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Brøcker CM, Hansen OI, Rohde MC. The impact of COVID-19 restrictions on sexual assault in Western Denmark. Forensic Sci Med Pathol 2024; 20:166-173. [PMID: 37505320 DOI: 10.1007/s12024-023-00682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
This study sets out to investigate whether the 15-month nationwide COVID-19 lockdown in Denmark had an impact on the victim demographics, location of sexual assaults, and relationship between victim and perpetrator in the Western part of Denmark compared to the 15 months prior to the lockdown initiatives. This study is a retrospective study including a total of 596 cases. Cases were identified in the database of the Department of Forensic Medicine Aarhus, including cases labeled "rape," "attempted rape," and "later reported." 315 cases were found between March 11th 2020 and June 10th 2021 (lockdown) and 281 cases were found between December 11th 2018 and March 10th 2020(pre-lockdown). Fewer victims were in the age group 15-24 during lockdown (58.4%) than pre-lockdown (71.7%). Fewer stranger rapes occurred during lockdown (11%) than pre-lockdown (19.7%). During lockdown, more sexual assault occurred at a private site (80.1%) than pre-lockdown (60%); correspondingly, fewer public sexual assaults occurred during lockdown (10.3%) than pre-lockdown (26%). No statistically significant difference was observed regarding police reporting of the assault or alcohol intake in the victim prior to assault. We found an overall change in demographics regarding sexual assaults during the lockdown period indicating the restrictions during the lockdown could have affected the patterns of sexual assault in Denmark.
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Affiliation(s)
- Cecilie Marie Brøcker
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Ole Ingemann Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Marianne Cathrine Rohde
- Department of Forensic Medicine, Aarhus University, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Wellum AK, Ramaekers RMD, Schepers J, Welie JVM, Lange G, Hurks PM. Prevalence Rate and Risk Factors of Sexual Assault Among University Students in the Netherlands. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:12210-12232. [PMID: 37609758 PMCID: PMC10619186 DOI: 10.1177/08862605231192849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
This research documents the prevalence rate and demographic risk factors for sexual assault among undergraduate and graduate students enrolled at a Dutch university. The present study used a sample of N = 2,887 students who filled in responses to a campus climate survey about students' experiences with sexual assault and diverse demographic variables. Results showed that approximately one in four students (25.3%) experience non-consensual sexual touching, and almost one in ten are raped (9.2%). Next, to examine the effects of demographic factors and their interactions on sexual assault, the dataset was divided randomly into two subsamples. Exploratory multiple regression analyses were conducted on the first subsample and confirmatory multiple regression analyses on the second. Variables that increased odds for unwanted sexual touching, rape, and any type of sexual assault were gender; being a member of a student or a study association; having a disability; and being in a relationship (in this context, "any type of sexual assault" refers to any incident that included unwanted touching, attempted rape, or rape). LGBQ+ sexual orientation was significant for any kind of sexual assault and for rape; and being a member of a sport association was significant for any kind of sexual assault and for sexual touching.
