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

The psychosocial aid response after the 22/03/2016 attacks in Belgium: a community case study

Introduction

After the terrorist attacks, early psychosocial care is provided to people considered at risk of developing mental health issues due to the attacks. Despite the clear importance of such early intervention, there is very few data on how this is registered, who is targeted, and whether target-recipients accept such aid.

Methods

Using registry data from the Centre General Wellbeingwork (CAW), a collection of centers in the regions Brussels and Flanders that provide psychosocial care, we examined the early psychosocial care response after the terrorist attacks of 22/03/2016 in Belgium.

Results

In total, 327 people were listed to be contacted by the CAW, while only 205 were reached out to (62.7%). Most were contacted within a month (84.9%), and were victims of the attacks (69.8%). Overall, the majority was female (55.6%).

Conclusion

Overall, target recipients were witnesses and survivors of the attacks, though a large proportion of people were not reached by the early outreach.

The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study

Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12 years of age and 14 years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1 year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = - 0.03, 95% CI - 0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.

Mental health of sexual assault victims and predictors of their use of support from in-house psychologists at Belgian sexual assault care centres

BACKGROUND

Sexual assault (SA) can induce a negative impact on victims' mental health. Specialised SA services generally offer medical care and a forensic examination to SA victims. However, there is a large variation in how these services provide mental health support.

OBJECTIVE

This study aims to assess mental health problems of SA victims attending the Belgian Sexual Assault Care Centres (SACCs) and identify predictors for victims' use of support from in-house psychologists.

METHOD

Health records of victims ≥ 16 years who presented within one week post-SA to one of the three Belgian SACCs between 25 October 2017 and 31 October 2019 were reviewed. An AIC-based stepwise backward binary logistic regression was used to analyse the association between victim, assault, service use and mental health characteristics and follow-up by a SACC-psychologist.

RESULTS

Of the 555 victims, more than half had a history of mental health problems. Of those assessed, over 70% showed symptoms of posttraumatic stress disorder (PTSD), depression and/or anxiety disorder. One in two victims consulted a SACC-psychologist. Victims with a mental health history (OR 1.46, p = .04), victims accompanied by a support person during acute care (OR 1.51, p = .04), and victims who were assaulted by an acquaintance in comparison to those assaulted by a stranger (OR 1.60, p = .039) were more likely to attend their appointment with the SACC-psychologist.

CONCLUSION

The study reaffirms the high mental health burden among victims attending specialised SA services, stressing the need to provide effective mental health interventions at these services and improve their longer-term use by victims. Prescheduling of appointments with an in-house psychologist in combination with phone reminders may improve the uptake of such services. Health care providers must be vigilant about potential barriers faced by victims without a mental health history or social support in attending appointments with mental health professionals.

Non-Consensual Sex and Help-Seeking Behavior Among PrEP Users in Belgium: Findings from an Online Survey

Non-consensual sex poses a threat not only to sexual health but also to mental and physical health in general. HIV pre-exposure prophylaxis (PrEP) users might be particularly vulnerable to non-consensual sex because of interplaying factors such as mental health disorders, a high number of sex partners, engagement in chemsex, and the widespread use of dating apps. The objectives of this study were to assess the occurrence of non-consensual sex, its associated factors, and related help-seeking behavior among PrEP users. We analyzed data from an online survey among PrEP users in Belgium (09/2020-02/2022). Almost one in five participants (34/187, 18.2%) reported having ever experienced non-consensual sex. The most reported form was having sex against one's will, followed by having been given drugs against one's will, and having had sex without a condom against one's will. The vast majority of those who had experienced non-consensual sex (29/34, 85.3%) did not seek help afterward, mostly due to a lack of perceived need (21/29, 72.4%). Reported barriers to seeking help were shame (6/29, 20.7%) and lack of awareness of help services (3/29, 10.3%). Having experienced non-consensual sex in the past five years was associated with younger age and suicidal ideation in a multivariable logistic regression model. We conclude that addressing barriers to non-consensual sex help services is crucial to maximize their use and minimize the consequences of non-consensual sex experiences. PrEP consultations also represent an opportunity to offer such help given PrEP users are already familiar with these PrEP services and engaged in care.

"Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence

Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.

Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury—An RCT study

Objective

Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol—GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery.

Methods

The study’s design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre—treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences – International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study.

Results

Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study’s findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic.

Conclusion

The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.

Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

Post-Rape Experiences of Undocumented Mexican Women in the U.S.-Mexico Border Region: A Critical Ethnography

Introduction: Numerous undocumented immigrant women in the United States have survived rape, and many have experienced physical and psychological consequences. Although rape disclosure can facilitate early intervention and improve health outcomes, most undocumented immigrant women do not disclose rape, and little is known about their post-rape experiences. Methods: This critical ethnography explored the post-rape experiences of undocumented immigrant women of Mexican (UIWM) origin living in the U.S. Mexico border region. Data collection and analysis were guided by Carspecken's framework for critical qualitative research. Six women, who identified as UIWM participated in the study. Each was interviewed using a semistructured approach. Results: Interview data revealed three domains: Glimpses of Support, Barrier After Barrier, and Overcoming. In accordance with Carspecken's framework, a theoretical lens was applied to these domains. The application of Feminist Intersectional Theory and Standpoint Theory united the domains into the theme Struggling to Heal. Conclusion: This study suggests that the marginalization of these survivors detrimentally impacts their post-rape experiences and describes the intersections of multiple forces on their experiences, including the cultural and sociopolitical context of the border region. This study lays the foundation for future research aimed at mitigating disclosure and help-seeking barriers for this marginalized group.

Modified prolonged exposure therapy as Early Intervention after Rape (The EIR-study): study protocol for a multicenter randomized add-on superiority trial

BACKGROUND

Sexual assault and rape are the traumatic life events with the highest probability for posttraumatic stress disorder (PTSD), which can have devastating consequences for those afflicted by the condition. Studies indicate that modified prolonged exposure (mPE) therapy may be effective in preventing the development of PTSD in recently traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such interventions as part of routine care.

METHODS/DESIGN

This is a multicenter randomized controlled add-on superiority trial that enrolls patients attending sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms 3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difficulties, pelvic floor hyperactivity, and sexual dysfunction. The first 22 subjects will constitute an internal pilot trial to test acceptance of the intervention and feasibility of the assessment battery.

DISCUSSION

This study will guide further research and clinical initiatives for implementing strategies for preventing post-traumatic stress symptoms after rape and provide new knowledge about which women may benefit the most from such initiatives and for revising existing treatment guidelines within this area.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05489133. Registered on 3 August 2022.

Depression and post-traumatic stress symptoms two years post-rape and the role of early counselling: Rape Impact Cohort Evaluation (RICE) study

Background: Survivors of sexual violence are at higher risk of adverse mental health outcomes compared to those exposed to other interpersonal traumas.Objective: To examine the trajectory of both post-traumatic stress disorder (PTSD) and depression as well as the role of early counselling over 24 months among rape survivors.Method: The South African Rape Impact Cohort Evaluation (RICE) study enrolled women aged 16-40 years attending post-rape care services within 20 days of a rape incident (n = 734), and a comparison group (n = 786) was recruited from primary health care. Women were followed for 24 months; the main study outcomes were depression and PTSD. Reports of early supportive counselling by the exposed group were also included. The analysis included an adjusted joint mixed model with linear splines to account for correlated observations between the outcomes.Results: At 24 months, 45.2% of the rape-exposed women met the cut-off for depression and 32.7% for PTSD. This was significantly higher than levels found among the unexposed. Although a decline in depression and PTSD was seen at 3 months among the women who reported a rape, mean scores remained stable thereafter. At 24 months mean depression scores remained above the depression cut-off (17.1) while mean PTSD scores declined below the PTSD cut-off (14.5). Early counselling was not associated with the trajectory of either depression or PTSD scores over the two years in rape-exposed women with both depression and PTSD persisting regardless of early counselling.Conclusion: The study findings highlight the importance to find and provide effective mental health interventions post-rape in South Africa.

