Help seeking among victims of crime: a review of the empirical literature

Factors Associated with Transgender and Gender Diverse People's Experience of Sexual Coercion, and Help-Seeking and Wellbeing Among Victims/Survivors: Results of the First Australian Trans and Gender Diverse Sexual Health Survey

Purpose: Our study examined factors associated with transgender and gender diverse ("trans") people's experience of sexual coercion, as well as the factors associated with help-seeking and wellbeing among victims/survivors. Methods: We analyzed cross-sectional data from the first Australian Trans and Gender Diverse Sexual Health Survey, conducted in 2018. Logistic regressions were undertaken to identify factors associated with sexual coercion, help-seeking, and wellbeing. Results: Of the sample of 1448 participants, 53.4% had been sexually coerced, which was associated with older age, Aboriginal or Torres Strait Islander descent, nonbinary gender, being presumed female gender at birth, currently living publicly some or all the time as their affirmed gender, having regular sex, and use of drugs to enhance or alter sexual experiences. Protective factors included having a higher income and access to gender affirming care. Help-seeking was reported among 49.5% of victims/survivors and was associated with having more trans friends. Wellbeing among victims/survivors was associated with being older, residing in regional/remote areas, having higher levels of education and annual income, being presumed female gender at birth, having stronger satisfaction with one's sex life, and good health care access. Wellbeing was not associated with help-seeking. Conclusion: Sexual coercion was prevalent among participants, but help-seeking behavior was low. Protective factors identified underscore the importance of socioeconomic supports, access to health and gender affirming care, and peers. Accessible peer-led and culturally safe preventive and trauma-focused supports should also be considered for trans people who experience sexual coercion.

A Conceptual Model of Help-Seeking by Black Americans After Violent Injury: Implications for Reducing Inequities in Access to Care

Many inequities exist in serving and supporting Black survivors of violent crime. A key question in reducing inequities in care after victimization is whether police first responders and other formal system providers identify the victim as an "offender" and/or someone who is "undeserving" of supports. These labels and associated biases can directly reduce access to supports through a variety of mechanisms that include police withholding information about one's rights as a victim, among other direct and indirect barriers to social and health services. Unaddressed financial, mental, and physical health consequences of victimization contribute to poorer health outcomes later in life. This paper seeks to bring together the extant research on help-seeking, discrimination in criminal legal system functioning, and barriers to victim services by synthesizing these discrete threads into a theoretically and empirically informed conceptual model that captures the range of factors that shape Black Americans' decision to report their victimization to the police and subsequent help-seeking. Qualitative and quantitative data from a purposive sample of 91 Black victims of community violence is used to ground the developing model. The conceptual model can help lay the foundation for research that seeks to remedy the marked mismatch between the prevalence of violent victimization and help-seeking among Black Americans. Research findings can be applied to guide policies and programming to reduce inequities in care for victims of violence.

But Someone Was Right There: An Examination of How Third-Party Presence Is Associated With Rape and Sexual Assault Victim Help-Seeking Behavior and Reports to Police

This research evaluates whether third-party presence is associated with rape and sexual assault (RSA) victims help-seeking and reporting to police, addressing a gap in the literature about how the presence of a third-party is associated with victim behavior. This research uses secondary data from the National Crime Victimization Survey (NCVS). Findings indicate that third-party presence has no statistically significant association with help-seeking and marginal significance with police reporting. This research focuses on third-party presence as a precursor to understanding victim help-seeking behaviors and reports to police. This research raises questions about the expected role of third parties in RSA victimizations.

Evaluation of Integrative Community Therapy with Domestic Violence Survivors in Quito, Ecuador

Integrative community therapy (ICT) is a methodology used in the public health arena to deal with problems facing communities such as depression, substance abuse, and stress. This approach is unique as it builds on critical pedagogy, cultural anthropology, communication, resilience, and systems theory. Additionally, creative arts therapies point to the utility of music as a therapeutic tool. This study employed ICT and a music workshop with domestic violence survivors in Quito, Ecuador, via a pre-post comparison group design. A total of 87 women completed the six-week study-49 in the intervention group and 38 in the comparison group. Measures were taken on self-esteem, general health, resilience, dating violence attitudes, and social support. Additionally, the intervention group answered open-ended questions about their experience, and some participated in a focus group (n = 21). The quantitative results indicated that there was improvement in the domains of general health, self-esteem, and social support for the intervention group compared to the comparison group. Themes from the qualitative responses indicated changes in the relationship with the aggressor, psychological and emotional changes, changes in feelings of social support, and changes for the future. The study found promising results for this approach with domestic violence survivors, possibly leading to a community-grounded, non-hierarchical, culturally-responsive intervention for this population.

