An acute post-rape intervention to prevent substance use and abuse

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

Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.

A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims

Although rape has been linked to risk for suicidal ideation and attempts, there are scant data on the efficacy of brief interventions to reduce suicidality among recent rape victims. This secondary analysis of a randomized controlled trial investigated whether a video intervention delivered in the emergency department (ED), cortisol measured at the ED, and prior rape history predicted postrape suicidal ideation independently or in combination with the other predictors. Participants were 235 women aged 15-71 years who presented to the ED for a sexual assault medical forensic examination and were randomly assigned to either receive a video intervention that addressed avoidance and promoted healthy coping strategies or standard care prior to the examination. Participants also provided a blood sample for cortisol and completed at least one of three follow-ups at 6 weeks, 3 months, or 6 months postrape. The intervention conferred protection against suicidal ideation among women with elevated cortisol and a prior rape; however, it did not reduce risk for women without a prior rape, particularly those with elevated cortisol. It may be important to consider the influence of prior rape and neuroendocrine reactivity in developing treatments to address suicidal ideation among rape victims. More specifically, there appears to be value in screening victims for prior rape and administering this brief intervention to reduce suicidal ideation; however, other avenues should be explored for victims without a prior rape history. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study

BACKGROUND

Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault.

METHODS

Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey.

RESULTS

Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged.

CONCLUSION

Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.

Secondary prevention for posttraumatic stress and related symptoms among women whohave experienced a recent sexual assault: A systematic review and meta-analysis

BACKGROUND

Women who have experienced a recent sexual assault (SA) are at high risk for posttraumatic stress disorder (PTSD) and related conditions, with approximately half of women experiencing SA meeting criteria for PTSD. There are no guidelines for the prevention of PTSD and other common mental health disorders after SA. Thus, the purpose of this systematic review and meta-analysis is to synthesize research on secondary preventions for PTSD after SA, determine efficacy whether any intervention seems promising, and ascertain when, how, and to whom interventions should be delivered.

METHODS

After searching electronic databases for secondary preventions for PTSD and related conditions among women who have experienced a recent SA, 17 studies were reviewed, their quality was rated on the clinical trial assessment measure, and 10 studies were meta-analyzed (7 were excluded, as they were not randomized controlled trials or due to the absence of heterogeneity).

RESULTS

Results suggested a small-to-moderate effect of prevention on reducing PTSD and related symptoms. There was no moderating effect of medication versus psychosocial interventions, timing, treatment modality, or targeted versus universal prevention. Half of the studies were of high quality.

CONCLUSION

Cognitive-behavioral secondary preventions for PTSD appear to be safe and effective among women who have experienced a recent SA. Future research should identify best practices and mechanisms of treatment, and once identified, it should move toward implementation science.

Early Psychological Intervention After Rape: A Feasibility Study

Rape is the most common trauma leading to post-traumatic stress disorder (PTSD) among women, with a conditioned prevalence of up to 50%. PTSD is considered to be a lethal condition associated with increased risk of suicide, drug- and alcohol dependence, neurological- and vascular problems, as well as sick leave. Given the scope of this problem, novel and swiftly delivered interventions for this large vulnerable population are clearly warranted. One previous trial conducted in the United States (N = 137) showed that an adapted brief version of prolonged exposure (PE) to the fearful memory of the event and situations, provided in the immediate aftermath after trauma (<72 h after a traumatic event), was effective in reducing early PTSD symptoms in rape victims. The aims of the present study were to adapt the brief PE protocol to a Swedish context and investigate its feasibility and delivery in 10 executive patients recruited at the Emergency Clinic for Rape Victims in Stockholm. Ten participants were provided with three sessions of early PE with overall successful results in terms of session attendance, home-work compliance, and also symptom reduction of PTSD and depressive symptoms. However, only a fraction of the screened patients at the Emergency Clinic (5.2%) were eligible to be included in the study, where the majority (40%) were excluded due to the time criteria of 72 h. In this article, we will present detailed results of the intervention and elaborate on how to increase feasibility of preventive interventions for rape victims. In the current form, providing PE with the strict time criteria was not feasible in the clinical setting that constitutes the Emergency Department for rape.