Examining Associations Between Participant Gender, Desired Partner Gender, and Views Toward Sexually Coercive Behaviors

Sexual coercion—pursuit of sexual activity with a partner who has not provided full consent (Huppin & Malamuth, Sexual Coercion, Hoboken, New Jersey, 2015) is a pervasive problem that carries psychological and financial costs. Although much past research has focused on sexually coercive acts performed by men and directed at women, the current work evaluates the independent and interactive roles of participant gender, desired partner gender, and sexual orientation in predicting individuals’ views toward sexual coercion, a psychological outcome linked with coercive sexual behavior (e.g., Zinzow & Thompson in Archives of Sexual Behavior, 44:213–222, 2015). To this end, 1021 cisgender men and women (M_age = 26.46 years) who self-identified as heterosexual, gay/lesbian, or bisexual rated the acceptability of sexually coercive behaviors performed by individuals of their gender. Consistent with past behavioral research, men rated these acts to be more acceptable when performed by same-gender others than did women. Extending past research, this gender difference was observed across variation in desired partner genders and sexual orientations. Further, an attraction to women predicted higher acceptability ratings among men but not among women. Finally, identification as heterosexual (as compared to gay/lesbian or bisexual) predicted more favorable views toward these behaviors across participant gender. Taken together, these findings suggest that men who are attracted to women (specifically) may be most likely to view coercive behaviors as acceptable, and thus may be most likely to utilize them, when pursuing sexual activity.

Serum adiponectin-levels are predictive of probable posttraumatic stress disorder in women

Background

Accumulative evidence indicates a role for adiponectin, a polypeptide secreted by adipose tissue, in the pathophysiology of posttraumatic disorder (PTSD) via metabolic and inflammatory pathways. This study examined adiponectin as a potential predictive biomarker for PTSD among female rape survivors.

Methods

We evaluated the relationship of baseline serum adiponectin levels to the development of probable PTSD at 3- and 6-months post rape-exposure and compared adiponectin levels between 542 rape-exposed (RE) and 593 rape-unexposed women (RUE). Probable PTSD were defined as Davidson Trauma Scale score ≥40. Data were analysed using multivariate regression models and a generalized estimating equation (GEE) model. We adjusted for clinically relevant covariates associated with PTSD, as well as adiposity indices.

Results

Participants who were in the mid-and high adiponectin tertile groups versus the lowest tertile group had a significantly reduced risk of probable PTSD among at 6 months follow-up, independent of adiposity(aOR = 0.45[0.22–1.05], p = 0.035; aOR = 0.44[0.22–0.90], p = 0.024). However, there was no effect of group (RE vs. RUE).

Limitations

Adiponectin assays were conducted on non-fasting blood samples and information on chronic medication, dietary factors and levels of physical activity were not collected. There was a high attrition rate among rape exposed participants.

Conclusions

Our results show that higher serum adiponectin levels are associated with reduced risk of probable PTSD over a 6-month period. This finding supports the hypothesis that serum adiponectin is a potential risk biomarker for PTSD.

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The prospective associations between adiponectin, an anti-inflammatory cytokine and development of PTSD was examined in a cohort of rape exposed women.

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Serum adiponectin levels were inversely associated with probable PTSD at 6 month among control but not rape exposed women.

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Results suggest that adiponectin may serve as a potential risk biomarker of PTSD.

Supporter-focused early intervention for recent sexual assault survivors: Study protocol for a pilot randomized clinical trial

INTRODUCTION

Sexual assault is a common form of trauma that is associated with elevated risk for negative psychosocial outcomes. Although survivors' social relationships could serve as a major protective factor against negative outcomes, survivors' supporters often lack knowledge regarding effective responses and may inadvertently respond in ways that are detrimental to healing. Communication and Recovery Enhancement (CARE) is a 2-session early intervention for survivors of a past-10-week sexual assault and their supporters that aims to improve supporters' ability to respond effectively.

