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Kaul A, Connell-Jones L, Paphitis SA, Oram S. Prevalence and risk of sexual violence victimization among mental health service users: a systematic review and meta-analyses. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1285-1297. [PMID: 38570379 PMCID: PMC11291586 DOI: 10.1007/s00127-024-02656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE People with mental disorders are more likely to experience sexual violence than the general population, but little is known about the prevalence of sexual violence in people who use psychiatric services. This paper aims to estimate the prevalence and odds of sexual violence victimisation within mental health services by gender and mental health setting (i.e. inpatient, outpatient and mixed settings). METHODS This study is a systematic review and meta-analysis (PROSPERO registration number: CRD4201810019). Three databases (Medline, Embase, PsychINFO) were searched and citation tracking, and reference screening of included studies was conducted. Studies were included if the prevalence and/or risk of sexual violence in psychiatric service users were reported or calculable across the past year or adult lifetime. The methodological quality of included studies was assessed. A random effects meta-analyses was conducted to estimate odds ratios and pooled prevalence estimates of sexual violence in different mental health settings. RESULTS Twenty-six studies were included encompassing 197,194 participants. The meta-analyses revealed high pooled prevalence estimates and increased odds of sexual violence victimisation in male and female psychiatric service users compared to non-psychiatric service users. CONCLUSIONS Mental health practitioners should be trained to respond effectively to disclosures of sexual violence, particularly from these vulnerable groups. Future sexual violence interventions should consider mental health as a treatment outcome.
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Affiliation(s)
- Anjuli Kaul
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Laura Connell-Jones
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sharli Anne Paphitis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sian Oram
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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2
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Basile KC, Chen J, Friar NW, Smith SG, Leemis RW. Association of Contact Sexual Violence Victimization and Health in the U.S. Am J Prev Med 2024; 66:860-869. [PMID: 38331115 PMCID: PMC11182425 DOI: 10.1016/j.amepre.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Sexual violence victimization is related to negative impacts, including chronic health conditions. Less is known about possible confounders of this relationship. This study examines the association between lifetime experience of contact sexual violence (CSV) and health conditions by sex, controlling for demographics and other victimization. METHODS Data are from the 2016/2017 National Intimate Partner and Sexual Violence Survey, a nationally representative study of English- or Spanish-speaking adults. Ten health conditions (e.g., HIV/AIDS) and four activity limitations (e.g., difficulty dressing) were examined related to CSV victimization. Logistic regression models examined the association between CSV victimization and health controlling for demographics and other victimization experiences. Analyses were conducted in 2022 to 2023. RESULTS For women and men, many health conditions and activity limitations were significantly associated with CSV after controlling for demographics. Accounting for other victimization, female CSV victims had higher odds of experiencing difficulty sleeping (Adjusted Odds Ratio [AOR]=1.3); difficulty concentrating, remembering, or making decisions (AOR=1.7); and difficulty doing errands alone (AOR=1.4) than nonvictims. Male victims had higher odds than nonvictims of having HIV/AIDS (AOR=5.2); frequent headaches (AOR=1.5); chronic pain (AOR=1.5); difficulty sleeping (AOR=1.4); serious difficulty hearing (AOR=1.3); and difficulty concentrating, remembering, or making decisions (AOR=1.5). CONCLUSIONS CSV had a negative impact on health, although other types of victimization appear to also have an impact, especially for women. Demographic characteristics also aid the understanding of the relationship between CSV and health. Efforts to prevent CSV and other forms of violence can be coupled with healthcare- and population-level approaches to improve long-term health.
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Affiliation(s)
- Kathleen C Basile
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jieru Chen
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norah W Friar
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon G Smith
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth W Leemis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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3
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Kaur A, Brown MJ, James TA, Nkwonta CA, Hart MJ. Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study. AIDS Care 2024; 36:272-279. [PMID: 37139537 PMCID: PMC10622329 DOI: 10.1080/09540121.2023.2208323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.
