(s)
| | | | | | | | | | - Maj Hansen
- University of Southern Denmark, Odense, Denmark
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Kilimnik CD, García-Ramírez G, Salamanca NK, Mazzone GM, Mullican KN, Davis KC, Orchowski LM, Leone RM, Kaysen D, Gilmore AK. Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2169-2183. [PMID: 38226754 DOI: 10.1111/acer.15194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation. METHODS A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks. RESULTS The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men. CONCLUSIONS Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.
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Affiliation(s)
- Chelsea D Kilimnik
- Department of Psychology & Neuroscience and the Renée Crown Wellness Institute, University of Colorado Boulder, Colorado, Boulder, USA
| | - Grisel García-Ramírez
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Nashalys K Salamanca
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
- Department of Psychology, Georgia State University, Georgia, Atlanta, USA
| | | | - K Nicole Mullican
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Lindsay M Orchowski
- Department of Psychiatry and Human Behavior, Brown University, Rhode Island, Providence, USA
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Debra Kaysen
- Division of Public Mental Health and Population Sciences, Department of Psychiatry, Stanford University School of Medicine, California, Stanford, USA
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
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O'Doherty L, Whelan M, Carter GJ, Brown K, Tarzia L, Hegarty K, Feder G, Brown SJ. Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood. Cochrane Database Syst Rev 2023; 10:CD013456. [PMID: 37795783 PMCID: PMC10552071 DOI: 10.1002/14651858.cd013456.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well-being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post-traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma-focused cognitive and behavioural approaches, there is a range of low-intensity interventions along with new and emerging non-exposure based approaches (trauma-sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults. OBJECTIVES To assess the effects of psychosocial interventions on mental health and well-being for survivors of rape, sexual assault or sexual abuse experienced during adulthood. SEARCH METHODS In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches. SELECTION CRITERIA Any study that allocated individuals or clusters of individuals by a random or quasi-random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait-list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group's psychological therapies list. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%). The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face-to-face (41) or other individual formats (four); groups (nine); or involved computer-only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding. Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African-American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty-two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty-two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry. The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post-treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.22 to -0.44; 16 studies, 1130 participants; low-certainty evidence; large effect size based on Cohen's D); and depression (SMD -0.82, 95% CI -1.17 to -0.48; 12 studies, 901 participants; low-certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low-certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low-certainty evidence). We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one-third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I2 = 30% (adverse events) to I2 = 87% (PTSD). AUTHORS' CONCLUSIONS Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post-treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation. We conclude that a range of behavioural and CBT-based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post-treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head-to-head comparisons of different intervention types; in particular, of novel, emerging therapies, with one-year plus follow-up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.
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Affiliation(s)
- Lorna O'Doherty
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Maxine Whelan
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Grace J Carter
- Institute for Health and Wellbeing, Coventry University, Coventry, UK
| | - Katherine Brown
- Department of Psychology and Sports Science, University of Hertfordshire, Hatfield, UK
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Brown
- Faculty of Arts, Business and Law, Law School, USC: University of the Sunshine Coast, Sippy Downs, Australia
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Dworkin ER, Jaffe AE, Bedard-Gilligan M, Fitzpatrick S. PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies. TRAUMA, VIOLENCE & ABUSE 2023; 24:497-514. [PMID: 34275368 PMCID: PMC8766599 DOI: 10.1177/15248380211032213] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Sexual assault is associated with higher rates of posttraumatic stress disorder (PTSD) than other traumas, and the course of PTSD may differ by trauma type. However, the course of PTSD after sexual assault has not been summarized. The aim of this meta-analysis was to identify the prevalence and severity of PTSD and changes to the average rate of recovery in the 12 months following sexual assault. METHOD Authors searched four databases for prospective studies published before April 2020 and sought relevant unpublished data. Eligible studies assessed PTSD in at least 10 survivors of sexual assault in at least two time points, starting within 3 months postassault. Random effects linear-linear piecewise models were used to identify changes in average recovery rate and produce model-implied estimates of monthly point prevalence and mean symptom severity. RESULTS Meta-analysis of 22 unique samples (N = 2,106) indicated that 74.58% (95% confidence interval [CI]: [67.21, 81.29]) and 41.49% (95% CI: [32.36, 50.92]) of individuals met diagnostic criteria for PTSD at the first and 12th month following sexual assault, respectively. PTSD symptom severity was 47.94% (95% CI: [41.27, 54.61]) and 29.91% (95% CI: [23.10, 36.73]) of scales' maximum severity at the first and 12th month following sexual assault, respectively. Most symptom recovery occurred within the first 3 months following sexual assault, after which point the average rate of recovery slowed. CONCLUSIONS Findings indicate that PTSD is common and severe following sexual assault, and the first 3 months postassault may be a critical period for natural recovery.
