Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault

Effectiveness of Brief Interventions for Sexual Assault Survivors: A Systematic Review and Meta-Analysis

BACKGROUND

Sexual assault is a pervasive social issue worldwide, with significant harmful impacts on survivors' mental health and well-being. Sexual assault services that provide specialist crisis and therapeutic programs are contending with long waiting lists. Brief interventions are emerging as a potential strategy to provide timely care, but it is important to know whether these approaches remain effective in improving patient outcomes.

AIM

To synthesize evidence informing the effectiveness of brief interventions on person-centered outcomes for people who have experienced sexual assault.

METHODS

Four databases were systematically searched for trials testing the effectiveness of brief interventions (≤6 sessions) for sexual assault survivors. Studies were appraised, and data was extracted. Results from trials with homogenous data were combined in meta-analyses, and evidence certainty was assessed using GRADE. Remaining studies were synthesized descriptively.

RESULTS

Eighteen studies were included. Meta-analyses of randomized trials (n = 7) provide moderate certainty evidence that brief interventions improve symptoms of posttraumatic stress disorder (6 studies), depression (4 studies), and anxiety (2 studies). Results across other controlled and single-group pre-post studies further supported these findings.

DISCUSSION

Brief interventions can have a significant impact on reducing mental health symptoms for survivors who have experienced a sexual assault, providing support for the use of these models of care to broaden the reach and accessibility of sexual assault support services. There is limited evidence about other person-centered outcomes, such as quality of life measures, when considering brief interventions.

Sexual and domestic violence enquiry: A national exploratory survey of asking and telling in sexual health services in the UK

BACKGROUND

Gender-based violence in the form of domestic and sexual abuse represent a worldwide public health and civil rights issue. Healthcare and sexual health have a central role to play in prevention, particularly in the identification of sexual and domestic violence/abuse within a frontline service in which it often presents. Survivors of sexual violence and abuse commonly pass through sexual health services without being asked about their victimisation. Healthcare should be able to identify survivors, provide first line support, refer to specialist services and link to comprehensive post assault care.

METHODS

In the first joint study of its kind, the Univeristy of the West of England worked with the British Association for Sexual Health and HIV (BASHH) and their Sexual Violence Specialist Interest Group (SVSIG). We report the findings of a snapshot, non-probability, exploratory survey of current comparative sexual and domestic violence/abuse enquiry practice in Genito Urinary Medicine services across the UK.

RESULTS

Sixty-two responding services evidenced variable practice around asking, collating data, referral, training and staff supervision.

CONCLUSIONS

This benchmarking study of practice in the UK sets a bar against which all services can measure and improve current practice on gender-based violence identification, a crucial role of sexual health services in reducing the inequalities driven harm of undisclosed trauma.

Exploring the Experiences of Sexual Violence/Abuse Survivors Attending a Recovery Group: A Qualitative Study of Recovery and Evaluation Implications

Sexual violence/abuse (SV/A) is increasingly recognized requiring improved, evidence-based treatments. Delivery of group-based support in survivor services is common but often lacks evaluation. This qualitative study explored how survivors experienced groups and wanted recovery measured. Semistructured interviews with survivors of SV/A from two groups (N = 13, female: 25-64 years: mainly White British, heterosexual) were analyzed using an inductive approach to thematic analysis. Three overarching themes were identified including "anger," recovery "in the company of" others and "different destinations." The work contributes recognition of the need for evaluation with meaning to survivors and the potential for anger to be used in group activism.

Associations between the type of help after sexual harm and adolescents' suicidal ideation

INTRODUCTION

This cross-sectional study aimed to determine the association between receiving external help after sexual harm and suicidal ideation among Korean adolescents. The help received was classified into professional and nonprofessional to test the strength of the association according to the type of help.

METHODS

Using data from the 2017-2019 Korean children and youth rights study, we analyzed a total of 18,740 middle and high school students. The dependent variable was suicidal ideation; the primary and secondary independent variable was experience of sexual harm and receiving help after sexual harm, respectively. Data were analyzed using χ2 tests and multivariable logistic regression analyses.