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Affiliation(s)
- Amandeep Kaur
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208
| | - Monique J. Brown
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Titilayo A. James
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208
| | | | - Mackenzie J. Hart
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC
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Lathan EC, Selwyn CN, Gigler ME, Langhinrichsen-Rohling J, Gilmore AK. College Students' Trust, Betrayal, and Needs During and After Their Worst Nonassault-Related Healthcare Experiences Differ Based on Sexual Violence Exposure. VIOLENCE AND VICTIMS 2023; 38:858-878. [PMID: 37989528 DOI: 10.1891/vv-2022-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
The BITTEN theoretical framework conceptually links patient's past healthcare betrayal and trauma experiences with their current and future healthcare interactions. BITTEN was used to examine whether healthcare experiences, behaviors, and needs differ between those with and without a history of sexual violence exposure. College students at two public universities in the southeastern United States (n = 1,381; 59.5% White, 61.0% women) completed measures about their self-selected worst or most frightening but nonassault-related healthcare experience. Multivariate general linear and mediation models were used to test theory-derived hypotheses. Participants exposed to sexual violence reported greater healthcare institutional betrayal, lower trust, and greater need for tangible aid and trauma-informed care during their worst nonassault-related healthcare experience. They also reported greater current healthcare avoidance alongside increased utilization of more physical and mental healthcare appointments, even after accounting for gender and race differences. These results suggest that, with minimal information about past sexual violence exposure, healthcare providers could be better poised to predict and address vulnerable patients' healthcare needs.
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Affiliation(s)
- Emma C Lathan
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, AL, USA
| | - Margaret E Gigler
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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de Klerk HW, van der Pijl MSG, de Jonge A, Hollander MH, Verhoeven CJ, Montgomery E, Gitsels-van der Wal JT. (Non-)disclosure of lifetime sexual violence in maternity care: Disclosure rate, associated characteristics and reasons for non-disclosure. PLoS One 2023; 18:e0285776. [PMID: 37792790 PMCID: PMC10550179 DOI: 10.1371/journal.pone.0285776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND In maternity care, disclosure of a past sexual violence (SV) experience can be helpful to clients to discuss specific intimate care needs. Little evidence is available about the disclosure rates of SV within maternity care and reasons for non-disclosure. AIM The aim of this study was to examine (1) the disclosure rate of SV in maternity care, (2) characteristics associated with disclosure of SV and (3) reasons for non-disclosure. METHODS We conducted a descriptive mixed method study in the Netherlands. Data was collected through a cross-sectional online questionnaire with both multiple choice and open-ended items. We performed binary logistic regression analysis for quantitative data and a reflexive thematic analysis for qualitative data. RESULTS In our sample of 1,120 respondents who reported SV, 51.9% had disclosed this to a maternity care provider. Respondents were less likely to disclose when they received obstetrician-led care for high-risk pregnancy (vs midwife-led care for low-risk pregnancy) and when they had a Surinamese or Antillean ethnic background (vs ethnic Dutch background). Reasons for non-disclosure of SV were captured in three themes: 'My SV narrative has its place outside of my pregnancy', 'I will keep my SV narrative safe inside myself', and 'my caregiver needs to create the right environment for my SV narrative to be told'. CONCLUSIONS The high level of SV disclosure is likely due to the Dutch universal screening policy. However, some respondents did not disclose because of unsafe care conditions such as the presence of a third person and concerns about confidentiality. We also found that many respondents made a positive autonomous choice for non-disclosure of SV. Disclosure should therefore not be a goal in itself, but caregivers should facilitate an inviting environment where clients feel safe to disclose an SV experience if they feel it is relevant for them.