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Affiliation(s)
- Emily R Dworkin
- 12353University of Washington School of Medicine, Seattle, WA, USA
| | - Anna E Jaffe
- University of Nebraska, Lincoln-Lincoln, NE, USA
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Hahn CK, Kilimnik CD, Brady KT, Marx BP, Rothbaum BO, Saladin ME, Gilmore AK, Metts CL, Back SE. Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology. Contemp Clin Trials 2023; 125:107002. [PMID: 36436732 PMCID: PMC9989773 DOI: 10.1016/j.cct.2022.107002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Christine K Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Chelsea D Kilimnik
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Brian P Marx
- Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
| | - Barbara O Rothbaum
- Emory School of Medicine, Emory University, 01 Dowman Dr., Atlanta, GA 30322, USA.
| | - Michael E Saladin
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA
| | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
| | - Christopher L Metts
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA.
| | - Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St., 2nd Fl. S., MSC 861, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee St. Charleston, SC 29401, USA.
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Walsh K, Gilmore AK, Barr SC, Frazier P, Ledray L, Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS. The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP17325-NP17343. [PMID: 34229508 DOI: 10.1177/08862605211028006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures.
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Affiliation(s)
- Kate Walsh
- University of Wisconsin-Madison, WI, USA
| | | | - Simone C Barr
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Linda Ledray
- SANE SART Resource Service, Minneapolis, MN, USA
| | - Ron Acierno
- University of Texas Health Science Center, Houston, TX, USA
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Kliewer W, Svikis DS, Yousaf N, Ashton H, Cyrus JW. Psychosocial Interventions for Alcohol and/or Drug Misuse and Use Disorders in Women: A Systematic Review. J Womens Health (Larchmt) 2022; 31:1271-1304. [PMID: 35363075 DOI: 10.1089/jwh.2021.0488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although men and women who misuse substances have different needs, no rigorous systematic literature review has been conducted examining psychosocial substance use interventions for women across a broad range of types of therapeutic approaches and populations. Materials and Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review. English language, peer-reviewed research articles indexed in PubMed, PsycINFO, CINAHL Complete, and Web of Science through May 6, 2021, were searched. Peer-reviewed articles were included in the review if they were written in English; described a randomized controlled trial of a psychosocial intervention to reduce substance misuse and related problems in women; and reported quantitative data on alcohol or illicit drug use as an outcome that was linked to the interventions. Results: A total of 51 articles met eligibility criteria, reflecting a broad array of interventions with different levels of methodological rigor. Several, but not most, interventions were tailored to meet the needs of specific subgroups of women, but evidence regarding the efficacy of tailoring was inconclusive. Overall, 61% of studies reported one or more positive substance-related intervention effects, with target substance (alcohol only vs. other drugs only or both alcohol and other drugs) and intervention dosage associated with intervention success. Conclusions: Fewer studies targeting alcohol only reported one or more positive intervention outcomes. This warrants further study, given that polysubstance use is the norm, not the exception. Future research might also focus on reducing treatment barriers to women, as this has the potential to improve overall treatment outcomes for this population.
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Affiliation(s)
- Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace S Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nazish Yousaf
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Heather Ashton
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John W Cyrus
- VCU Libraries, Virginia Commonwealth University, Richmond, Virginia, USA
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Lomax J, Meyrick J. Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault. J Health Psychol 2022; 27:305-331. [PMID: 32838568 PMCID: PMC8777327 DOI: 10.1177/1359105320950799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.