RESULTS

Experience of sexual harm was significantly associated with higher suicidal ideation, and receiving help after sexual harm was significantly associated with lower suicidal ideation compared with not receiving help, regardless of gender. Furthermore, lower suicidal ideation was more strongly associated with receiving professional help in female adolescents, and receiving nonprofessional help in male adolescents.

CONCLUSIONS

Receiving help after sexual harm was negatively associated with suicidal ideation, and the strength of this association varied with gender and the type of help received. These results can aid the development of evidence-based crisis intervention for victims of sexual harm.

Understanding drivers of female sex workers' experiences of external/enacted and internalised stigma: findings from a cross-sectional community-centric national study in South Africa

To deepen our understanding of sex work stigma, and to its drivers and their interrelation, we conducted an analysis using structural equation modelling of the South African National Sex Worker Survey. We enrolled 3005 women in sex work using multi-stage sampling across all South Africa's provinces. Experience of external/enacted and internalised stigma was widespread. Non-partner rape, intimate partner violence and partner controlling behaviour (often expressions of external/enacted stigma) compounded internalised stigma. These experiences of violence, other manifestations of external/enacted stigma and food insecurity, were key drivers of internalised stigma, and often had an impact on mental health. We found that considerable protection against stigma emanated from viewing sex work positively. This resistance to stigma provided opportunities to shift the narrative. Reducing sex workers' exposure to external/enacted stigmatising behaviour, including by enabling more to work indoors, and providing greater protection from partner violence and rape, are critical for better health and well-being. Ending the criminalisation of sex work is foundational for safer working conditions and better health outcomes for sex workers, similarly providing adequately funded mental and physical health and social care through sex work specific programmes.

Characteristics of Sexual Violence Against Adolescent Girls: A 10 Years' Retrospective Study of 731 Sexually Abused Adolescents

Introduction

Sexual violence against young girls is a pervasive multifaceted phenomenon which embraces several different forced sexual acts, including attempted and/or completed rape, sexual coercion and harassment, and sexual contact with force or threat of force. The aim of this study is to evaluate the characteristics of sexual violence in adolescent girls, by a retrospective analysis of 731 consecutive cases of sexually abused girls.

Materials and Methods

We analyzed demographic characteristics, risk factors for rape, and the eventual subsequent presence and type of ano-genital lesions.

Results

We found that sexual violence with penetration was perpetrated in 591 (80%) cases. Vulnerability factors related with a major risk of rape were age >17 years old and consumption of alcohol and/or other drugs. About 196 (55%) victims had at a least one genital lesion.

Conclusion

A prompt identification of red flags of sexual violence may help physicians in suspecting and managing cases of sexual assault in adolescent girls, even in the absence of typical lesions.

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort

Rape stigma, both external and self‐stigmatization (self‐blame), is associated with adverse health outcomes. Understanding its origins and resilience factors is critical for reducing and preventing it. We describe the prevalence of rape stigma, the characteristics of women experiencing it and the pathways to experiencing greater stigma. The Rape Impact Cohort Evaluation study enrolled 852 women aged 16–40 years who had been raped from post‐rape care centres in Durban, South Africa. We present a descriptive analysis of the baseline data, a multinomial logistic regression model of factors associated with different levels of stigma and a structural equation model (SEM). Most women reported stigmatizing thoughts or experiences, with self‐stigmatizing thoughts being more prevalent than external stigmatization. The multinomial model showed that experiences of childhood or other trauma, emotional intimate partner violence (IPV), having less gender equitable attitudes and food insecurity were significantly associated with medium or high versus low levels of stigma. Internal and external stigma were significantly associated with each other. Women who had been previously raped reported less stigma. The SEM showed a direct path between food insecurity and rape stigma, with poorer women experiencing more stigma. Indirect paths were mediated by more traditional gender attitudes and childhood trauma experience and other trauma exposure. Our findings confirm the intersectionality of rape stigma, with its structural drivers of food insecurity and gender inequality, as well as its strong association with prior trauma exposure. Rape survivors may benefit from gender‐empowering psychological support that addresses blame and shame.