Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study

"There Is No One Way to Get Over It": An Examination of Psychotherapy and Complementary Therapy Use Within a Sample of Survivors Who Experienced Sexual Violence

Literature on sexual violence survivors' service utilization is limited due to examination of singular therapies or narrow timeframes. Using surveys (n = 303) and interviews (n = 20), this study increases understanding of survivors' healing. Results show varied therapy use including psychotherapy (76.9%), yoga (50.2%), and massage (32.1%), among others. Mean number of therapies used was over three. Service utilization was delayed over a decade on average. Latent class analysis divided respondents into classes: psychotherapy and bodywork use (42.66%), high therapy use (9.14%), and minimal therapy use (48.20%). Interviews provide additional insight and describe barriers. Recommendations for policy, practice, and future research are discussed.

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.

Evaluation of the relationship between the detectability of seminal stains on laundered fabric and stain age

In some cases of sexual assault that are not reported to judicial authorities within a certain time, it is important to detect and identify seminal stains on laundered fabrics. In this study, we aimed to reveal the effect of the time from staining to laundering on the detectability and identification of seminal stains on laundered clothes. A total of 180 pieces of fabric (four different colours and five different types) were stained with seminal fluids, and three different lag times (12 hours, 1 week and 1 month) from staining to laundering were used. Three different laundering protocols were applied to these fabrics after staining. The built-in camera of the Mobile Multispectral UV-VIS-IR Imaging System® was used to take photos (1260 in total) of the stains with seven different wavelength and filter options, and the obtained images were evaluated. The Seratec® PSA Semiquant test was used to analyse the presence of prostate-specific antigen (PSA) in the seminal stains laundered after different lag times. We observed that in examining with the forensic light source (FLS) system, the time from staining to laundering affected the detectability of seminal stains on pieces of cloth. The best fluorescence was obtained in the examination of semen-stained fabric with FLS, particularly when the fabric was not laundered for one month after staining. On the other hand, the time from staining to laundering had a more limited effect on PSA test positivity than on the results of the examination with FLS.

Emotion Dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure

Despite growing evidence in support of emotion dysregulation as a risk factor for the development of posttraumatic stress disorder (PTSD) following trauma exposure, few studies have examined temporal relations between emotion dysregulation and the onset and/or worsening of PTSD symptoms over time. The aim of the present study was to extend research on temporal associations between emotion dysregulation and PTSD in a sample of individuals recruited from hospital emergency departments soon after a traumatic event. Adult participants (N = 85; 62.4% female) completed self-report measures of emotion dysregulation and PTSD symptoms within 2 weeks of experiencing a traumatic event. Symptoms of PTSD were assessed approximately 3 months posttrauma. The results of a hierarchical linear regression analysis demonstrated that the inclusion of emotion dysregulation accounted for a significant amount of unique variance, β = .23, ΔR2 = .04, p = .042, in 3-month PTSD symptom severity over and above other risk factors and baseline PTSD symptoms. No specific facet of emotion dysregulation emerged as a significant predictor of 3-month PTSD symptoms when all facets were included on the same step of the model, βs = -.04-.33, ps = .133-.954. These results demonstrate that posttraumatic emotion dysregulation may predict PTSD symptoms 3 months after trauma exposure. These findings are consistent with a growing body of literature that speaks to the relevance of emotional processes to the onset and maintenance of PTSD following exposure to a traumatic event.

Informing Human Trafficking Clinical Care Through Two Systematic Reviews on Sexual Assault and Intimate Partner Violence

BACKGROUND

There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV).

METHOD

We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect.

RESULTS

Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy.

CONCLUSIONS

Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors.

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.