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Affiliation(s)
- Hannah W. de Klerk
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marit S. G. van der Pijl
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine H. Hollander
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corine J. Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Elsa Montgomery
- Florence Nightingale Faculty of Nursing, Division of Methodologies, Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Janneke T. Gitsels-van der Wal
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Caswell RJ, Ross JDC, Maidment I, Bradbury-Jones C. Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2661-2679. [PMID: 35762535 DOI: 10.1177/15248380221111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
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Caswell RJ, Hodson J, Bradbury-Jones C, Ross JDC. Where do those experiencing sexual violence seek help and is routine enquiry acceptable within a sexual healthcare setting? Findings from a population-based survey. BMJ Open 2023; 13:e073204. [PMID: 37673457 PMCID: PMC10496700 DOI: 10.1136/bmjopen-2023-073204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES Most sexual violence (SV) remains undisclosed to healthcare professionals. The aims of this study were to identify where support would be sought after SV and whether routine enquiry about SV was acceptable in a sexual healthcare setting. DESIGN An online population-based survey collected data on a history of SV and preferences on support after SV, in addition to sociodemographic data. Respondents' views on being routinely asked about SV were sought. SETTING AND PARTICIPANTS This online survey was based in England, UK. There were 2007 respondents. RESULTS The police were the most frequent first choice for support after experiencing SV (n=520; 25.9%); however, this was less common in individuals in younger age groups (p<0.001) and in those with a history of SV (17.2% vs 29.9%, p<0.001). For the 27.1% (532 of 1960) of respondents who reported a history of SV, the first choice of place for support was Rape Crisis or similar third-sector organisation. The majority of respondents supported routine enquiry about SV during Sexual and Reproductive Health Service (SRHS) consultations (84.4%), although acceptability was significantly lower in older age groups. CONCLUSIONS AND STUDY IMPLICATIONS A greater awareness of the influence of sociodemographic factors, including ethnicity, age, gender, disability and a history of SV, when planning and delivering services for those who have experienced SV is needed. A history of SV is common in the general population, and a 'one-size-fits-all' approach to encourage disclosure and access to support is unlikely to be optimal. Routine enquiry about SV is highly acceptable in an SRHS setting and likely to improve disclosure when appropriately implemented.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
| | - James Hodson
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Linnemørken LTB, Stangeland H, Reme SE, Stensland SØ. Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: a mixed-methods study. Pain Rep 2023; 8:e1072. [PMID: 37114243 PMCID: PMC10129107 DOI: 10.1097/pr9.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach. Objectives We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment. Methods The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to "other events," were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to "other events" were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants. Results The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of "other events" were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed. Conclusion The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.
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Affiliation(s)
- Lene Therese Bergerud Linnemørken
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division for Health Services, Department of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Corresponding author. Address: Division of Emergencies and Critical Care, Department of Research and Development, Building 18, Oslo University Hospital, POB 4956 Nydalen, 0424 Oslo, Norway. Tel.: +4747313851. E-mail address: (L.T.B. Linnemørken)
| | - Helle Stangeland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
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Differences in Sexual and Physical Abuse History by Presenting Chief Complaint in an Outpatient Urogynecology Population. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:344-350. [PMID: 36808928 DOI: 10.1097/spv.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
IMPORTANCE One in 3 women experience sexual or physical violence in their lifetimes. Health consequences for survivors are numerous, including urogynecologic symptoms. OBJECTIVES We aimed to determine prevalence and factors that predict a history of sexual or physical abuse (SA/PA) in outpatient urogynecology, specifically whether the chief complaint (CC) predicts a history of SA/PA. STUDY DESIGN This cross-sectional study analyzed 1,000 newly presenting patients to 1 of 7 urogynecology offices in western Pennsylvania from November 2014 to November 2015. All sociodemographic/medical data were retrospectively abstracted. Univariable and multivariable logistic regression analyzed risk factors based on known associated variables. RESULTS One thousand new patients had a mean age of 58.4 ± 15.8 years with a body mass index (BMI) of 28.8 ± 6.5. Nearly 12% reported a history of SA/PA. Patients with CC of pelvic pain were more than twice as likely to report abuse compared with all other CCs (odds ratio [OR], 2.690; 95% confidence interval [CI], 1.576-4.592). Prolapse was the most common CC (36.2%) but had the lowest prevalence of abuse (6.1%). Nocturia was an additional urogynecologic variable predictive of abuse (OR, 1.162 per nightly episode; 95% CI, 1.033-1.308). Increasing BMI and decreasing age both increased the risk of SA/PA. Smoking conferred the highest likelihood of abuse history (OR, 3.676; 95% CI, 2.252-5.988). CONCLUSIONS Although those with a CC of prolapse were less likely to report abuse history, we recommend routine screening for all women. Pelvic pain was the most common CC among women reporting abuse. Special efforts should be made to screen those at higher risk with complaints of pelvic pain who are younger, smokers, with higher BMI, and with increased nocturia.