The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review

BACKGROUND

Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice.

METHODS

A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.

RESULTS

We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.

CONCLUSIONS

This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.

Refinement and Pilot Testing of a Brief, Early Intervention for PTSD and Alcohol Use Following Sexual Assault

Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.

Supporting Rape Survivors Through the Criminal Injuries Compensation Scheme: An Exploration of English and Welsh Independent Sexual Violence Advisors' Experiences

English and Welsh responses to rape have long been critically examined, leading to attempted improvements in the criminal justice system. Despite this, little attention has been paid to the Criminal Injuries Compensation Scheme (CICS) and the difficulties applying it to rape. To begin addressing this gap, researchers interviewed three, and qualitatively surveyed 22, Independent Sexual Violence Advisors. The findings suggest that CICS may not only reinforce rape myths and disadvantage vulnerable survivors, but is also a source of validation and contributes to survivor justice. The study, while exploratory, therefore, highlights the need for further discussion about rape survivor compensation.

A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms

Introduction

Technology-based mental health interventions are becoming increasingly common, and several have begun to target multiple outcomes in a single intervention. Recent developments in the treatment of co-occurring posttraumatic stress disorder and substance use disorder has led to the development and testing of technology-based interventions for these disorders. The current systematic review examined technology-based interventions designed to improve mental health outcomes among patients with co-occurring trauma symptoms and substance use.

Methods

Of 601 articles reviewed, 14 included a technology-based intervention for patients with these co-occurring problems.

Results

Seven of these studies provided preliminary evidence that technology-based interventions are likely to be efficacious in reducing either trauma symptoms or substance use. The seven remaining studies demonstrated that technology-based interventions for co-occurring trauma symptoms and substance use are feasible.

Discussion

This review suggests that technology-based interventions for co-occurring trauma symptoms and substance use are feasible, but more work is needed to assess efficacy using scientifically rigorous studies.

Rape as an Economic Crime: The Impact of Sexual Violence on Survivors' Employment and Economic Well-Being

This article examines how isolated instances of sexual violence affect adult female survivors' employment and economic well-being. This study draws on data from 27 in-depth, qualitative interviews with sexual assault survivors and rape crisis service providers. The findings suggest that sexual assault and the related trauma response can disrupt survivors' employment in several ways, including time off, diminished performance, job loss, and inability to work. By disrupting income or reducing earning power, all of these employment consequences have implications for survivors' economic well-being in the months or years following the assault. In addition, I argue that for many survivors, these employment consequences compound one another and ultimately shift survivors' long-term economic trajectories. By highlighting survivors' lived experiences of the financial aftermath of sexual assault, these findings help to illuminate the processes by which sexual violence decreases survivors' income over the life course. Understanding the financial effects of sexual violence can help researchers better understand and predict the recovery process, while helping practitioners to design more effective interventions for survivors.

Psychological Outcomes After a Sexual Assault Video Intervention: A Randomized Trial

Sexual assault survivors are at risk for a number of mental and physical health problems, including posttraumatic stress disorder and anxiety. Unfortunately, few seek physical or mental health services after a sexual assault (Price, Davidson, Ruggiero, Acierno, & Resnick, 2014). Mitigating the impact of sexual assault via early interventions is a growing and important area of research. This study adds to this literature by replicating and expanding previous studies (e.g., Resnick, Acierno, Amstadter, Self-Brown, & Kilpatrick, 2007) examining the efficacy of a brief video-based intervention that provides psychoeducation and modeling of coping strategies to survivors at the time of a sexual assault nurse examination. Female sexual assault survivors receiving forensic examinations were randomized to standard care or to the video intervention condition (N = 164). The participants completed mental health assessments 2 weeks (n = 69) and 2 months (n = 74) after the examination. Analyses of covariance revealed that women in the video condition had significantly fewer anxiety symptoms at the follow-up assessments. In addition, of those participants in the video condition, survivors reporting no previous sexual assault history reported significantly fewer posttraumatic stress symptoms 2 weeks after the examination than those with a prior assault history. Forensic nurses have the unique opportunity to intervene immediately after a sexual assault. This brief video intervention is a cost-effective tool to aid with that process.