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Muldoon KA, Talarico R, Fell DB, Illingworth H, Sampsel K, Manuel DG. Population-Level Trends in Emergency Department Encounters for Sexual Assault Preceding and During the COVID-19 Pandemic Across Ontario, Canada. JAMA Netw Open 2022; 5:e2248972. [PMID: 36580330 PMCID: PMC9856789 DOI: 10.1001/jamanetworkopen.2022.48972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Lockdown measures and the stress of the COVID-19 pandemic are factors associated with increased risk of violence, yet there is limited information on trends in emergency department (ED) encounters for sexual assault. OBJECTIVE To compare changes in ED encounters for sexual assault during the COVID-19 pandemic vs prepandemic estimates. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used linked health administrative data from 197 EDs across Ontario, Canada, representing more than 15 million residents. Participants included all patients who presented to an ED in Ontario from January 11, 2019, to September 10, 2021. Male and female individuals of all ages were included. Data analysis was performed from March to October 2022. EXPOSURES Sexual assault, defined through 27 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, procedure and diagnoses codes. MAIN OUTCOMES AND MEASURES Ten bimonthly time periods were used to compare differences in the frequency and rates of ED encounters for sexual assault between 2020 to 2021 (during the pandemic) compared with baseline prepandemic rates in 2019. Rate differences (RDs) and age adjusted rate ratios (aRRs) and Wald 95% CIs were calculated using Poisson regression. RESULTS From January 11, 2019, to September 10, 2021, there were 14 476 656 ED encounters, including 10 523 for sexual assault (9304 [88.4%] among female individuals). The median (IQR) age was 23 (17-33) years for female individuals and 15 (4-29) years for male individuals. Two months before the pandemic, ED encounters increased for sexual assault among female individuals (8.4 vs 6.9 cases per 100 000; RD, 1.51 [95% CI, 1.06 to 1.96]; aRR, 1.22 [95% CI, 1.09 to 1.38]) and male individuals (1.2 vs 1.0 cases per 100 000; RD, 0.19 [95% CI, 0.05 to 0.36]; aRR, 1.19 [95% CI, 0.87 to 1.64]). During the first 2 months of the pandemic, the rates decreased for female individuals (4.2 vs 8.3 cases per 100 000; RD, -4.07 [95% CI, -4.48 to -3.67]; aRR, 0.51 [95% CI, 0.44 to 0.58]) and male individuals (0.5 vs 1.2 cases per 100 000; RD, -0.72 [95% CI, -0.86 to -0.57]; aRR, 0.39 [95% CI, 0.26 to 0.58]). For the remainder of the study period, the rates of sexual assault oscillated, returning to prepandemic levels during the summer months and between COVID-19 waves. CONCLUSIONS AND RELEVANCE These findings suggest that lockdown protocols should evaluate the impact of limited care for sexual assault. Survivors should still present to EDs, especially when clinical care or legal interventions are needed.
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Affiliation(s)
- Katherine A. Muldoon
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- ICES, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- ICES, University of Ottawa, Ottawa, Ontario, Canada
| | - Deshayne B. Fell
- ICES, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kari Sampsel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Faculty of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G. Manuel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
- ICES, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Santaularia NJ, Osypuk TL, Ramirez MR, Mason SM. Violence in the Great Recession. Am J Epidemiol 2022; 191:1847-1855. [PMID: 35767881 PMCID: PMC10144667 DOI: 10.1093/aje/kwac114] [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: 10/14/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.
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Affiliation(s)
- N Jeanie Santaularia
- Correspondence to Dr. Jeanie Santaularia, Carolina Population Center, 123 West Franklin Street Chapel Hill, NC 27516 (e-mail: )
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Khatib N, Sampsel K. CAEP Position Statement Executive Summary : Where is the love? Intimate partner violence (IPV) in the Emergency Department (ED). CAN J EMERG MED 2022; 24:691-694. [PMID: 36255657 PMCID: PMC9579564 DOI: 10.1007/s43678-022-00386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nour Khatib
- Department of Emergency Medicine, Markham Stouffville Hospital, Lakeridge Health, University of Toronto, Toronto, ON, Canada.