Empathy for a Black Woman Victim of Police Sexual Violence: The Roles of Crime-Related Stress and Stereotype Attributions

Police sexual violence has been ranked as the second most common form of misconduct among police officers. Moreover, there is evidence that Black women are at heightened risk of being victims of such police violence. A report titled Say Her Name: Resisting Police Brutality Against Black Women has brought international attention to the minimal empirical focus on such police violence toward Black women. To address this lacuna in the literature, using an incident of police sexual assault of a woman, we assessed whether victim's race and participants' level of crime-related stress (i.e., stress due to crime victimization) would influence empathic responding toward the victim. Prolific participants (N = 411) first completed a measure of crime-related stress. They then read an article describing a White police officer's sexual assault of a Black or White woman. Next, participants completed a racial stereotype-related measure (i.e., Black women's higher sexual proclivity) and a stereotype-unrelated measure (i.e., perceived victim untrustworthiness), and reported their victim-directed empathic responding. At high stress levels, participants reported less empathy for the Black (relative to White) victim. At low stress levels, there was greater Black victim-directed empathy. The race effects on empathy were mediated by heightened attribution of Black women-related stereotypical beliefs to the Black victim at high stress levels and by diminished attribution at low stress levels. In sum, we addressed the lacuna in the literature on police sexual violence against Black women while providing evidence that stress can play a critical role in the occurrence of the oft-cited outgroup-directed empathy deficit.

A Qualitative Investigation of Service Providers' Experiences Supporting Raped and Sexually Abused Men

Substantial gaps remain in our understanding of the risks and barriers that exist for men affected by rape and sexual abuse. The present research utilized semi-structured interviews with 12 service providers from specialist organizations in the United Kingdom. An interpretative phenomenological analysis revealed three superordinate themes: (a) survivors' needs for agency, safety, and control as functions of their masculinity; (b) the impact of rape myths and their challenge to therapeutic intervention; and (c) survivors' expectations around reporting and the police. The role of masculinity and social stigma permeated participants' accounts, with negative stereotypes and male rape myths influencing reporting, access to services, and survivors' coping mechanisms. Results are discussed in relation to current service provision within the United Kingdom, and avenues for improvement are suggested.

"I Have to Fight to Get Out": African American Women Intimate Partner Violence Survivors' Construction of Agency

African American women survivors of intimate partner violence are disproportionately murdered and help-seeking is a critical variable to examine as it relates to it. There is an urgent need to develop culturally salient interventions that center African American women's ways of knowing. An initial step to doing so is identifying how they employ their sense of individual agency during help-seeking. This paper reflects findings from a study designed to do just that. We conducted 30 in-depth, semi-structured interviews with women who self-identified as African American. Constructivist grounded theory methodology was employed. Constructed agency emerged from the data. This nascent theory explicates four phases of African American women survivors' help-seeking: resistance, persistence, rejection, and resignation. Constructed agency provides practitioners and researchers with a theoretical model to examine African American women's nuanced help-seeking efforts when seeking informal supports and interventions from formal providers.

The dilemma of trauma-focused therapy: effects of imagery rescripting on voluntary memory

Trauma-focused imagery-based interventions are suspected to alter or even distort declarative voluntary memory of a traumatic event, especially if they involve the active modification of imagery, e.g., as used in imagery rescripting (ImRs). However, systematic research is lacking so far. To investigate whether ImRs modifies voluntary memory of a standardized autobiographical aversive event (Trier Social Stress Test) (Session 1), healthy participants (N = 100) were randomly assigned to either an intervention condition receiving one session of ImRs or to a no-intervention control condition (NIC) (Session 2). Voluntary memory was examined using a free recall (Sessions 2 and 3) and a cued recall (Sessions 3 and 4). Although voluntary memory tended to deteriorate over time, contrary to expectations, this effect was not associated with ImRs. Remarkably, the number of correct details in free recall even improved in ImRs but not in NIC. This challenges the view that ImRs alters voluntary memory.