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10
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LoGiudice JA, Tillman S, Sarguru SS. A Midwifery Perspective on Trauma-Informed Care Clinical Recommendations. J Midwifery Womens Health 2023; 68:165-169. [PMID: 36658770 DOI: 10.1111/jmwh.13462] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Jenna A LoGiudice
- Fairfield University, Egan School of Nursing and Health Studies, Fairfield, Connecticut
| | - Stephanie Tillman
- Saint Louis University, Albert Gnaegi Center for Health Care Ethics, St. Louis, Missouri, United States
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11
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Chhetri S, Gonzalez-Pons K, Andrews A, Carlson E, Grace J, Thompson EL, Spence EE. The Body in Crisis: A Health Needs Assessment among Female Survivors of Interpersonal Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1970-NP1989. [PMID: 35533375 DOI: 10.1177/08862605221098393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND When women who experience violence seek social services, they are looking to meet immediate needs: shelter, safety, and support. Seeking assistance as part of a crisis may inadvertently detract attention away from other critical needs. Literature illustrates the emotional and physical effects of violence on women's bodies, as well as their long-term health. While health may present as an urgent need in cases of serious injury, it is often overlooked in crisis-oriented service delivery systems. This study explored the experience with violence, health status, and holistic healthcare needs among women accessing interpersonal violence services in Texas. METHODS A tablet-based survey was conducted at a family justice center, rape crisis center, and emergency shelter among women (N = 99) in Fort Worth, Texas. Survey questions assessed the participants' demographic information, health status, health needs, healthcare utilization, barriers to accessing healthcare, and experience with interpersonal violence among participating women. RESULTS Two-thirds of the sample reported suffering injuries from victimization experiences. More than half of the sample (62%) reported they went to the emergency room at least one time in the last 6 months, with 11 women reported staying five or more nights in the hospital in the last 6 months. Participants described urgent (e.g., advised by healthcare provider, too serious for a clinic) and non-urgent (e.g., not having another source of care, closest provider) reasons for using the emergency room. Roughly, half of the sample (50%) reported having at least three chronic conditions. DISCUSSION This study illustrated that women seeking interpersonal violence related (IPV) services have multiple unmet needs and lack adequate access to physical and mental health care. Since the majority of the sample was living in poverty, there are multiple costs and investments in the participants' health that were forgone for their survival. This study provides data in support of the development of health-related services for IPV survivors.
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Affiliation(s)
- Shlesma Chhetri
- 12376University of North Texas Health Science Center, Fort Worth, Texas, USA
| | | | - Alita Andrews
- 12329University of Texas at Arlington, Arlington, TX, USA
| | - Erin Carlson
- 12329University of Texas at Arlington, Arlington, TX, USA
| | - Jessica Grace
- 12376University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erika L Thompson
- 12376University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Emily E Spence
- 12376University of North Texas Health Science Center, Fort Worth, Texas, USA
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12
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Marshall D, Green S, Jones BM, Starrs C, Montgomery GH, Minassian K, Wunder B, Force J, Schnur JB. Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer. J Am Coll Radiol 2022; 19:1236-1243. [PMID: 36126825 PMCID: PMC10354668 DOI: 10.1016/j.jacr.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.