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Affiliation(s)
| | - Jane Meyrick
- University of the West of England
Bristol, Bristol, UK
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10
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Arean P, Hull D, Pullmann MD, Heagerty PJ. Protocol for a sequential, multiple assignment, randomised trial to test the effectiveness of message-based psychotherapy for depression compared with telepsychotherapy. BMJ Open 2021; 11:e046958. [PMID: 34728440 PMCID: PMC8565526 DOI: 10.1136/bmjopen-2020-046958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Digital mental health tools have become popular alternatives to traditional psychotherapy. One emerging form of digital mental health is message-based care, the use of text messages or asynchronous voice or video messaging to provide psychotherapy. There has been no research into whether this is an effective method of psychotherapy as a stand-alone treatment or in combination with traditional psychotherapy. METHODS AND ANALYSIS This is a sequential, multiple assignment randomised trial to compare message-based care, videoconference-psychotherapy and a combination of the two treatments in 1000 depressed adults. Participants will be recruited through Talkspace, a digital mental health company, and randomised to receive 6 weeks of either message-based care only or videoconference-psychotherapy only. At 6 weeks, participants will be evaluated for their response to treatment. Those with a 50% or more response to treatment will continue with their assigned condition. Those who do not respond will be randomised to either monthly videoconference-psychotherapy or weekly videoconference-psychotherapy plus message-based care. Primary outcomes will be depression and social functioning. We will also explore moderators of treatment outcome. ETHICS AND DISSEMINATION The study received ethics approval from the University of Washington Institutional Review Board. Results of this study will be presented in peer-reviewed journals and at professional conferences. TRIAL REGISTRATION NUMBER NCT04513080; Pre-results.
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Affiliation(s)
- Patricia Arean
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Derrick Hull
- Research and Development, Talkspace Network LLC, New York City, New York, USA
| | - Michael D Pullmann
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
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11
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Walsh K, Badour CL, Zuromski KL, Gilmore AK, Kilpatrick DG, Acierno R, Resnick HS. A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims. Psychol Serv 2021; 18:703-708. [PMID: 33661694 PMCID: PMC8417147 DOI: 10.1037/ser0000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although rape has been linked to risk for suicidal ideation and attempts, there are scant data on the efficacy of brief interventions to reduce suicidality among recent rape victims. This secondary analysis of a randomized controlled trial investigated whether a video intervention delivered in the emergency department (ED), cortisol measured at the ED, and prior rape history predicted postrape suicidal ideation independently or in combination with the other predictors. Participants were 235 women aged 15-71 years who presented to the ED for a sexual assault medical forensic examination and were randomly assigned to either receive a video intervention that addressed avoidance and promoted healthy coping strategies or standard care prior to the examination. Participants also provided a blood sample for cortisol and completed at least one of three follow-ups at 6 weeks, 3 months, or 6 months postrape. The intervention conferred protection against suicidal ideation among women with elevated cortisol and a prior rape; however, it did not reduce risk for women without a prior rape, particularly those with elevated cortisol. It may be important to consider the influence of prior rape and neuroendocrine reactivity in developing treatments to address suicidal ideation among rape victims. More specifically, there appears to be value in screening victims for prior rape and administering this brief intervention to reduce suicidal ideation; however, other avenues should be explored for victims without a prior rape history. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Kelly L. Zuromski
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda K. Gilmore
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dean G. Kilpatrick
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Heidi S. Resnick
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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12
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Gilmore AK, Walsh K, Frazier P, Meredith L, Ledray L, Davis J, Acierno R, Ruggiero KJ, Kilpatrick DG, Jaffe AE, Resnick HS. Post-Sexual Assault Mental Health: A Randomized Clinical Trial of a Video-Based Intervention. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10614-10637. [PMID: 31709903 PMCID: PMC7232869 DOI: 10.1177/0886260519884674] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The current study assessed the efficacy of a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims. PPRS was compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Primary outcomes were posttraumatic stress disorder (PTSD) symptoms and perceived present control. Prior SA was examined as a moderator of treatment effects. Women (n = 233; aged 15 years and older; 59.70% identified as a racial or ethnic minority) who received a post-SA medical forensic exam participated in the study (NCT01430624). Participants were randomized to watch the PPRS video (n = 77), the PIRI video (n = 77), or receive TAU (n = 79). Participants completed measures of PTSD symptoms and perceived present control 1.5-, 3-, and 6-months post-SA. An interaction between condition and prior SA was found on PTSD symptom frequency and on perceived present control. Among women with a prior SA, women in the PPRS versus TAU condition reported less frequent PTSD symptoms 6-months post-SA. Those in the PPRS condition had lower perceived present control than those in the TAU condition among those with no prior SA 3-months post-SA. However, at 6-months post-SA, among women with a prior SA, women in the PPRS reported higher perceived present control than those in TAU. These findings partially replicate a prior study in which PPRS was found to be beneficial in mitigating the development of PTSD symptoms, but only for women with a prior SA.