Trends in US Emergency Department Use After Sexual Assault, 2006-2019

IMPORTANCE

Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality.

OBJECTIVE

To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation's Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022.

MAIN OUTCOMES AND MEASURES

Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics.

RESULTS

Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population.

The Relationship Between Perceived Social Support and PTSD Symptoms After Exposure to Physical Assault: An 8 Years Longitudinal Study

Consequences of nondomestic violence are known to be multifaceted with high rates of emotional and psychological problems in addition to physical injuries, and victims report many trauma related symptoms. This study explore if perceived social support (PSS) (Social Provisions Scale [SPS]) and post-traumatic stress disorder (PTSD) symptoms (Impact of Event Scale [IES-22]) are interrelated among adult victims at four assessment points up until eight years after the exposure to physical assault; soon after the event (T1), three months after T1 (T2), one year after T1 (T3), and eight years after T1 (T4). One hundred and forty-three subjects participated at T1, 94 at T2, 73 at T3, and 47 accepted a follow-up at T4. At T1, 138 of 143 completed the questionnaires within 16 weeks after the incident. PTSD symptoms were highly correlated across time (p < .001); PSS were significantly correlated only between T1 and T2 (p < .001), T1 and T3 (p < .05), and between T2 and T3 (p < .05). Cross-lagged analyses showed an inverse relationship between prior PSS and later PTSD symptoms across all time points (ps < .05); not proved between prior PTSD symptoms and later PSS (ps > .1). PSS at T1 was an independent predictor of PSS one year and eight years after the incident. We conclude that higher perception of social support protects against the development of PTSD symptoms; diminished perception of social support increases the risk of developing PTSD symptoms. These findings suggest that PSS after experiencing a violent assault should be considered as an important factor in natural recovery in the long run, as well as essential alongside psychiatric treatment. Establishing psychosocial interventions for victims of physical violence in the acute phase may prevent prolonged trauma reactions.

Immigrants’ Length of Residence and Stalking Victimization in Canada: A Gendered Analysis

Although previous studies have explored the role of gender on stalking victimization, we know very little about how female and male immigrants are exposed to stalking victimization over time after their arrival to their host society. To address this void in the literature, we use the 2014 Canada General Social Survey to compare stalking victimization among native-born individuals, recent immigrants (those who have been in Canada for fewer than 10 years), and established immigrants (those who have been in Canada for 10 years or more) separately for women and men. Applying gender-specific complementary log-log models, we find that female (OR = 0.63, p < 0.05) and male (OR = 0.46, p < 0.01) recent immigrants are less likely to experience stalking victimization than their native-born counterparts. We also find that female established immigrants (OR = 0.65, p < 0.05) are less likely to experience stalking victimization than their native-born counterparts although there is no significance difference for male established immigrants (OR = 1.01, p > 0.05). Overall, this study points to the importance of understanding the intersection between immigrants’ length of residence and gender in the context of stalking victimization in Canada. Based on these findings, we discuss several implications for policymakers and directions for future research.

The use of professional help and predictors of unmet needs for dealing with mental health to legal problems among victims of violence, accidents, theft and threat, and nonvictims in the general population

AIMS

Victims of violence, accidents, theft, and serious threat (hereafter abbreviated as victims) are more than nonvictims at risk for problems in different domains, varying from mental health to legal problems. However, the extent to which victims with these problems compared to nonvictims with similar problems receive problem-related professional or formal help is unclear. It is unknown if predictors of unmet needs differ between victims and nonvictims. Aim of the present study is to fill this gap of knowledge.