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Affiliation(s)
- Deborah Marshall
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York.
| | - Sheryl Green
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Medical Director, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Brianna M Jones
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Clodagh Starrs
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Guy H Montgomery
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin Minassian
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Bruce Wunder
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - James Force
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie B Schnur
- Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Co-Director of the Integrative Behavioral Medicine Program, Icahn School of Medicine at Mount Sinai, New York, New York
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Geba M, Powers S, Williams B, Dort KR, Rogawski McQuade ET, McManus KA. A Missed Opportunity: Extragenital Screening for Gonorrhea and Chlamydia Sexually Transmitted Infections in People with HIV in a Southeastern Ryan White HIV/AIDS Program Clinic Setting. Open Forum Infect Dis 2022; 9:ofac322. [PMID: 35899288 PMCID: PMC9310267 DOI: 10.1093/ofid/ofac322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, (4) the percentage of extragenital STIs that would have been missed without multisite screening.
Methods
Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men.
Results
In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). 68% (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site.
Conclusions
Screening rates were similar across all anatomical sites indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs prior to implementation of multisite screening.
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Affiliation(s)
- Maria Geba
- Department of Medicine, University of Virginia , Charlottesville, VA , USA
| | - Samuel Powers
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Brooke Williams
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Kathryn R Dort
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
| | - Elizabeth T Rogawski McQuade
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
- Public Health Sciences, University of Virginia , Charlottesville, VA , USA
| | - Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia , Charlottesville, VA , USA
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Yesodharan R, Shehata SA, Jose TT, Hagras AM, Nayak V. Medico-legal history taking from the victims of sexual assaults: the role of nurse examiners. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sexual assault examiners provides comprehensive health care to victims of sexual assault. Communication with the victim is important to collect relevant information from the victims. Ineffective communications can cause re-victimization and hamper the medico-legal evidence collection.
Main text
This article aims to orient the novice examiner and nurses to the prerequisites of medico-legal history collection, techniques of building trust, establishing rapport, ensuring privacy and confidentiality, taking consent, communicating effectively with the victims of sexual assault, and components of medico-legal history collection.
Conclusions
Novice examiners and nurses need to be trained in collecting medico-legal history and evidence. The examiners who conduct the examination should be dedicated to delivering compassionate and high-quality care to individuals who have disclosed sexual assault.
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Selwyn CN, Lathan EC, Richie F, Gigler ME, Langhinrichsen-Rohling J. Bitten by the System that Cared for them: Towards a Trauma-Informed Understanding of Patients' Healthcare Engagement. J Trauma Dissociation 2021; 22:636-652. [PMID: 33446088 DOI: 10.1080/15299732.2020.1869657] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The BITTEN theoretical framework of trauma-informed healthcare proposes that each patient presents to a healthcare encounter with a baseline level of historical institutional Betrayal and trauma exposure that interacts with their Indicator for healthcare engagement to potentially Trigger trauma symptoms, impacting patients' Trust in healthcare providers and shaping their current and future Expectations of and Needs for healthcare. The current study sought to test and extend components of the BITTEN theoretical framework to better understand the link between trauma exposure (childhood trauma and institutional betrayal) and healthcare engagement. Results largely supported the propositions of the BITTEN theoretical framework: childhood trauma was directly related to healthcare avoidance behaviors. The relation between childhood trauma and healthcare avoidance was partially mediated by patients' reduced trust in healthcare providers. Further, the relation between childhood trauma and reduced trust in healthcare providers was potentiated by experiences of institutional betrayal. Interpreting patients' interactions with healthcare providers and the healthcare system as a whole in light of their interpersonal and institutional trauma histories is needed to more fully embody trauma-informed healthcare. The BITTEN theoretical framework of trauma-informed healthcare appears to be a viable foundation for developing a trauma-informed understanding of patients' healthcare engagement.