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Affiliation(s)
| | | | | | | | - Linda Ledray
- SANE-SART Resource Service, Minneapolis, MN, USA
| | | | - Ron Acierno
- University of Texas Health Science Center at Houston, Houston, TX, USA
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13
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Dir AL, Hahn C, Jaffe AE, Stanton K, Gilmore AK. Depressive Symptoms Following Recent Sexual Assault: The Role of Drug and Alcohol Use, Acute Stress, and Assault Characteristics. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:5900-5913. [PMID: 30353780 PMCID: PMC6656621 DOI: 10.1177/0886260518803605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual assault is a common traumatic experience that can have a wide-ranging impact on psychological functioning, including experience of depressive symptoms. Although many studies have examined lifetime rates of depression among those with sexual assault history, less is known regarding risk factors for depressive symptoms following recent sexual assault. The study examined whether drug use history is uniquely related to depressive symptoms following recent assault. N = 65 individuals, 95.4% female; 73.8% White; M(SD)age = 28.89 (10.29), who had recently experienced sexual assault (less than 60 days) and completed a SAMFE (sexual assault medical forensic examination) were interviewed via phone and completed questionnaires regarding depressive and acute/post-traumatic stress symptoms and substance use history. Demographic information as well as information related to the assault was also collected. 68.7% of the sample reported clinically significant levels of depressive symptoms (PHQ-9, Patient Health Questionnaire, scores ⩾ 12). In a linear regression adjusted for acute/post-traumatic stress (b = 0.26, p < .01) and other variables, polydrug use was significantly associated with depressive symptoms (b = 3.26, p = .04). Single-drug use (b = 0.96), physically forced sexual assault (b = -1.11), victim-perpetrator relationship (b = 0.15), prior sexual assault (b = -1.02), alcohol misuse (b = -0.09), age (b = 0.07), race (b = 2.78), and days since assault (b = -0.02) were not significantly associated with depressive symptoms (all ps > .05). Results highlight the potential role of drug use history in increasing risk of experiencing clinically significant depressive symptoms following recent assault.
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Affiliation(s)
- Allyson L. Dir
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Christine Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Anna E. Jaffe
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kimberly Stanton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Amanda K. Gilmore
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- College of Nursing, Medical University of South Carolina, Charleston, SC
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14
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Short NA, Morabito DM, Gilmore AK. Secondary prevention for posttraumatic stress and related symptoms among women whohave experienced a recent sexual assault: A systematic review and meta-analysis. Depress Anxiety 2020; 37:1047-1059. [PMID: 32442345 PMCID: PMC7680285 DOI: 10.1002/da.23030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/23/2020] [Accepted: 04/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Women who have experienced a recent sexual assault (SA) are at high risk for posttraumatic stress disorder (PTSD) and related conditions, with approximately half of women experiencing SA meeting criteria for PTSD. There are no guidelines for the prevention of PTSD and other common mental health disorders after SA. Thus, the purpose of this systematic review and meta-analysis is to synthesize research on secondary preventions for PTSD after SA, determine efficacy whether any intervention seems promising, and ascertain when, how, and to whom interventions should be delivered. METHODS After searching electronic databases for secondary preventions for PTSD and related conditions among women who have experienced a recent SA, 17 studies were reviewed, their quality was rated on the clinical trial assessment measure, and 10 studies were meta-analyzed (7 were excluded, as they were not randomized controlled trials or due to the absence of heterogeneity). RESULTS Results suggested a small-to-moderate effect of prevention on reducing PTSD and related symptoms. There was no moderating effect of medication versus psychosocial interventions, timing, treatment modality, or targeted versus universal prevention. Half of the studies were of high quality. CONCLUSION Cognitive-behavioral secondary preventions for PTSD appear to be safe and effective among women who have experienced a recent SA. Future research should identify best practices and mechanisms of treatment, and once identified, it should move toward implementation science.