METHODS

Data was extracted from surveys of the VICTIMS-study (2018, 2019 and 2020), conducted with the Dutch population-based longitudinal LISS panel. Each survey assessed 1.) experiences with physical violence, accidents, theft, and serious threat and other traumatic or stressful events in the past 12 months and 2.) various problems and use of professional help, e.g. do receive help, do not need help, could use help but do not use it, cannot find or afford help for these problems. Multivariate logistic regression analyses were performed to assess differences in problems, in the use of problem-related professional help, and in predictors of unmet needs between victims (N = 1,756) and nonvictims (N = 5,000).

RESULTS

Victims more often had assessed problems than nonvictims. Victims compared to nonvictims with similar problems had 1.5 to 2 times more often unmet needs: they could not find or afford professional help for their mental, physical, partner/family, financial and legal problems. In addition, victims less often received help for legal and administrative problems. Most predictors of unmet needs, e.g. could use help but do not use it, cannot find or afford help, were not significant and hardly differed between both groups.

CONCLUSIONS

The findings that victims compared to nonvictims more often have various problems and more often cannot find or afford problem-related professional help, suggest that there is room for improvement for victims services.

Sexual and Nonsexual Interpersonal Violence, Psychiatric Disorders, and Mental Health Service Use

Exposure to potentially traumatic events (PTEs) increases an individual's risk of suffering from psychiatric disorders. However, only a small proportion of individuals exposed to PTEs use health care services (HCS). Few studies have examined how exposure to different types of PTEs affect the odds an individual will suffer from a psychiatric disorder and access HCS. The present study aimed to examine the associations among lifetime exposure to sexual and nonsexual violence, psychiatric disorder presence, and utilization of HCS. Data were drawn from a large cross-sectional survey (N = 19,958) representative of four regions of France. Lifetime occurrence of traumatic events, past-year DSM-IV Axis I psychiatric disorders, and past-year use of HCS were assessed using the CIDI-SF. Lifetime exposure to violence, particularly sexual violence, was associated with significantly higher odds of suffering from common psychiatric disorders in the past year, including major depression, aOR = 1.70, 95%CI [1.34, 2.17], which was present among 36.9% of participants who reported sexual violence exposure, 20.9% of those who reported exposure to nonsexual violence, and 7.1% of those exposed to neither. Compared to participants who were not exposed to sexual violence, victims of sexual violence were more likely to have contacted health care professionals due to a mental health problem and to have received psychotropic medication. However, a significant portion of individuals with psychiatric disorders did not report receiving potentially beneficial HCS. The present findings highlight the need to identify victims of violence and improve access to appropriate services for this population.

Exploring the Immediate Effects of COVID-19 Containment Policies on Crime: an Empirical Analysis of the Short-Term Aftermath in Los Angeles

This work investigates whether and how COVID-19 containment policies had an immediate impact on crime trends in Los Angeles. The analysis is conducted using Bayesian structural time-series and focuses on nine crime categories and on the overall crime count, daily monitored from January 1st 2017 to March 28th 2020. We concentrate on two post-intervention time windows-from March 4th to March 16th and from March 4th to March 28th 2020-to dynamically assess the short-term effects of mild and strict policies. In Los Angeles, overall crime has significantly decreased, as well as robbery, shoplifting, theft, and battery. No significant effect has been detected for vehicle theft, burglary, assault with a deadly weapon, intimate partner assault, and homicide. Results suggest that, in the first weeks after the interventions are put in place, social distancing impacts more directly on instrumental and less serious crimes. Policy implications are also discussed.

Giving Voice to Silence: Empowerment and Disempowerment in the Developmental Shift from Trauma 'Victim' to 'Survivor-Advocate'

In the past several years, a public conversation in the United States about interpersonal violence has flourished, sustained by the work of advocates who are themselves survivors. This surge in public sharing of trauma stories is a rhetorical form of resistance to ideologies in mainstream American culture that impose silence on survivors (e.g., the "just world" belief). However, the developmental progression from trauma 'victim' to empowered public 'survivor/advocate' accommodates to dominant American cultural preferences that stories of adversity have a redemptive story line. In a redemptive story, negative experiences are followed by something positive (e.g., personal growth, lessons learned, strength gained). In this paper, we draw from theory and the sparse relevant literature across multiple disciplines to conceptualize when and for whom the redemptive storying of trauma (or, redemptive master narrative) is available, advantageous, and systemically encouraged. Among the proposed advantages of redemptive storying are its psychological health benefits; potential to empower self and others; promotion of meaning-making, mission, and communal solidarity; and the larger social/political changes that can emerge from giving voice to silenced experiences. Proposed challenges to redemptive storying include layers of societal oppression and marginalization that shape the redemption stories of many survivor-advocates; ongoing connection to or dependence on relationships and communities that enable abuse; and the reality of historical trauma and other forms of intergenerational trauma, which complicate the linear, individualistic story of redemption. With this theory-driven framework, we wish to promote compassion for survivors, along with interdisciplinary, inclusive, and intersectional research in this understudied area.