Evaluating the persistence of laundered semen stains on fabric using a forensic light source system, prostate-specific antigen Semiquant test and DNA recovery-profiling

Semen stains on the clothes of victims of sexual assault can remain as evidence even after garments have been laundered. In this study, we aimed to investigate the effectiveness of commonly preferred methods to detect semen stains in two different fabric types that were laundered with different washing machine programmes and washing powders, and to obtain a DNA profile from the semen stains. For this purpose, a comprehensive study was performed on semen-stained underwear using three different methods for stain detection, confirmation and identification: a forensic light source (FLS) system, the prostate-specific antigen (PSA) test and DNA recovery profiling. With FLS applications, stronger fluorescence was achieved in wash protocols performed at a low temperature (30°C) on semen-stained cotton underwear. DNA recovery between 13.45 and 55.00 ng/µl was obtained by modifications in the DNA extraction step when the effect of temperature and washing powder on DNA recovery was evaluated, and these were enough for short tandem repeat (STR) typing in all samples. This study shows that when semen-stained underwear is washed after a month, some semen stains can be determined by FLS and PSA, and all stains can be identified by STR analyses.

Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault

Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.

Interventions to support recovery after domestic and sexual violence in primary care

Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013-2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother-child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother-child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.

The recovery of semen from bathwater using the Evidence Recovery System (ERS)

Sexual offences are under-reported and ascertaining accurate offence numbers is difficult. Any methods which could increase the ability to obtain biological evidence or reduce the additional distress associated with reporting a sexual offence may result in an increase in reporting this crime type. The Evidence Recovery System (ERS) is designed to collect trace evidence, including hairs, fibres and biological evidence, from bath or shower water in a non-invasive manner. Initially, samples of semen were placed in baths filled with water, and washing was simulated using a range of body wash products. The water was then drained through the ERS before its filters were subjected to acid phosphatase testing and haematoxylin and eosin staining of spermatozoa. Recovered spermatozoa were then graded accordingly. Following this, the experiment was repeated with the addition of dirt/dust particulates during the washing stage, to simulate recovery of biological evidence in a more realistic environment. The results showed that spermatozoa considered 'easy to find' could regularly be obtained from bathwater using the ERS. It appeared that this recovery was not affected by the presence of different body wash products. When dust/dirt particles were added, the number of spermatozoa recovered increased at two of the evidence collection stages. The difference in recovery was considered to be statistically significant. This study provides evidence to suggest the feasibility of use of the ERS as a method to collect semen evidence from individuals subjected to sexual offences. The recovery of spermatozoa does not appear to be affected by the presence of a body wash, but does appear to be improved when skin cells, hair and other debris are transferred into the water, as would be likely during a bath/shower. Further to this, the possibility of obtaining spermatozoa from the home bath or shower of a victim following a post-offence bathing experience is implied.

Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time

BACKGROUND

Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression.

METHODS

Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of the three follow-ups.

RESULTS

Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol.

CONCLUSIONS

Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a 6-month follow-up.

Early interventions for PTSD: a review

The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic.

Randomized controlled trial of an internet-based intervention using random-digit-dial recruitment: the Disaster Recovery Web project

Disasters occur with high frequency throughout the world and increase risk for development of mental health problems in affected populations. Research focused on the development and evaluation of secondary prevention interventions addressing post-disaster mental health has high potential public-health impact. Toward this end, internet-based interventions (IBIs) are particularly attractive in that they: (1) offer a low-cost means of delivering standardized, targeted, personalized intervention content to a broad audience; and (2) are easily integrated within a stepped care approach to screening and service delivery. We describe a unique study design intended to evaluate an IBI with a disaster-affected population-based sample. Description and rationale are provided for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this intervention include the use of a population-based sample, telephone and internet-based assessments, and development of a highly individualized web-based intervention. Challenges related to the development and large-scale evaluation of IBIs targeting post-disaster mental health problems, as well as implications for future research and practice are discussed.