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Affiliation(s)
- Nicole A. Short
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA
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15
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Bragesjö M, Larsson K, Nordlund L, Anderbro T, Andersson E, Möller A. Early Psychological Intervention After Rape: A Feasibility Study. Front Psychol 2020; 11:1595. [PMID: 32733345 PMCID: PMC7360814 DOI: 10.3389/fpsyg.2020.01595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Rape is the most common trauma leading to post-traumatic stress disorder (PTSD) among women, with a conditioned prevalence of up to 50%. PTSD is considered to be a lethal condition associated with increased risk of suicide, drug- and alcohol dependence, neurological- and vascular problems, as well as sick leave. Given the scope of this problem, novel and swiftly delivered interventions for this large vulnerable population are clearly warranted. One previous trial conducted in the United States (N = 137) showed that an adapted brief version of prolonged exposure (PE) to the fearful memory of the event and situations, provided in the immediate aftermath after trauma (<72 h after a traumatic event), was effective in reducing early PTSD symptoms in rape victims. The aims of the present study were to adapt the brief PE protocol to a Swedish context and investigate its feasibility and delivery in 10 executive patients recruited at the Emergency Clinic for Rape Victims in Stockholm. Ten participants were provided with three sessions of early PE with overall successful results in terms of session attendance, home-work compliance, and also symptom reduction of PTSD and depressive symptoms. However, only a fraction of the screened patients at the Emergency Clinic (5.2%) were eligible to be included in the study, where the majority (40%) were excluded due to the time criteria of 72 h. In this article, we will present detailed results of the intervention and elaborate on how to increase feasibility of preventive interventions for rape victims. In the current form, providing PE with the strict time criteria was not feasible in the clinical setting that constitutes the Emergency Department for rape.
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Affiliation(s)
- Maria Bragesjö
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Larsson
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
| | - Lisa Nordlund
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
| | - Therese Anderbro
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Möller
- Department of Obstetrics and Gynecology, Emergency Clinic for Rape Victims, Stockholm South Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
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16
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Stefanidou T, Hughes E, Kester K, Edmondson A, Majeed-Ariss R, Smith C, Ariss S, Brooker C, Gilchrist G, Kendal S, Lucock M, Maxted F, Perot C, Shallcross R, Trevillion K, Lloyd-Evans B. The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review. PLoS One 2020; 15:e0231260. [PMID: 32275695 PMCID: PMC7147790 DOI: 10.1371/journal.pone.0231260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice. METHODS A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted. RESULTS We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services. CONCLUSIONS This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.
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Affiliation(s)
| | - Elizabeth Hughes
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Katherine Kester
- Division of Psychiatry, University College London, London, United Kingdom
| | - Amanda Edmondson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Rabiya Majeed-Ariss
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Christine Smith
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Steven Ariss
- Centre for Assistive Technology and Connected Healthcare (CATCH) and School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Charlie Brooker
- Centre for Criminology and Sociology, Royal Holloway University of London, Surrey, United Kingdom
| | - Gail Gilchrist
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sarah Kendal
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Mike Lucock
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Fay Maxted
- The Survivors Trust, Rugby, Warwickshire, United Kingdom
| | - Concetta Perot
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rebekah Shallcross
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Kylee Trevillion
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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17
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Gilmore AK, Flanagan JC. Acute mental health symptoms among individuals receiving a sexual assault medical forensic exam: the role of previous intimate partner violence victimization. Arch Womens Ment Health 2020; 23:81-89. [PMID: 30762148 PMCID: PMC6733667 DOI: 10.1007/s00737-019-0947-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/28/2019] [Indexed: 01/02/2023]
Abstract
Sexual assault and intimate partner violence (IPV) are common in the USA, and they often co-occur. Individuals with multiple victimization experiences have more severe mental health outcomes compared to those with one victimization. The current study examined mental health symptoms and their association with IPV victimization history among a sample of individuals who experienced a recent sexual assault and received a sexual assault medical forensic examination. A total of 82 participants (92.70% female) completed a post-sexual assault survey as part of clinical care to coordinate follow-up services. IPV history and prior sexual assault were assessed as well as mental health symptoms including acute stress and depressive symptoms. It was found that individuals with an IPV history reported more acute stress and depressive symptoms compared to those without an IPV history. No differences were found based on prior sexual assault history. These findings highlight the importance of screening for IPV history during the sexual assault medical forensic examination to coordinate care.