Sleep and women intimate partner victimization: prevalence, effects and good practices in health care settings

Intimate Partner Violence is a global health issue with higher prevalence worldwide, mostly in women, higher social and economic costs and devastating physical and mental health consequences for the victims. Sleep disturbances has been associated with other mental health issues, being an important symptom when diagnosing post-traumatic stress disorder, depression or anxiety. It can also constitute an important sign to help health professionals to identify potential victims of intimate partner violence. This review paper main objectives are to address the connection between intimate partner violence and sleep disruption, the role and barriers of health professionals in screening this type of violence when sleep problems are present, and to describe good practices in order to identify these victims and to provide support. It has been found that intimate partner victims commonly experience significant sleep disturbances that include truncated sleep, nightmares and less restful sleep. Health professionals are first-line professionals with a pivot role to screen and identify women victims. However, a set of personal (e.g., lack of knowledge and inadequate perceptions about violence, cultural issues) and organizational barriers (e.g., time constraints, lack of training, absence of institutional protocols) may limit the accurate reading of those symptoms. Accordingly, health professionals must be alert not only to physical health conditions associated with violence (acute physical injuries, chronic physical injuries, obstetric and genital injuries), but also psychological problems, like depression, anxiety, post-traumatic stress disorder, alcohol or drug misuse, sleep disturbances, insomnia and nightmares. In the presence of alert symptoms related to violence, health professionals become able to screen, identify and provide ongoing care for women, promoting a trusting relationship and assuming an attentive non-judgmental listening.

The Willingness to Intervene in Cases of Intimate Partner Violence Against Women (WI-IPVAW) Scale: Development and Validation of the Long and Short Versions

Willingness to intervene when one becomes aware of a case of intimate partner violence against women (IPVAW) reflects the level of tolerance and acceptance of this type of violence in society. Increasing the likelihood of intervention to help victims of IPVAW is also a target for prevention strategies aiming to increase informal social control of IPVAW. In this study, we present the development and validation of the Willingness to Intervene in Cases of Intimate Partner Violence (WI-IPVAW) scale. We report data for both the long and short versions of the scale. We analyzed the latent structure, the reliability and validity of the WI-IPVAW across four samples (N = 1648). Factor analyses supported a bifactor model with a general non-specific factor expressing willingness to intervene in cases of IPVAW, and three specific factors reflecting different intervention preferences: a preference for setting the law enforcement process in motion ("calling the cops" factor), a preference for personal intervention ("personal involvement" factor), and a preference for non-intervention ("not my business" factor). Configural, metric, and partial scalar invariance across genders were supported. Two short versions of the scale, with nine and six items, respectively, were constructed on the base of quantitative and qualitative criteria. The long and short versions of the WI-IPVAW demonstrated both high reliability and construct validity, as they were strongly related to the acceptability of IPVAW, victim-blaming attitudes, perceived severity of IPVAW, and hostile sexism. These results confirm that both the long and short versions of the WI-IPVAW scale are psychometrically sound instruments to analyze willingness to intervene in cases of IPVAW in different settings and with different research needs (e.g., long versions for clinical and research settings, and short versions for large population surveys). The WI-IPVAW is also useful for assessing prevention policies and public education campaigns design to promote a more responsive social environment in cases of IPVAW, thus contributing to deter and reduce this major social and public health problem.