Acute stress among adolescents and female rape victims measured by ASC-Kids: a pilot study

BACKGROUND

Rape is considered a stressful trauma and often with durable consequences. How the aftermath of rape is for young adolescents' girls considering acute stress is an overlooked field and remains to be studied.

AIMS

In this study, we wanted to investigate acute stress among adolescent victims of rape and the psychometric properties of the Acute Stress Checklist for Children (ASC-Kids).

METHODS

A clinical sample (n = 79) of raped girls, 13-17 years old who had turned to a special rape victim unit for treatment, answered the ASC-Kids. ASC-Kids was also given to a group of minor stressed, non-raped adolescents in the same age range (n = 154) together with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI), and the Sense of Coherence Scale 13 (SOC-13).

RESULTS

The scores from the groups were compared and showed significant differences in mean values on all the diagnostic criteria of acute stress disorder. In the clinical group, 36.7% obtained full ASD criteria. ASC-Kids could discriminate well between groups. Cronbach's alpha was found to be excellent, and the correlation between the UCLA PTSD RI and ASC-Kids found to be good; both ASC-Kids and UCLA PTSD RI had a good and moderate negative correlation with SOC-13.

CONCLUSION

Adolescent female rape victims were shown to have a very high level of acute stress, and the ASC-Kids was found to have sound psychometrics and can be a valuable screening instrument to support clinicians in their assessments of an indication of adolescents after potentially stressful events such as rape.

The Role of Sexual Violence in Creating and Maintaining Economic Insecurity Among Asset-Poor Women of Color

This article argues that economic instability and sexual violence reinforce each other in two ways. First, the devastating psychological consequences of sexual assault can diminish work performance and disrupt income, creating economic instability, particularly for the asset-poor. Latina and African American women face particular risk due to barriers to appropriate post-assault resources and low rates of asset ownership. Second, income- and asset poverty increase women’s risk for sexual violence and complicate recovery. Women with financial and social resources can leverage these assets to both avoid and recover from sexual assault, whereas women without such resources lack these options. Policy solutions are proposed.

Comparing the effect of two educational programs on the quality of life of hemodialysis patients in iran

Background:

Various researchers have shown that the health level, performance status, and quality of life (QOL) are often less than expected especially in hemodialysis (HD) patients.

Objectives:

This study aimed to determine the effect of the two methods of educational programs on health- related QOL (HRQOL) in Iranian HD patients.

Patients and Methods:

In this quasi-experimental, pretest-posttest interventional study, we employed each subject as his/her own control. The study was conducted at the dialysis units in three major general hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. A total of 90 HD patients were randomly allocated to two 45-patient groups of oral and video education programs, respectively. The educational programs included dietary and fluid regimens, the care of fistula and skin, and stress management. HRQOL was assessed in both groups using a Farsi version of the Short Form Health Survey (SF-36) before and after the educational programs. Repeated measures analysis of variance and ANOVA were used for data analysis through SPSS.

Results:

SF-36 domains of physical functioning (P < 0.021), role physical (P < 0.031), social functioning (P < 0.001) and mental health (P < 0.001) were significantly increased in both oral and vide education groups after the interventions. There was no difference in the effectiveness of the two educational programs.

Conclusions:

Appropriate interventions may potentially lead to improvement in the HRQOL of these patients. Therefore, video education as an effective, inexpensive, simple, and attractive method is recommended for HD patients.

Longitudinal tracking methods in a study of adult women sexual assault survivors

Standard methods of tracking participants longitudinally are discussed in the context of the experience of one research team studying the impact of sexual assault on victims over time. The researchers considered implementing standard tracking methods used in population-based studies to retain participants over time, but chose to adapt and modify such methods in an effort to build trust and rapport with sexual assault victims recruited from the community. Issues related to methodological decision making and implementation in longitudinal studies are discussed, including effects tracking methods might have on participants and the reality of studying and retaining participants from sensitive populations.