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Affiliation(s)
- Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, USA
| | - Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, USA
| | - Fallon Richie
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - Margaret E Gigler
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, USA
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16
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Selwyn CN, Lathan E. Helping Primary Care Patients Heal Holistically via Trauma-Informed Care. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Palmieri J, Valentine JL. Using Trauma-Informed Care to Address Sexual Assault and Intimate Partner Violence in Primary Care. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Day S, Singh GJ, Jones S, Kinsella R. Sexual assault reporting amongst users of online sexual health services. Int J STD AIDS 2020; 32:280-285. [DOI: 10.1177/0956462420963940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.
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Affiliation(s)
- Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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19
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Kissos L, Goldner L, Butman M, Eliyahu N, Lev-Wiesel R. Can artificial intelligence achieve human-level performance? A pilot study of childhood sexual abuse detection in self-figure drawings. CHILD ABUSE & NEGLECT 2020; 109:104755. [PMID: 33075702 DOI: 10.1016/j.chiabu.2020.104755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide phenomenon that has negative long-term consequences for the victims and their families, and inflicts a considerable economic toll on society. One of the main difficulties in treating CSA is victims' reluctance to disclose their abuse, and the failure of professionals to detect it when there is no forensic evidence (Bottoms et al., 2014; McElvaney, 2013). Estimated disclosure rates for child sexual abuse based on retrospective adult reports range from 23 % to 45 % (e.g., Bottoms et al., 2014). This study reports the four stages in the development of a Convolutional Neural Network (CNN) system designed to detect abuse in self-figure drawings: (1) A preliminary study to build a Gender CNN; (2) Expert-level performance evaluation, (3) validation of the CSA CNN, (4) testing of the CSA CNN model. The findings indicate that the Gender CNN achieved 88 % detection accuracy and outperformed the CSA CNN by 19 percentage points. The CSA CNN achieved 72 % accuracy on the test set with 80 % precision and 79 % recall for the abuse class prediction. However, human experts outperformed the CSA CNN by 16 percentage points, probably due to the complexity of the task. These preliminary results suggest that CNN, when further developed, can contribute to the detection of child sexual abuse.
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Affiliation(s)
- Limor Kissos
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Israel
| | - Limor Goldner
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Israel
| | | | | | - Rachel Lev-Wiesel
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Israel; ANIMA-EY LTD, Rishon Lezion, Israel.
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20
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Caswell RJ, Maidment I, Ross JDC, Bradbury-Jones C. How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review. BMJ Open 2020; 10:e037599. [PMID: 32554729 PMCID: PMC7304828 DOI: 10.1136/bmjopen-2020-037599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services. METHODS AND ANALYSIS To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories. DATA ANALYSIS A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field. ETHICS AND DISSEMINATION This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies. PROSPERO REGISTRATION DETAILS CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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21
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Maunder RG, Hunter JJ, Tannenbaum DW, Le TL, Lay C. Physicians' knowledge and practices regarding screening adult patients for adverse childhood experiences: a survey. BMC Health Serv Res 2020; 20:314. [PMID: 32293444 PMCID: PMC7158053 DOI: 10.1186/s12913-020-05124-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/18/2020] [Indexed: 12/27/2022] Open
Abstract
Background Adverse Childhood Experiences (ACEs) are common and associated with many illnesses. Most physicians do not routinely screen for ACEs. We aimed to determine if screening is related to knowledge or medical specialty, and to assess perceived barriers. Methods Physicians in Ontario, Canada completed an online survey in 2018–2019. Data were analyzed in 2019. Results Participants were 89 family physicians, 46 psychiatrists and 48 other specialists. Participants screened for ACEs “never or not usually” (N = 58, 31.7%), “when indicated” (N = 67, 36.6%), “routinely” (N = 50, 27.3%) or “other” (N = 5, 2.7%). Screening was strongly associated with specialty (Chi2 = 181.0, p < .001). The modal responses were: family physicians - “when indicated” (66.3%), psychiatrists - “routinely” (91.3%), and other specialists - “never or not usually” (77.1%). Screening was not related to knowledge of prevalence of ACEs, or of the link between ACEs and mental health, but was significantly associated with knowing that ACEs are associated with physical health. Knowing that ACEs are linked to stroke, ischemic heart disease, COPD, and diabetes predicted greater screening (Chi2 15.0–17.7, each p ≤ .001). The most prevalent perceived barriers to screening were lack of mental health resources (59.0%), lack of time (59.0%), concern about causing distress (49.7%) and lack of confidence (43.7%). Conclusions Enhancing knowledge about ACEs’ negative influence on physical illness may increase screening. Efforts to promote screening should address concerns that screening is time-consuming and will increase referrals to mental health resources. Education should focus on increasing confidence with screening and with managing patient distress.