Victim Empowerment, Safety, and Perpetrator Accountability Through Collaboration: A Crisis to Transformation Conceptual Model

This article describes the development of the Victim Empowerment, Safety, and Perpetrator Accountability through Collaboration (VESPAC) model based on a grounded theory analysis of congressionally mandated and permissible purpose areas for grants authorized by the Violence Against Women Act. These areas are reflective of ongoing and emerging needs of victims and agencies serving victims and are rooted in the expertise, insight, and concerns of those who work most closely with victims and perpetrators on a regular basis. Analysis resulted in five overarching and interconnected themes: Community Readiness, Victim Services, Justice Responses, Coordinated Community Responses, and Cultural Relevance. The final model emphasizes the centrality of coordinated community responses to ensure that the remaining components of the model work in tandem across time to achieve victim safety and perpetrator accountability in a culturally appropriate way. The model also may help agencies, coalitions, and communities think “big” and consider more strategically about where their strengths best fit in the vast scope of victim needs necessary to meet safety goals and where they might benefit most from the expertise of partners.

Psychological distress following crime victimization: An exploratory study from an agency perspective

Deficits in recognition of suffering play a significant role in the etiology of psychological distress in crime victims. However, given the preliminary status of the literature, it seems necessary to take other factors into account as well. Starting from an agency perspective, this study explored three such factors: negative self-attributions, peritraumatic distress, and early posttraumatic emotions. More specifically, this study explored whether the association between recognition deficits and posttraumatic stress disorder (PTSD) symptoms observed in other studies could be replicated and, if so, whether this association was mediated by negative self-attributions and would decrease in strength when taking into account the adverse roles of peritraumatic distress and early posttraumatic emotions. To address these questions, we used prospective data from 201 victims who had reported a crime to the Dutch police. Recognition deficits, negative self-attributions, peritraumatic distress, and early posttraumatic emotions were assessed within 1 month after the crime report and PTSD symptoms 1 month later. Results indicated that the association between recognition deficits and PTSD symptoms was partly mediated by negative self-attributions and that the strength of this association decreased when controlling for peritraumatic distress and early posttraumatic emotions.

Establishing the Prevalence of Intimate Partner Violence Among Hair Salon Clients

This study determined prevalence of intimate partner violence (IPV) victimization among female clients at three hair salons in Connecticut using an anonymous tablet based screening tool. While many may assume that women receive services at hair salons, victims of IPV are often isolated by their partners and unable to access help. Of the 203 clients who participated, 40 (20%) had experienced IPV in her lifetime. In identifying the prevalence of IPV within the salon setting, this study provides support for community-based programs and supports their legitimacy as an important locus for identifying women experiencing IPV and connecting them to resources.

Mental Health Help Seeking Among Traumatized Individuals: A Systematic Review of Studies Assessing the Role of Substance Use and Abuse

OBJECTIVE

Prior research has suggested that competing neurobehavioral decision-making processes might affect health outcomes among traumatized populations. Regulatory imbalances to impulsive and executive decision systems are affected by high levels of stress, including stress resulting from traumatic events. Such regulatory imbalances have been associated with addictive behaviors. However, it is not well known whether addictive behavior increases or decreases the likelihood of utilization of behavioral health services among traumatized populations. The aim of this study is to systematically review mental health utilization studies targeting traumatized populations to determine the direction of association between substance use and behavioral health utilization.

METHOD

Databases of literature were searched in a systematic manner, and 37 relevant studies were recovered and analyzed.

FINDINGS

Of the 37 relevant studies that included addictive behaviors as a predictor of utilization, 16 showed a positive significant relationship and 6 showed a negative significant relationship. Studies showing a negative significant relationship used younger samples with more recent trauma exposure.

CONCLUSION

Studies have shown that for the most part, substance abuse increases the likelihood of utilization, except among younger populations with more recent trauma. Longitudinal studies that access how utilization evolves over time among traumatized populations and interacts with posttraumatic stress disorder (PTSD) and substance abuse severity are necessary to better understand how decision-making processes of traumatized individuals may increase the likelihood of chronic PTSD.