Prevention of anxiety disorders

Research into the prevention of anxiety has increased dramatically in the past few years. Prevention programs have been directed at broad, nonspecific anxiety and at more specific anxiety types, such as panic disorder and post-traumatic stress disorder. Prevention of anxiety is still a relatively new field, but there has been a recent surge of literature reporting on different prevention programs. Universal prevention trials have shown modest but promising results, and school-based programs offered to all students also help to reduce stigmatization and common barriers to accessing treatment (eg, time, location, and cost). In contrast, targeted programs tend to show somewhat larger effects but rely on identification of relevant populations. Specific programs for the prevention of panic disorder and post-traumatic stress disorder have also demonstrated some preliminary success. This paper reviews the recent studies of prevention of anxiety and discusses several key issues, specifically (1) identification of at-risk participants for prevention programs, (2) motivation for participation, (3) optimal age for intervention, and (4) who should deliver the program.

Domestic violence and sexual assault agency directors' perspectives on services that help survivors

Community-based domestic violence and sexual assault service providers need sound knowledge regarding services that work well to improve the lives of survivors. This exploratory, qualitative research aimed to help provide such knowledge by investigating domestic violence and sexual assault agency executive directors' ( n = 14) opinions regarding what services are most helpful for survivors. In-depth interviews with directors provided findings about (a) critical services for survivors; (b) essential service delivery practices; (c) ideal services that are challenging to deliver because of funding and other barriers; and (d) areas of service delivery practice uncertainty due to a lack of best practices.

Outreach, engagement, and practical assistance: essential aspects of PTSD care for urban victims of violent crime

The purpose of this article is to examine the literature on the increased risk factors of disadvantaged inner-city residents for becoming victims of violence and for developing posttraumatic stress disorder (PTSD) and barriers to accessing comprehensive mental health services. Second, the article discusses the limitations of evidence-based treatments for early intervention with urban victims of violence and provides a new model of care emphasizing outreach, engagement, and practical assistance. Finally, the article concludes with recommendations for comprehensive hospital-based urban programs in terms of practice, policy, and research.

Cognitive-behavioral psychology: implications for disaster and terrorism response

Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The purpose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitive-behavioral perspectives and intervention methods can enhance the effectiveness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individuals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cognitive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral therapy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response.

Longitudinal determinants of posttraumatic stress in a population-based cohort study

BACKGROUND

Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited.

METHODS

We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models.

RESULTS

Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]).

CONCLUSIONS

These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.

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.

Characteristics and psychosocial needs of victims of violent crime identified at a public-sector hospital: data from a large clinical trial

OBJECTIVE

This study explores the feasibility of recruiting acutely injured public-sector crime victims into a research protocol and identifies baseline characteristics associated with posttraumatic distress in the enrolled sample (N=541).

METHOD

Assertive research tracking methods were used to enroll participants, who completed baseline interviews. Descriptive statistics were used to define characteristics of the sample and prevalence of psychosocial problems and posttraumatic distress. Multiple regression analysis was performed to identify predictors of posttraumatic distress.

RESULTS

A high percentage (78%) of eligible victims completed baseline interviews within 1 month of victimization. The sample was largely male, ethnic minority, unemployed and living below the poverty level. Trauma symptoms were highly prevalent, with three quarters having significant posttraumatic distress. Female gender, preexisting psychiatric disorder, trauma history, case management needs and employment status were predictive of greater symptomatology. Stabbing victims had lower distress.

CONCLUSIONS

Comprehensive mental health and case management services that proactively engage disadvantaged victims are needed to meet the complex problems of this population.

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.

PTSD and depression after the Madrid March 11 train bombings

The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.

An evaluation of three brief programs for facilitating recovery after assault

Ninety female recent assault survivors who met symptom criteria for posttraumatic stress disorder (PTSD) were randomized to one of three interventions: Brief Cognitive Behavioral Intervention, which focused on processing the traumatic event (B-CBT); assessment condition (AC); or supportive counseling (SC). Within 4 weeks of an assault, participants met weekly with a therapist for four 2-hr sessions. Across all interventions, participants reported decreases in PTSD symptoms, depression, and anxiety over time. At postintervention, participants in B-CBT reported greater decreases in self-reported PTSD severity and a trend toward lower anxiety than those in SC. At 3-month follow-up, participants in B-CBT evidenced lower general anxiety than those in SC and a trend toward lower self-reported PTSD severity. At last available follow-up (on average, 9-months postassault), all three interventions were generally similar in outcome. These findings suggest that a trauma-focused intervention aimed at those with severe PTSD symptoms after an assault can accelerate recovery.