| | - Kari Sampsel
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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Santaularia NJ, Ramirez MR, Osypuk TL, Mason SM. Measuring the hidden burden of violence: use of explicit and proxy codes in Minnesota injury hospitalizations, 2004-2014. Inj Epidemiol 2021; 8:63. [PMID: 34724989 PMCID: PMC8559360 DOI: 10.1186/s40621-021-00354-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/30/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Commonly-used violence surveillance systems are biased towards certain populations due to overreporting or over-scrutinized. Hospital discharge data may offer a more representative view of violence, through use of proxy codes, i.e. diagnosis of injuries correlated with violence. The goals of this paper are to compare the trends in violence in Minnesota, and associations of county-level demographic characteristics with violence rates, measured through explicitly diagnosed violence and proxy codes. It is an exploration of how certain sub-populations are overrepresented in traditional surveillance systems. METHODS Using Minnesota hospital discharge data linked with census data from 2004 to 2014, this study examined the distribution and time trends of explicit, proxy, and combined (proxy and explicit) codes for child abuse, intimate partner violence (IPV), and elder abuse. The associations between county-level risk factors (e.g., poverty) and county violence rates were estimated using negative binomial regression models with generalized estimation equations to account for clustering over time. RESULTS The main finding was that the patterns of county-level violence differed depending on whether one used explicit or proxy codes. In particular, explicit codes suggested that child abuse and IPV trends were flat or decreased slightly from 2004 to 2014, while proxy codes suggested the opposite. Elder abuse increased during this timeframe for both explicit and proxy codes, but more dramatically when using proxy codes. In regard to the associations between county level characteristics and each violence subtype, previously identified county-level risk factors were more strongly related to explicitly-identified violence than to proxy-identified violence. Given the larger number of proxy-identified cases as compared with explicit-identified violence cases, the trends and associations of combined codes align more closely with proxy codes, especially for elder abuse and IPV. CONCLUSIONS Violence surveillance utilizing hospital discharge data, and particularly proxy codes, may add important information that traditional surveillance misses. Most importantly, explicit and proxy codes indicate different associations with county sociodemographic characteristics. Future research should examine hospital discharge data for violence identification to validate proxy codes that can be utilized to help to identify the hidden burden of violence.
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Affiliation(s)
- N. Jeanie Santaularia
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Minnesota Population Center, University of Minnesota, 225 19th Ave S #50th, Minneapolis, MN 55455 USA
| | - Marizen R. Ramirez
- grid.17635.360000000419368657Division of Environmental Health Sciences, University of Minnesota School of Public Health, 1260 Mayo Building, MMC 807, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Theresa L. Osypuk
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA ,grid.17635.360000000419368657Minnesota Population Center, University of Minnesota, 225 19th Ave S #50th, Minneapolis, MN 55455 USA
| | - Susan M. Mason
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454 USA
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Men F, Urquia ML, Tarasuk V. Examining the relationship between food insecurity and causes of injury in Canadian adults and adolescents. BMC Public Health 2021; 21:1557. [PMID: 34399730 PMCID: PMC8367649 DOI: 10.1186/s12889-021-11610-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population. METHODS Linking the Canadian Community Health Survey 2005-2017 to National Ambulatory Care Reporting System 2003-2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income. RESULTS Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07-1.25) and 1.35 (95% CI 1.24-1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29-2.53) including self-harm (aRR 1.87; 95% CI 1.03-3.40) and violence (aRR 1.79; 95% CI 1.19-2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22-1.46) including fall (aRR 1.43; 95% CI 1.24-1.65), medical complication (aRR 1.39; 95% CI 1.06-1.82), being struck by objects (aRR 1.43; 95% CI 1.07-1.91), overexertion (aRR 1.31; 95% CI 1.04-1.66), animal bite or sting (aRR 1.60; 95% CI 1.08-2.36), skin piercing (aRR 1.80; 95% CI 1.21-2.66), and poisoning (aRR 1.65; 95% CI 1.05-2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09-2.21), falls (aRR 1.22; 95% CI 1.08-1.37), being struck (aRR 1.20; 95% CI 1.01-1.43), and overexertion (aRR 1.25; 95% CI 1.04-1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries. CONCLUSIONS Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
- Department of Consumer Sciences, The University of Alabama, Tuscaloosa, Alabama, USA.
| | - Marcelo L Urquia
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Cid A, Leguisamo M. Gender equality does not prevent sexual abuse of women - awareness of a global public health problem. Health Care Women Int 2021; 43:885-897. [PMID: 34339608 DOI: 10.1080/07399332.2021.1944149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined the prevalence of sexual abuse against women around the world and the protective factors that may prevent this violence. Demographic and Health Survey (DHS) data from 470,000 women in 50 countries informed our multivariate estimates. Our results show that one out of ten women aged 18-49 years old, experienced -at least once in their life time- sexual abuse, and most perpetrators are people in the environment of their victims. We also find that women educational attainment is a key factor in order to prevent sexual abuse, but gender equality achievements in economics, politics and health do not guarantee lower rates of sexual abuse. These results promote further discussions on strategies to strengthen effective preventive programs, especially for vulnerable women.