Friendships Lost: The Social Consequences of Violent Victimization

Few studies have examined the impact of violent victimization on friendship networks. This study used two waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the effects of violent victimization on number peer- and self-reported friendships. Guided by stigma theory (Goffman, 1963), fixed-effect regression models controlling for depression, delinquency, substance use, and school engagement were completed to predict changes in number of friends following victimization. Consistent with the theory, results indicate that experiencing violent victimization (e.g., jumped, stabbed, shot at) was associated with a decrease in number of friends. These effects were magnified for females and for individuals with a greater number of depressive symptoms. These results were consistent even when models were run separately for each individual type of victimization. Treatment and prevention implications are discussed.

A population-based study of help seeking and self-medication among trauma-exposed individuals

Epidemiologic studies of trauma highlight the imbalance between prevalence of psychiatric diagnoses and help seeking. We investigated prevalence and correlates of help seeking and self-medication in Norwegian adults with trauma history with a focus on common posttrauma outcomes of posttraumatic stress disorder (PTSD) and substance use disorders (alcohol or drug). Participants reporting at least 1 PTSD symptom (n = 307) were asked if they consulted with a doctor/another professional (help seeking) or used drugs/alcohol (self-medication) for trauma-related problems. PTSD, alcohol abuse or dependence (AUD), and drug use or dependence (DUD) were assessed via structured diagnostic interviews. Help seeking and self-medication were endorsed by 37.4% and 10.4% of the sample, respectively. As compared to the full sample, help seeking was endorsed at a greater rate in individuals with PTSD (χ2 = 8.59, p = .005) and at a lower rate in those with AUD (χ2 = 7.34, p < .004). Self-medication was more likely to be endorsed by individuals with PTSD than without PTSD (χ2 = 25.68, p < .001). In regression analyses, PTSD was associated with increased likelihood of self-medication (odds ratio [OR] = 4.56) and help seeking (OR = 2.29), while AUD was associated with decreased likelihood of help-seeking (OR = .29). When self-medication was included as a predictor, PTSD was no longer associated with help seeking, although AUD remained inversely associated. PTSD and AUDs have a nuanced relationship with formal help seeking as well as the use of substances to cope. Trauma-exposed individuals are likely engaging in adaptive and maladaptive coping strategies, the latter of which may be compounding distress. (PsycINFO Database Record

Barriers to Healthcare Provision for Victims of Sexual Assault: A Grounded Theory Study

Background:

Victims of sexual assault need comprehensive healthcare services to deal with the consequences of their experience. However, there are still many girls/women that delay seeking healthcare after they experience sexual assault.

Objectives:

To explore the process of health care and clinical services for victims of sexual assault in the health care centers of Iran.

Patients and Methods:

This was a qualitative study based on the grounded theory method. The sample consisted of 23 health care providers and 10 victims of sexual violence. Unstructured interviews and observations were used for data collection. Constant comparative analysis was used according to the Strauss and Corbin method.

Results:

The analysis of all data led to the extraction of four categories: “performing routines”, “victims’ expectations”, “conflict between expectations of victims and existing healthcare services”, and the core category of “neglect of healthcare providers to address the needs and expectations of victims”. Providers were offering health care to the victims of sexual violence regardless of their needs. Due to this neglect, victims sought illegal solutions to overcome the consequences that led to social stigma.

Conclusions:

The findings indicate the lack of mutual understanding between health care providers and victims of sexual violence in relation to the expectations and priorities of victims.

Violence Against Latinas: The Effects of Undocumented Status on Rates of Victimization and Help-Seeking

This study investigated whether legal status was related to interpersonal victimization and help-seeking by comparing Latina immigrants with permanent legal status with Latina immigrants who are undocumented on rates of reported interpersonal victimization, types of perpetrators, and rates of help-seeking. Data come from the Sexual Assault Among Latinas (SALAS) study, which interviewed 1,377 immigrant Latinas about their lifetime histories of sexual assault, physical assault, stalking, and threats along with help-seeking efforts. Results did not reveal significant differences between legal status and reported victimization rates or types of perpetrators. However, undocumented Latinas (n = 91) were less likely to seek formal help than those with permanent status. Results of this study indicate that undocumented status does not independently put women at risk of victimization, but that responses to violence are related to legal status.

