Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood.
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ABSTRACT:
SUBMITTER: O'Doherty L
PROVIDER: S-EPMC10552071 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
Publications
Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood.
O'Doherty Lorna L Whelan Maxine M Carter Grace J GJ Brown Katherine K Tarzia Laura L Hegarty Kelsey K Feder Gene G Brown Sarah J SJ
The Cochrane database of systematic reviews 20231005
<h4>Background</h4>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 a ...[more]
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Project description:Sexual victimization of adult women remains an underreported crime. This systematic review identified and synthesized the barriers to reporting, investigating, prosecuting, and sentencing cases of sexual assault and rape against adult women in Western countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted on August 3, 2023, across databases including PsycINFO, MEDLINE, Cochrane Library, Scopus, ProQuest Central, Web of Science, MedNar, and ProQuest Dissertations & Theses. Studies meeting the inclusion criteria provided relevant information on the decision not to formally disclose, investigate, prosecute, or convict incidents of sexual assault and rape of adult women. We included 28 studies and identified 70 barriers in total. Identified barriers were most prevalent to reporting, followed by investigating, prosecuting, and, lastly, sentencing. Key themes in the barriers included lack of trust in the criminal justice system, internal reactions, rape myths and societal norms, and perpetrator characteristics. The identified barriers emphasize an urgent need for reform of the criminal justice system's response to sexual assault and rape. Prioritizing victim-survivors' needs, enhancing transparency of the criminal justice system, and addressing attrition rates are crucial. Future studies need to engage with diverse population to address all victim-survivors' needs and provide further insights into the challenges across all stages of the criminal justice system to enhance the outcome of rape and sexual assault cases.
| S-EPMC11545439 | biostudies-literature
Project description:Women are at a higher risk of sexual assault, partly due to societal sexism. This scoping review addresses the question: What is known about the psychosocial consequences of sexual assault on women? To understand these impacts, various studies were reviewed. Searches were conducted in Web of Science, PubMed, Scopus, PsycArticles, and PsycINFO between April and May 2022. The methodology followed Arksey and O'Malley's (2005) framework. PRISMA guidelines were used for screening and the Scoping Reviews Checklist was employed to ensure the quality of the review process. As a result, 1744 studies were identified, and 21 were selected based on inclusion and exclusion criteria, with publication years ranging from 1997 to 2021. The total sample of women analyzed across these studies was 20,071 (M = 955.76; σ = 2236.53). These 21 studies examined the psychosocial consequences of sexual assault on women's lives. The primary psychosocial outcomes identified were depressive symptoms (n = 13), anxiety symptoms (n = 11), post-traumatic stress disorder (n = 11), alcohol dependence (n = 6), and sleep disorders (n = 3). In conclusion, this review enhances our understanding of the effects of sexual assault on women and identifies areas for future research to further understand and address this phenomenon. This work can ultimately guide efforts to improve the well-being of survivors.
| S-EPMC11782293 | biostudies-literature
Project description:BackgroundForensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity.AimTo help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens.MethodsWe used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board.ResultsIn a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up).ConclusionsThese behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.
| S-EPMC11333187 | biostudies-literature
Project description:This study aimed to examine the executive functioning of survivors exposed to recent sexual assaults. Twenty-seven female rape survivors who met the criterion for acute stress disorder (ASD) were enrolled and completed the assessment within 4 weeks after the traumatic experience. Additionally, 25 age-matched female health controls (HC) never exposed to such a traumatic event were enrolled. The assessments evaluated psychiatric symptoms including post-traumatic stress symptoms, depression, anxiety, and trait and state anger; general intelligence indexed by intellectual quotient (IQ); and executive functioning including set-shift/attention, planning, spatial working memory, and inhibition using the Cambridge Neuropsychological Test Automated Battery. The ASD group showed higher levels of depression, anxiety, and state anger, and lower IQ than the HC group. The ASD group also showed global impairment of executive functioning for set-shifting, attention, planning, and response inhibition compared to the HC group. Rather than being associated with low IQ and education levels, these results could be from trauma-related effects in survivors with ASD. Additionally, the state anger level was related to survivors' deficient executive functioning. The findings indicate the importance of providing assessment and intervention efforts to sexual assault survivors soon after the trauma occurs.
| S-EPMC6211069 | biostudies-literature
Project description:Study objectiveWe evaluate the impact of the COVID-19 pandemic on care for survivors of sexual assault in three urban Emergency Departments (ED) in the United States.MethodsA retrospective chart review was conducted on patients who presented after sexual assault to three EDs during 6-month intervals before and during the COVID-19 pandemic. We excluded individuals <18 years old. We performed a structured chart review to ascertain demographics, ED treatments, and adherence to guidelines for care of sexual assault survivors.ResultsOf 105 patients who received care after a sexual assault, 57 presented during the COVID-19 pandemic. The majority were female, White/Caucasian, and presented within 120 h of sexual assault. There was an increase in ED presentations for sexual assault during the pandemic. While there was no difference in medical care, there were fewer sexual assault advocates called during the pandemic. In addition, there was an increase in non-White survivors in the first 3 months of the pandemic that did not remain at 6 months.ConclusionThe care of survivors in the ED was disrupted by the COVID-19 pandemic. While medical care remained similar, fewer calls to sexual assault advocates, a key component of ED and long-term care of survivors, demonstrate a disruption in their care.