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Affiliation(s)
- Robert G Maunder
- Department of Psychiatry, Sinai Health System and University of Toronto, Room 915, Mount Sinai Hospital, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Jonathan J Hunter
- Department of Psychiatry, Sinai Health System and University of Toronto, Room 915, Mount Sinai Hospital, 600 University Ave, Toronto, ON, M5G 1X5, Canada
| | - David W Tannenbaum
- Department of Family Medicine, Sinai Health System and University of Toronto, Toronto, Canada
| | - Thao Lan Le
- Department of Psychiatry, Sinai Health System and University of Toronto, Room 915, Mount Sinai Hospital, 600 University Ave, Toronto, ON, M5G 1X5, Canada
| | - Christine Lay
- Department of Medicine, Women's College Hospital and University of Toronto, Toronto, Canada
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23
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Combellick JL, Dziura J, Portnoy GA, Mattocks KM, Brandt CA, Haskell SG. Trauma and Sexual Risk: Do Men and Women Veterans Differ? Womens Health Issues 2019; 29 Suppl 1:S74-S82. [PMID: 31253246 DOI: 10.1016/j.whi.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Trauma has been associated with risky sexual behavior in diverse populations. However, little is known about this association among men and women veterans. This study hypothesized that 1) a history of trauma would be associated with risky sexual behavior among men and women veterans, 2) interpersonal trauma would predict risky sexual behavior among women, whereas noninterpersonal trauma would predict risky sexual behavior among men, and 3) military-related trauma would constitute additional risk. Using data from 567 women and 524 men veterans enrolled at the Veterans Health Administration, this study investigated the association between trauma-related experiences and risky sexual behavior in the last 12 months. Risk and protective factors that have been frequently associated with sexual behavior in previous research were also included in the model. METHODS This study was drawn from the Women Veterans Cohort Study, a national survey of veterans. Bivariate and multivariate analyses were performed after multiple imputation for missing data. RESULTS Predictive factors associated with risky sexual behavior differed between men and women veterans. Among women, childhood sexual victimization and intimate partner violence were associated with risky sexual behavior. Among men, binge drinking was the single significant risk factor. Military exposures were not significantly associated with risky sexual behavior in either men or women. CONCLUSIONS This study lays the groundwork for theory-generating research into the psychological underpinnings of noted associations and underscores the importance of integrated health services to address the range of issues affecting sexual behavior and related health outcomes.
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Affiliation(s)
- Joan L Combellick
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Midwifery, Yale School of Nursing, Orange, Connecticut.
| | - James Dziura
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Northampton, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Collecting sexual assault history and forensic evidence from adult women in the emergency department: a retrospective study. BMC Health Serv Res 2018; 18:383. [PMID: 29843707 PMCID: PMC5975504 DOI: 10.1186/s12913-018-3205-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this retrospective study was to examine the discrepancy between information derived from written medical reports and the results of forensic DNA analyses on swabs collected from the victims in 122 cases of alleged sexual assault treated at the Emergency Department of Padua Hospital. The examination of discrepant results has proved useful to support a broader application of sexual assault management, particularly during the taking of case history. METHODS The Laboratory of Forensic Genetics of Padua University have processed samples from 122 sexual assault cases over a period of 5 years. RESULTS Of the 103 cases in which the victim reported a penetration and ejaculation, only 67 (55% of all the samples) correlated with positive feedback match from the laboratory. In 36 cases in which the patient reported penetration with ejaculation, no male DNA was found in the samples collected. Therefore, there was a total of 41 cases in which the patient's report were not supported by laboratory data. In the remaining ten cases, which had an ambiguous history, 3 tested positively for the presence of male DNA. CONCLUSIONS To avoid discrepancies between the medical reporting and reconstruction of sex crimes, it is crucial to deploy strategies which focus not only on the technical aspects of evidence collection, but also on how the victim's story is recorded; such efforts could lead to better management of sexual assault victims, and to a strengthened legal impact of forensic evidence and of crime reconstruction.