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Affiliation(s)
- Alejandro Cid
- Department of Economics, Universidad de Montevideo, Montevideo, Uruguay
| | - Mariana Leguisamo
- Department of Economics, Universidad de Montevideo, Montevideo, Uruguay
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McQueen K, Murphy-Oikonen J, Miller A, Chambers L. Sexual assault: women's voices on the health impacts of not being believed by police. BMC WOMENS HEALTH 2021; 21:217. [PMID: 34022858 PMCID: PMC8141152 DOI: 10.1186/s12905-021-01358-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
Background Sexual assault is a prevalent crime against women globally with known negative effects on health. Recent media reports in Canada indicate that many sexual assault reports are not believed by police. Negative reporting experiences of sexual assault have been associated with secondary victimization and trauma among survivors. However, little is known about the impact that being sexually assaulted and not believed by police has on a survivor’s health and well-being. The purpose of this study was to explore women’s experiences of not being believed by police after sexual assault and their perceived impact on health. Methods We conducted open-ended and semi-structured interviews with 23 sexual assault survivors who were sexually assaulted and not believed by police. The interviews explored the self-reported health impacts of not being believed by police and were conducted from April to July, 2019. All interviews were audio-recorded, transcribed, and entered into NVIVO for analysis. Data were analyzed using Colaizzi’s analytic method. Results Analysis revealed three salient themes regarding the health and social impact of not being believed by police on survivors of sexual assault: (1) Broken Expectations which resulted in loss of trust and secondary victimization, (2) Loss of Self, and (3) Cumulative Health and Social Effects. The findings showed that not being believed by police resulted in additional mental and social burdens beyond that of the sexual assault. Many survivors felt further victimized by police at a time when they needed support, leading to the use taking of alcohol and/or drugs as a coping strategy. Conclusion Reporting a sexual assault and not being believed by police has negative health outcomes for survivors. Improving the disclosure experience is needed to mitigate the negative health and social impacts and promote healing. This is important for police, health, and social service providers who receive sexual assault disclosures and may be able to positively influence the reporting experience and overall health effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01358-6.
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Affiliation(s)
- Karen McQueen
- School of Nursing, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B5E1, Canada.
| | | | - Ainsley Miller
- School of Nursing, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B5E1, Canada
| | - Lori Chambers
- Lakehead University, Gender and Women's Studies, Thunder Bay, Canada
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Commentary on Underrecognition of Nonfatal Intimate Partner Strangulation Within the Emergency Health Care Setting: Reasons and Opportunities for Change. J Emerg Nurs 2021; 47:373-375. [PMID: 33863578 DOI: 10.1016/j.jen.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/23/2022]
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Muldoon KA, Denize KM, Talarico R, Fell DB, Sobiesiak A, Heimerl M, Sampsel K. COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors. BMC Med 2021; 19:20. [PMID: 33541357 PMCID: PMC7861965 DOI: 10.1186/s12916-020-01897-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared. METHODS Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated. RESULTS Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%). CONCLUSION This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.
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Affiliation(s)
- Katherine A Muldoon
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada.
| | - Kathryn M Denize
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Agnes Sobiesiak
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
| | | | - Kari Sampsel
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, K1H-8L6, Canada
- Faculty of Medicine, Department of Emergency Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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Abstract
OBJECTIVE Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care. DESIGN Retrospective analysis. METHODS The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). RESULTS The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78). CONCLUSION We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.
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