| S-EPMC9927790 | biostudies-literature
Project description:IntroductionEmergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE).MethodsWe conducted a cross-sectional study between June-August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors during ED care. Survey questions addressed two major themes in quality of care: staff preparedness to provide trauma-response care; and available resources. Staff preparedness to provide trauma-informed care was assessed through observations of staff behaviors. We used Wilcoxon rank-sum and Kruskal-Wallis tests to analyze differences in responses according to geographic regions and SANE presence.ResultsA total of 315 advocates from 99 crisis centers completed the survey. The survey had a participation rate of 88.7% and a completion rate of 87.9%. Advocates who indicated that a higher proportion of their cases were attended by SANEs were more likely to report higher rates of trauma-informed staff behaviors. For example, the recalled rate of staff asking patients for consent at every step of the exam was significantly associated with SANE presence (P < 0.001). With respect to access to resources, 66.7% of advocates reported that hospitals often or always have evidence collection kits available; 30.6% reported that resources such as transportation and housing are often or always available, and 55.3% reported that SANEs are often or always part of the care team. The SANEs were reported to be more frequently available in the Southwest than in other US regions (P < 0.001) and in urban as opposed to rural areas (P < 0.001).ConclusionOur study indicates that support from sexual assault nurse examiners is highly associated with trauma-informed staff behaviors and comprehensive resources. Urban-rural and regional disparities exist regarding access to SANEs, suggesting that elevating nationwide quality and equity in care of survivors of sexual assault requires increased investments in SANE training and coverage.
| S-EPMC10284505 | biostudies-literature
Project description:Using newly available U.S. nationally representative data from the No More study (N = 1,307), this article investigates (a) knowledge of sexual assault and intimate partner violence (IPV) victims within one's social network; (b) who intervenes, whom they intervene on behalf of, and how they intervene; and (c) the perceived barriers to intervening in IPV specifically. The findings reveal that knowledge of violence, the likelihood of intervening, and the intervention approaches taken all vary demographically and by violence type. Among respondents who have known a victim, one- third report having intervened for sexual assault, while one-half report having intervened for IPV. For both types of violence, respondents are more likely to have intervened on behalf of family or friends than on behalf of more distant network members. However, respondents are more likely to have solicited the help of authorities and less likely to have offered safe haven in instances of sexual assault than in instances of IPV. The most commonly cited barriers to IPV intervention include fear of injury, fear of misinterpretation, and belief that IPV is a private matter, though these vary across demographic groups. These findings indicate that the decision to intervene is highly contextual-contingent on the individual characteristics of the intervener, situational characteristics of the violence, and the relationship between the intervener and the victim.
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Project description:Child sexual abuse is a severely underreported crime in the United States. The consequences of child sexual abuse extend beyond physical injury, including an increased likelihood to develop chronic physical and mental diseases/disorders, including substance abuse and suicide. Care involves trauma-informed screening, assessment, and documentation, education of, and access to sexually transmitted infection prophylaxis and emergency contraception, safety interventions, and access to community resources. Medical providers should know the response process their facility, community, and state practices for victims of sexual abuse. Acknowledging and responding to victims of sexual abuse as a multidisciplinary team will ensure comprehensive care for the patient.
| S-EPMC7702185 | biostudies-literature
Project description:ObjectivesThis study explores the promise of an intersectoral network in enhancing the response to transgender (trans) survivors of sexual assault.MethodsOne hundred and three representatives of healthcare and community organizations across Ontario, Canada were invited to participate in a survey. Respondents were asked to: 1) identify systemic challenges to supporting trans survivors, 2) determine barriers to collaborating across sectors, and 3) indicate how an intersectoral network might address these challenges and barriers. Descriptive statistics were used to summarize quantitative data and qualitative data were collated thematically.ResultsSixty-seven representatives responded to the survey, for a response rate of 65%. Several themes capturing the challenges organizations face in supporting trans survivors were identified: Lack of knowledge and training among providers, Inadequate resources across organizations and institutions, and Limited access to and availability of appropriate services. Barriers to collaborating across sectors considered important by the overwhelming majority of respondents were: Lack of trans-positive service professionals (e.g., a paucity of sensitivity training), lack of resources (e.g., staff, staff time and workload, spaces to meet), and Institutional structures (e.g., oppressive policies, funding mandates). Four ways in which a network could address these challenges and barriers emerged from the data: Center the voices of trans communities in advocacy; Support competence of professionals to provide trans-affirming care; Provide the platform, strategies, and tools to aid in organizational change; and Create space for organizations to share ideas, goals, and resources.ConclusionOur findings deepen our understanding of important impediments to enhancing the response to trans survivors of sexual assault and the role networks of healthcare and community organizations can play in comprehensively responding to complex health and social problems.
| S-EPMC7673577 | biostudies-literature
Project description:IntroductionSexual violence is a significant public health concern in the United States, affecting as many as one in two women and one in four men. However, few medical schools offer education on trauma-informed communication with patients who disclose sexual assault (SA). The goal of this training was to provide medical students with an understanding of how to empathically respond to SA disclosures, collect pertinent medical information while avoiding retraumatization, and empower patients to feel in control of their care.MethodsOne hundred forty-nine second-year medical students at Rush Medical College attended a 1-hour didactic lecture discussing the needs of SA survivors followed by small-group sessions during which they practiced trauma-informed communication skills. Students completed anonymous pre- and postsession surveys featuring nine Likert-scale questions that assessed comfort level providing trauma-informed care.ResultsOf the 149 attendees, 88 (59%) completed matched pre- and posttraining surveys that demonstrated significant improvement in all assessed metrics of trauma-informed care, including comfort collecting information, empowering survivors, and responding to and normalizing patients' concerns. Two weeks after completing the training, all 149 students also correctly answered a free-response question testing retention of key training takeaways on their Sexuality and Reproduction final exam.DiscussionThe training significantly improved medical student comfort in providing trauma-informed care across all collected metrics. The training can be feasibly reproduced at other institutions so that future physicians across specialties can provide trauma-informed care, ideally improving the acute and chronic health outcomes that disproportionately affect SA survivors.
| S-EPMC8366721 | biostudies-literature