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Affiliation(s)
- Amanda K Gilmore
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Julianne C Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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18
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Walsh K, Gilmore AK, Schumacher JA, Coffey SF, Frazier PA, Ledray L, Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS. Post-sexual assault cigarette smoking: Findings from a randomized clinical trial of a video-based intervention. Addict Behav 2020; 100:106121. [PMID: 31622944 DOI: 10.1016/j.addbeh.2019.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
Sexual assault (SA) is associated with elevated risk for cigarette smoking. The current study tested whether a brief video intervention delivered in the emergency department was effective at reducing smoking following SA. Participants were 233 girls and women (age 15+) who received a SA medical forensic examination (SAMFE) and were randomized to one of three conditions: 1) Prevention of Post-Rape Stress (PPRS), a brief video designed to reduce post-SA psychopathology; 2) Pleasant Imagery and Relaxation Information (PIRI), an active control video involving relaxation training; and 3) treatment as usual (TAU). Among those who participated at baseline, 154 participants completed at least one follow-up at 1.5, 3, and 6 months after the SAMFE. Participants reported the number of days of smoking and the average number of cigarettes smoked per day in the two weeks prior to the sexual assault as well as in the two weeks prior to each follow-up. Two-thirds (68.8%) of participants smoked prior to the SA or during any follow-up. One-fifth of participants who did not smoke prior to the SA smoked at one or more follow-ups. Smoking declined on average over follow-up although TAU was associated with increased initial smoking compared to PPRS; PPRS and PIRI did not differ. SA contributes to increases in smoking and the PPRS, a brief and cost-effective video-based intervention delivered during the SAMFE, can protect against increases in post-SA smoking. Trial registration: NCT01430624.
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19
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Hahn CK, Jaffe AE, Stanton K, Gilmore AK. The Association Between Type of Sexual Assault and Post-Assault Alcohol Misuse Is Moderated by Avoidance Among Recipients of a Sexual Assault Medical Forensic Examination. J Stud Alcohol Drugs 2019; 80:507-514. [PMID: 31603751 PMCID: PMC6811726 DOI: 10.15288/jsad.2019.80.507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/02/2019] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE The purpose of this study was to examine the association between the type of sexual assault (intoxicated vs. non-intoxicated) and post-assault avoidance on post-assault alcohol misuse among people who experienced a recent sexual assault. METHOD The sample included 72 adults aged 18-58 who completed a follow-up phone screen within 30 days of completing a sexual assault medical forensic examination. Participants reported demographics, prior sexual assault, if they were intoxicated from alcohol or other drugs during the sexual assault that preceded receipt of a sexual assault medical forensic examination, post-assault avoidance symptoms, and post-assault alcohol misuse. RESULTS Post-assault alcohol misuse was higher among participants with intoxicated (vs. non-intoxicated) sexual assault, prior sexual assault (vs. none), and who identified as White. There was a significant interaction between the type of sexual assault and avoidance symptoms on post-assault alcohol misuse. There was a significant association between avoidance symptoms and alcohol misuse (b = 0.82, p = .003) among participants who experienced a non-intoxicated sexual assault, but not among those who reported intoxication during the recent sexual assault (b = -0.33, p = .468). CONCLUSIONS Intoxicated sexual assault and post-assault avoidance may be influential factors contributing to post-assault alcohol misuse among people who are recently sexually assaulted. Interventions targeting post-sexual assault alcohol misuse should be tailored based on the type of recent assault and post-assault avoidance.