Modifiers of Neighbors' Bystander Intervention in Intimate Partner Violence: A Concept Mapping Study

Encouraging bystander intervention in intimate partner violence (IPV) against women is potentially an important method of reducing the prevalence of such violence in urban communities. Most existing research has been conducted on campuses and in relation to sexual violence among teens or young adults. Our understanding of which bystander behaviors are feasible is nascent, and our knowledge of which situational factors influence neighbors' self-reported willingness to intervene is underdeveloped. We conducted a concept mapping study to identify potential bystander intervention behaviors in IPV among neighbors in urban settings; we also assessed whether perceived feasibility and effectiveness of those behaviors varied by situational characteristics. Using data collected from 41 residents of a low-income New York City neighborhood in late 2011, concept mapping was used to create a conceptual map of the 74 behaviors identified by participants. We examined participant differences in mean feasibility (i.e., that the participants "could" or "would" enact a behavior), feasibility given two situational characteristics (if the couple was perceived to have a history of IPV, and if children were believed to be involved or present), and perceived effectiveness of bystander behaviors. Differences across select sociodemographic factors of participants were also analyzed. A 13-cluster solution emerged, with clusters of bystander behaviors grouped into four larger cluster areas: victim focused, parenting/education focused, perpetrator focused, and community involvement focused. Bivariate analyses revealed that participants rated the four cluster areas as more feasible when a child was believed to be involved. Male participants rated intervention as less feasible when the couple was believed to have a history of IPV. Participants who reported a history of IPV victimization rated all four cluster areas as less effective on average, as compared with participants without a history of IPV. This study explored bystander intervention into IPV outside of a college context and among urban adults living in high-poverty areas. Results suggest that the presence of children and perceived history of IPV may affect bystander intervention. Specific recommendations to build the research base on bystander intervention in adult IPV as well as what situational, sociodemographic, and other factors mitigate against intervention among potential responders are offered.

Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection

OBJECTIVES

To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health.

METHODS

We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt.

RESULTS

Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95).

CONCLUSIONS

Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.

Mobilizing victim services: the role of reporting to the police

Victim assistance programs have grown dramatically in response to the victim's rights movement and concern over difficulty navigating victim services. Evidence, however, indicates that very few victims seek assistance. The present study examined factors associated with victim service use including reporting to the police, the victim's demographic characteristics, the victim's injury, offender's use of a weapon, the victim's relationship to the offender, and the victim's mental and physical distress. Data came from a subset of the National Crime Victimization Survey 2008-2011 (N = 4,746), a stratified multistage cluster sample survey of persons age 12 years and older in the United States. Logistic regression models indicated that fewer than 10% of victims of violent crime sought help from victim services. Reporting to the police increased the odds of seeking services by 3 times. In addition, the odds of victims attacked by an intimate partner seeking services were 4.5 times greater than victims attacked by strangers. Findings suggest that additional exploratory work is needed in uncovering the mechanism of police involvement in linking victims to services. Specifically, do police understand what services are available to victims and why are police more likely to inform some types of victims about services more than others?

Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization

Recent findings from studies on adults show similarities between social anxiety disorder (SAD) and posttraumatic stress in the form of recurrent memories and intrusive and distressing images of earlier aversive events. Further, treatment models for SAD in adults have been successfully developed by using transdiagnostic knowledge on posttraumatic stress symptoms (PTSS). Studies on adolescents are though missing. The present study aimed at exploring the association between PTSS and SAD in Swedish adolescents. A second aim was to study mental health services utilization in relation to these conditions. A total of 5,960 high-school students participated and reported on SAD, life time victimization, PTSS and mental health service utilization. Socially anxious adolescents reported significantly higher levels of PTSS than adolescents not reporting SAD and this difference was seen in victimized as well as non-victimized subjects. Contact with a school counselor was the most common mental health service utilization in subjects with SAD and those with elevated PTSS. In the prediction of contact with a CAP-clinic, significant odds ratios were found for a condition of SAD and elevated PTSS (OR = 4.88, 95% CI = 3.53-6.73) but not for SAD only. Screening of PTSS in adolescents with SAD is recommended. The service of school counselors is important in detecting and helping young people with SAD and elevated PTSS. Clinical studies on SAD and PTSS in adolescents could aid in modifying treatment models for SAD.