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Amin P, Buranosky R, Chang JC. Physicians' Perceived Roles, as Well as Barriers, Toward Caring for Women Sex Assault Survivors. Womens Health Issues 2016; 27:43-49. [PMID: 27863981 DOI: 10.1016/j.whi.2016.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual assault (SA) affects about 40% of women in the United States and has many mental and physical health sequelae. Physicians often do not address SA with patients, although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care. METHODS We performed a qualitative study using semistructured one-on-one interviews with 16 faculty physicians from five specialties: obstetrics and gynecology (n = 4), internal medicine (n = 4), family medicine (n = 1), emergency medicine (n = 3), and psychiatry (n = 4). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors. RESULTS Physicians described two main categories of roles: clinical tasks (e.g., testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g., providing support, acting as patient advocate). Physician barriers fell into three main categories: 1) internal barriers (e.g., discomfort with the topic of SA), 2) physician-patient communication, and 3) system obstacles (e.g., competing priorities for time). CONCLUSIONS Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors.
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Affiliation(s)
- Priyanka Amin
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Raquel Buranosky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Magee-Womens Research Institute, Pittsburgh, Pennsylvania; Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Snyder BL. Women's experience of being interviewed about abuse: a qualitative systematic review. J Psychiatr Ment Health Nurs 2016; 23:605-613. [PMID: 27860081 DOI: 10.1111/jpm.12353] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: There is disagreement about the costs and benefits of asking women about their abuse experiences in practice and research settings. No known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: This review adds robust qualitative evidence that interviewing women about their abuse experiences can be a beneficial and healing experience for them. Mental health nurses are in an ideal position to create a therapeutic environment to interview women about their abuse experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are strongly encouraged to ask about and document abuse in all of their interviews and assessments, as well as act as advocates and discuss reported abuse within their interdisciplinary teams, to provide individualized, trauma-informed care. The mental health nurse should listen attentively, avoid judgement, offer reassurance, make appropriate referrals and provide resources for women, including those with both past and current abuse histories. Nurses are strongly encouraged to ask about abuse in all settings in which they encounter women, including in psychiatric and mental health settings. ABSTRACT Introduction Collections of quantitative data exist outlining the costs and benefits of asking female research participants about their abuse experiences; however, no known meta-syntheses have been conducted to evaluate the qualitative data that exist on the experiences of women being asked about their abuse. Aim/Question The purpose of this qualitative systematic review was to analyse and interpret qualitative findings regarding asking women about their abuse experiences with the intention of understanding risks and benefits. Method The sample (N = 11) was derived from an expansive search of peer-reviewed literature using multidisciplinary electronic databases. Qualitative findings were extracted, coded and categorized. Reflective memos were developed, and themes emerged. Results While initially distressing, being interviewed about abuse is more beneficial than harmful for women, due to the therapeutic process of talking about abuse. Discussion To maximize the therapeutic impact of discussing abuse, women must maintain autonomy and feel they are in a safe and confidential environment. Within this supportive atmosphere, very few women report any regret after discussing abuse and are able to identify positive outcomes. Implications for practice Findings from this review support the need for mental health nurses and other clinicians to create an optimal environment for discussing abuse and offer relevant practice recommendations. Researchers are encouraged to include women in studies that involve asking about abuse experiences.
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Affiliation(s)
- B L Snyder
- The University of Missouri - Columbia, Sinclair School of Nursing, Columbia, MO, USA
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