Longitudinal research with sexual assault survivors: a methodological review

Longitudinal research designs are relatively rare in the academic literature on rape and sexual assault despite their tremendous methodological rigor and scientific utility. In the interest of promoting wider use of such methods, we conducted a methodological review of projects that have used prospective longitudinal designs to study the occurrence of sexual victimization throughout the lifespan and/or the process of change during rape recovery (N = 32 projects). Five questions were examined: (a) What were the substantive foci of these longitudinal studies? (b) How were survivors recruited? (c) What participation rates were typical? (d) How long were participants followed over time and with what success rates? and (e) What incentives were used to increase participation? Most studies focused on postassault sequelae and recruited survivors from hospital emergency departments and other first-response help-seeking sites with highly variable participation rates. Retention rates were comparable across studies (approximately 70%).

Dietary and fluid compliance: an educational intervention for patients having haemodialysis

AIM

This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis.

BACKGROUND

Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake. Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective.

METHODS

Sixty-three patients having haemodialysis in three general hospitals in Tehran, Iran, were allocated into two groups at random for oral and/or video education. They were asked to give demographic and medical data. Bimonthly average values of serum potassium, sodium, calcium, phosphate, albumin, creatinine, uric acid, and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes. The data were collected in 2007.

FINDINGS

Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5% and 76.2% of patients in the oral and video teaching groups respectively. Statistically significant correlations were observed between demographic variables (age, educational level and occupation) and dietary and fluid compliances (P < 0.001). There was no difference between the effectiveness of two educational interventions.

CONCLUSION

Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral oedema.

Psychotherapies for trauma and substance abuse in women: review and policy implications

Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.

Longitudinal trajectories of cigarette smoking following rape

Although prior research has identified increases in cigarette smoking following trauma exposure, no studies have examined longitudinal trajectories of smoking following rape. The present investigation identified and characterized longitudinal (< 3 months, 3-6 months, and > 6 months post-assault) trajectories of smoking (N = 152) following a rape in a sample of 268 sexual assault victims participating in a forensic medical exam. Further, the authors examined acute predictors of subsequent smoking trajectories. Of participants endorsing smoking post-rape, a two-class solution was identified, with the majority of participants (74.6%) evidencing moderate smoking with a slight decrease over time and remaining participants showing heavy smoking with a slight increase over time. Having sustained an injury, minority status, and post-examination distress all predicted subsequent smoking trajectory.

Randomized study of the effect of video education on heart failure healthcare utilization, symptoms, and self-care behaviors

OBJECTIVE

Adherence to self-care behaviors improves heart failure (HF) morbidity and life quality. We examined short-term impact of video education (VE) in addition to standard education (SE) on HF healthcare utilization and self-care behavior adherence.

METHODS

One hundred and twelve hospitalized patients were randomly assigned to SE (n=53) or SE plus VE (n=59). Differences between groups were analyzed in patients who underwent 3-month follow-up (39 SE and 37 VE patients). Mean age was 60+/-14 years; mean HF length was 57 months.

RESULTS

Three-month healthcare utilization was similar between groups but VE patients needed less extra diuretic dosing (P<0.02), received more HF literature (P<0.03), and had less healthcare team telephone communication (P<0.04). VE patients had greater sign/symptom reduction (P<0.04); especially related to edema (P<0.01) and fatigue (P<0.01) and initiated more actions for edema (P<0.05) and dyspnea (with exercise or rest, both P<0.01). Overall, VE patients had a higher mean self-care behavior score (P<0.01), reflecting greater self-care adherence.

CONCLUSION

Video education prompts self-care behavior adherence to control worsening signs/symptoms of volume overload. During 3-month follow-up, utilization of most healthcare resources was unchanged.

PRACTICE IMPLICATIONS

VE is a useful adjunct to in-person education.

An acute post-sexual assault intervention to prevent drug abuse: updated findings

Sexual assault and rape routinely produce extreme distress and negative psychological reactions in victims. Further, past research suggests that victims are at increased risk of developing substance use or abuse post-rape. The post-rape forensic medical exam may itself exacerbate peritraumatic distress because it includes cues that may serve as reminders of the assault, thereby potentiating post-assault negative sequelae. To address these problems, a two-part video intervention was developed to take advantage of the existing sexual assault forensic exam infrastructure, and to specifically (a) minimize anxiety/discomfort during forensic examinations, thereby reducing risk of future emotional problems, and (b) prevent increased substance use and abuse following sexual assault. Updated findings with a sample of 268 sexual assault victims participating in the forensic medical exam and completing one or more follow-up assessments at: (1)<3 months post-assault; (2) 3 to 6 months post-assault; or (3) 6 months or longer post-assault indicated that the video was associated with significantly lower frequency of marijuana use at each time point, among women who reported use prior to the assault.

Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.

A critical analysis of approaches to targeted PTSD prevention: current status and theoretically derived future directions

Although efforts to prevent posttraumatic stress disorder (PTSD) have met with relatively limited success, theoretically driven preventive approaches with promising efficacy are emerging. The current article critically reviews investigations of PTSD prevention programs that target persons at risk for being exposed to a traumatic event or who have been exposed to a traumatic event. This review uniquely extends prior reviews in this area by using theories of PTSD to suggest future directions in the area of PTSD prevention. The authors first discuss the primary mechanisms of action believed to account for the failure for PTSD symptoms to remit among a substantial minority of traumatic event-exposed individuals. Second, empirical progress in PTSD prevention efforts is reviewed. Third, the authors consider how existing prevention programs target these mechanisms of action. Finally, the authors consider directions for future research in the area of targeted PTSD prevention.

Health care-based interventions for women who have experienced sexual violence: a review of the literature

Thirty publications that evaluated health care-based interventions for women who experienced sexual violence were reviewed. The findings highlight that clinicians often need training in the provision sexual assault care, and that not all emergency departments have sexual assault care protocols. Studies examining effectiveness found that Sexual Assault Nurse Examiner programs are very helpful, that health care-based sexual assault treatment settings attract more women than do forensic-based settings, that sexual assault survivors often prefer a combination of medication and counseling treatment, and that preexam administration of a video explaining the collection of forensic evidence may reduce women's stress during the procedure. Studies on postexposure HIV prophylaxis found that many women did not complete the treatment regimen, often because of side effects. Emergency contraception to prevent postrape pregnancy is not consistently offered to women. Only one study reported on abortion as part of the range of sexual assault services.

Internet-based intervention for mental health and substance use problems in disaster-affected populations: a pilot feasibility study

Early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost and as such are of particular interest. We describe the development and feasibility analysis of an Internet-delivered intervention designed to address mental health and substance-related reactions in disaster-affected populations. Participants (n = 285) were recruited from a cohort of New York City-area residents that had been followed longitudinally in epidemiological research initiated 6 months after the terrorist attacks of September 11, 2001. The intervention consisted of 7 modules: posttraumatic stress/panic, depression, generalized anxiety, alcohol use, marijuana use, drug use, and cigarette use. Feasibility data were promising and suggest the need for further evaluation.

Manifestations of enduring during interviews with sexual assault victims

The retelling of a sexual assault, whether during sexual assault care or law enforcement interviews, or in the process of seeking social support, is an emotionally stressful event, yet there is little research describing the psychological experiences of retelling. In a study of barriers to sexual assault care, 43 survivors recounted 76 assault events during individual interviews. Although assaults occurred from 1 to 15 years prior to the interview, participants demonstrated emotional upset. Using the praxis theory of suffering as a scaffold, the author describes manifestations of enduring and emotional suffering. The separation of enduring from emotional suffering indicates potential usefulness of the praxis theory of suffering in the provision of post-sexual assault care.

Preliminary evaluation of a video-based intervention for older adult victims of violence

The present study evaluated a brief, video-based intervention for older adults designed to: provide psychological education regarding common reactions to crime; offer information about healthy coping strategies to manage crime-related symptomatology; and increase awareness of effective safety planning strategies. Following reporting to police, 116 older adult crime victims were randomly assigned to receive either standard advocate-based services plus the video-based intervention or standard advocate services alone. Results indicated that older adult victims assigned to the video condition and assessed later that day exhibited greater awareness of crime-related symptoms, healthy coping strategies, and safety planning strategies than did the older adult victims assigned to standard practice of care. However, despite knowledge gains, and in contrast to our predictions, no differences on measures of anxiety or depression were evident between the treatment conditions at 6-week follow up.