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Affiliation(s)
- Christine K. Hahn
- National Crime Victims Research & Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Anna E. Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Kimberley Stanton
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Amanda K. Gilmore
- Mark Chaffin Center for Healthy Development and Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
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20
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Hahn CK, Jaffe AE, Stanton K, Gilmore AK. The Association Between Type of Sexual Assault and Post-Assault Alcohol Misuse Is Moderated by Avoidance Among Recipients of a Sexual Assault Medical Forensic Examination. J Stud Alcohol Drugs 2019; 80:507-514. [PMID: 31603751 PMCID: PMC6811726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/02/2019] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the association between the type of sexual assault (intoxicated vs. non-intoxicated) and post-assault avoidance on post-assault alcohol misuse among people who experienced a recent sexual assault. METHOD The sample included 72 adults aged 18-58 who completed a follow-up phone screen within 30 days of completing a sexual assault medical forensic examination. Participants reported demographics, prior sexual assault, if they were intoxicated from alcohol or other drugs during the sexual assault that preceded receipt of a sexual assault medical forensic examination, post-assault avoidance symptoms, and post-assault alcohol misuse. RESULTS Post-assault alcohol misuse was higher among participants with intoxicated (vs. non-intoxicated) sexual assault, prior sexual assault (vs. none), and who identified as White. There was a significant interaction between the type of sexual assault and avoidance symptoms on post-assault alcohol misuse. There was a significant association between avoidance symptoms and alcohol misuse (b = 0.82, p = .003) among participants who experienced a non-intoxicated sexual assault, but not among those who reported intoxication during the recent sexual assault (b = -0.33, p = .468). CONCLUSIONS Intoxicated sexual assault and post-assault avoidance may be influential factors contributing to post-assault alcohol misuse among people who are recently sexually assaulted. Interventions targeting post-sexual assault alcohol misuse should be tailored based on the type of recent assault and post-assault avoidance.
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Affiliation(s)
- Christine K. Hahn
- National Crime Victims Research & Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Anna E. Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Kimberley Stanton
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Amanda K. Gilmore
- Mark Chaffin Center for Healthy Development and Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia
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21
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Wadsworth P, Krahe JAE, Allen E. Occupational Well-Being in Sexual Assault Victims and Survivors. J Holist Nurs 2019; 38:170-185. [PMID: 31347435 DOI: 10.1177/0898010119863537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.
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22
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Gilmore AK, Walsh K, Frazier P, Ledray L, Acierno R, Ruggiero KJ, Kilpatrick DG, Resnick HS. Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention. Am J Addict 2019; 28:376-381. [PMID: 31242340 DOI: 10.1111/ajad.12922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/03/2019] [Accepted: 05/10/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).
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Affiliation(s)
- Amanda K Gilmore
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Kate Walsh
- Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Patricia Frazier
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Ron Acierno
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Kenneth J Ruggiero
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Dean G Kilpatrick
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Heidi S Resnick
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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23
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Dacosta-Sánchez D, Fernández-Calderón F, González-Ponce B, Díaz-Batanero C, Lozano ÓM. Severity of Substance Use Disorder: Utility as an Outcome in Clinical Settings. Alcohol Clin Exp Res 2019; 43:869-876. [PMID: 30861142 DOI: 10.1111/acer.14020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Some authors have pointed out the usefulness of the levels of substance use disorder (SUD) as a treatment outcome. However, in order to use this variable as an outcome measure, its impact needs to be addressed within a clinical context. The aim of this study was to analyze the sensitivity of SUD levels as a measure for detecting reliable changes and to make a comparison between the changes in SUD levels detected when using the number of criteria fulfilled and when using the reliable change index (RCI). METHODS The sample consisted of 206 (106 in follow-up) patients diagnosed with abuse/dependence on alcohol and cocaine, according to DSM-IV criteria. The Substance Dependence Severity Scale for DSM-5 was used to determine current alcohol use disorder (AUD) and cocaine use disorder (CUD). Number of DSM-5 criteria fulfilled and RCI were used to determine the change in SUD levels. RESULTS No association was found between adherence to/abandonment of treatment and AUD severity levels (χ2 = 7.029, p = 0.071) or CUD severity levels (χ2 = 2.044, p = 0.413). Statistical significant differences for levels of AUD (z = -3.870, p = 0.000) and CUD (z = -5.382, p = 0.000) were found between baseline assessment and follow-up. According to the number of DSM-5 criteria and RCI, the Kappa coefficient for the change in patient status (improved, worsened, or no change) was k = 0.61 for alcohol patients and k = 0.64 for cocaine patients. The "mild" category showed the greatest inconsistency between both procedures. CONCLUSIONS Levels of SUD are sensitive to the impact of treatment as measured by the difference between the baseline assessment and 3-month follow-up. However, conclusions differ according to whether the DSM-5 criteria or the RCI is applied.
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Affiliation(s)
- Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology , University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - Bella González-Ponce
- Department of Clinical and Experimental Psychology , University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - Óscar M Lozano
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
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