Description of an early intervention to prevent substance abuse and psychopathology in recent rape victims

Approximately 683,000 adult women are raped each year. Only one in seven of these victims report the assault to police and receive forensic exams and other professional services. For many rape victims, this may be the only professional contact with service providers; however these services are typically limited to evidence collection and prophylactic STD treatment. Yet this exam also presents a unique opportunity for a preventive intervention to help prepare women to cope with potential stress related to rape-exam procedures and to address potential post rape psycho-pathology. This article reviews psychological interventions for trauma victims used in the acute post rape time frame and provides data from an ongoing clinical trial that evaluates delivery of a preventive intervention for victims presenting for forensic rape exams.

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.

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

The trauma of rape is routinely associated with extreme acute distress. Such peri-event anxiety increases risk of developing psychopathology and substance use or abuse post-rape, with the degree of initial distress positively predicting future problems. Unfortunately, the nature of post-rape forensic evidence collection procedures may exacerbate initial distress, thereby potentiating post-rape negative emotional sequelae. Consequently, substance use may increase in an effort to ameliorate this distress. To address this, a two-part video intervention was developed for use in acute post-rape time frames to (a) minimize anxiety during forensic rape examinations, thereby reducing risk of future emotional problems, and (b) prevent increased post-rape substance use and abuse. Pilot study data with 124 rape victims indicated that the low-cost, easily administered intervention was effective in reducing risk of marijuana abuse at 6 weeks. Nonstatistically significant trends also were evident for reduced marijuana use. Trends were also noted in favor of the intervention in the subgroup of women who were actively using substances pre-rape (among pre-rape alcohol users, 28% viewers vs. 43% nonviewers met criteria for post-rape alcohol abuse; among pre-rape marijuana users, the rates of post-marijuana use were 17% vs. 43%).

Establishing a sexual assault nurse examiner (SANE) program in the emergency department

Sexual assault cases present complex medical, psychological, social, and legal challenges to emergency practitioners. Sexual Assault Nurse Examiner (SANE) programs were designed to improve and expedite this patient care. The following review describes unique requirements, objectives, and resources when developing a program based in the Emergency Department.

Posttraumatic stress symptoms in mothers of premature infants

OBJECTIVE

To examine mothers' responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response.

DESIGN

Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity.

PARTICIPANTS

A convenience sample of 30 mothers of high-risk premature infants.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being--neonatal intensive-care unit stress, depressive symptoms, and worry about the infant--and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults.

RESULTS

All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms.

CONCLUSIONS

These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed provide a basis for interventions with these highly vulnerable mothers and infants.

Early interventions following psychological trauma

What is the best way to provide early interventions for psychiatric disorders after trauma? The terrorist attacks of September 11, 2001, have raised urgent concerns about the evidence for early treatments after trauma that can prevent psychiatric disorders. This review outlines the expected course of posttraumatic stress reactions and discusses the current means of identifying people who are at risk of developing disorders. A critique of psychological debriefing and an analysis of evidence for cognitive-behavioral therapy as an early intervention is provided. The major challenges for early intervention are discussed, including increasing treatment effectiveness, delivering therapy when it is required by thousands of people, and developing early interventions for a wide array of psychiatric disorders in addition to posttraumatic stress disorder that can develop following trauma.

Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks

Estimates of acute mental health symptoms in the general population after disasters are scarce. We assessed the prevalence and correlates of acute posttraumatic stress disorder (PTSD) in residents of Manhattan 5-8 weeks after the terrorist attacks of September 11, 2001. We used random-digit dialing to contact a representative sample of adults living in Manhattan below 110th Street. Participants were interviewed about prior life events, personal characteristics, exposure to the events of September 11th, and psychological symptoms after the attack. Among 988 eligible adults, 19.3% reported symptoms consistent with PTSD at some point in their life, and 8.8% reported symptoms consistent with a diagnosis of current (within the past 30 days) PTSD. Overall, 57.8% of respondents reported at least one PTSD symptom in the past month. The most common past-month symptoms were intrusive memories (27.4%) and insomnia (24.5%). Predictors of current PTSD in a multivariable model were residence below Canal Street, low social support, life stressors 12 months prior to September 11th, perievent panic attack, losing possessions in the attacks, and involvement in the rescue efforts. These findings can help guide resource planning for future disasters in densely populated urban areas.

Intrusive Thoughts in Posttraumatic Stress Disorder

This article reviews the literature on prevalence, associated features, assessment, and treatment of intrusive symptoms associated with posttraumatic stress disorder (PTSD). Research indicates that among trauma survivors, intrusive thoughts and imagery are quite common and distressing. It appears that early intrusions may be predictive of long-term distress and that avoidance and suppression can maintain intrusions. The treatment outcome literature for PTSD indicates that current cognitive behavioral treatments are effective in reducing intrusions. New data from a recent treatment outcome study for PTSD with comorbid panic attacks, using Multiple Channel Exposure Therapy, also suggest that this treatment is effective in significantly reducing intrusions.

Psychological sequelae of the September 11 terrorist attacks in New York City

BACKGROUND

The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks.

METHODS

We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks.

RESULTS

Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks.

CONCLUSIONS

There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

Emergency evaluation and intervention with female victims of rape and other violence

Given the high prevalence of crime within the general population and the increased rates of victimization among those seeking medical care, professionals who work in emergency departments, primary care medical facilities, or mental health settings need to be prepared to address physical and psychological problems related to sexual and physical assault. In this paper, interpersonal violence prevalence studies are reviewed in terms of study design and findings for sexual assault and physical assault. Common injuries following both forms of assault are documented, followed by a review of long-term medical outcomes. In addition to a review of physical health outcomes, primary psychological effects of violence are also reviewed. Strategies with which to screen for interpersonal violence in the medical setting are offered, and issues related to mandatory reporting are summarized. Interventions for assault victims that can be implemented in the medical setting are outlined, and a new hospital-based treatment for victims of rape is described.

Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder

OBJECTIVES

To assess the effectiveness of brief psychological debriefing for the management of psychological distress after trauma, and the prevention of post traumatic stress disorder.

SEARCH STRATEGY

Electronic searching of MEDLINE, EMBASE, PsychLit, PILOTS, Biosis, Pascal, Occ.Safety and Health, CDSR and the Trials Register of the Depression, Anxiety and Neurosis group. Hand search of Journal of Traumatic Stress. Contact with leading researchers.

SELECTION CRITERIA

The inclusion criteria for all randomized studies was that they should focus on persons recently (one month or less) exposed to a traumatic event, should consist of a single session only, and that the intervention involve some form of emotional processing/ventilation by encouraging recollection/reworking of the traumatic event accompanied by normalisation of emotional reaction to the event.

DATA COLLECTION AND ANALYSIS

8 trials fulfilled the inclusion criteria. Quality was generally poor. Data from two trials could not be synthesised.

MAIN RESULTS

Single session individual debriefing did not reduce psychological distress nor prevent the onset of post traumatic stress disorder (PTSD). Those who received the intervention showed no significant short term (3-5 months) in the risk of PTSD (pooled odds ratio 1.0, 95% ci 0.6-1.8). At one year one trial reported that there was a significantly increased risk of PTSD in those receiving debriefing (odds ratio 2.9, 95% ci 1.1-7.5). The pooled odds ratio for the two trials with follow ups just included unity (odds ratio 2.0, 95% ci 0.9-4.5). There was also no evidence that debriefing reduced general psychological morbidity, depression or anxiety.

REVIEWER'S CONCLUSIONS

There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.