OBJECTIVE

In this paper, we present a study protocol for a pilot randomized clinical trial of CARE (NCT05345405). The goal of this pilot trial is to understand the feasibility, acceptability, and preliminary efficacy of two versions of CARE: a version in which survivors and supporters attend sessions together (dyadic version) and a version in which supporters attend sessions alone (supporter-only version).

METHODS

Survivors aged 14+ with elevated posttraumatic stress will enroll with a supporter of their choosing. Dyads will be randomized to dyadic CARE, supporter-only CARE, or waitlist control, and will complete self-report assessments at baseline, post-session-1, and follow-ups (1, 2, and 3 months post-baseline). We will use descriptive statistics, effect sizes, and exploratory statistical tests to characterize the acceptability of both CARE versions, impact on knowledge change from baseline to 1 month, impact on disclosure experiences at 1 month, and impact on functional outcomes at 3 months.

DISCUSSION

Results will be used to inform future changes to CARE and determine whether a fully-powered randomized controlled trial is warranted.

Early Intervention Eye Movement Desensitization and Reprocessing Following Major Musculoskeletal Trauma: How Soon Is Too Soon?

Major trauma centers have increased survival following serious physical injury, resulting in increased demand for specialist multidisciplinary rehabilitation. We aimed to explore the feasibility of using early intervention eye movement desensitization and reprocessing (EMDR) therapy in an acute inpatient setting, using a non-concurrent, multiple-baseline, pre-post test case-series design. Unfortunately, no patients were recruited. This paper sets out the challenges and reflections of setting up a psychological intervention study in this setting and provides suggestions for further research.

Development of multidisciplinary sexual assault centres in the Netherlands

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.

Posttraumatic Stress Disorder Symptoms 2 Months After Vaginal Delivery

OBJECTIVE

To assess the prevalence of posttraumatic stress disorder (PTSD) symptoms and identify characteristics associated with it 2 months after singleton vaginal delivery at or near term.

METHODS

We conducted an ancillary cohort study of the TRAAP (TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery) randomized controlled trial in 15 French hospitals in 2015-2016. Women who had singleton vaginal delivery after 35 weeks of gestation were enrolled. After randomization, characteristics of labor and delivery were prospectively collected and paid special attention to postpartum blood loss. Posttraumatic stress disorder profile and provisional diagnosis were assessed 2 months after childbirth by two self-administered questionnaires: the IES-R (Impact of Event Scale-Revised) and the TES (Traumatic Event Scale). Associations between potential risk factors and PTSD symptoms were analyzed by multivariable logistic or linear regression modeling, depending on the type of dependent variable.

RESULTS

Questionnaires were returned by 2,740 of 3,891 women for the IES-R and 2,785 of 3,891 women for the TES (70.4% and 71.6% response rate). The prevalence of PTSD symptoms was 4.9% (95% CI 4.1-5.8%; 137/2,785) with the TES, and the prevalence of PTSD provisional diagnosis was 1.6% (95% CI 1.2-2.1%; 44/2,740), with the IES-R and 0.4% (95% CI 0.2-0.8%; 9/2,080) with the TES. Characteristics associated with a higher risk of PTSD in multivariable analysis were vulnerability factors - notably migrant status and history of psychiatric disorder (adjusted odds ratio [aOR] 2.7 95% CI 1.4-5.2) - and obstetric factors - notably induced labor (aOR 1.5 95% CI 1.0-2.2), being labor longer than 6 hours (aOR 1.7 95% CI 1.1-2.5), postpartum hemorrhage of 1,000 mL or more (aOR 2.0 95% CI 1.0-4.2), and bad memories of delivery at day 2 postpartum (aOR 4.5 95% CI 2.4-8.3) as assessed with the IES-R. Results were similar with the TES.

CONCLUSION

Approximately 1 of 20 women with vaginal delivery have PTSD symptoms at 2 months postpartum. History of psychiatric disorder, postpartum hemorrhage, and bad memories of deliveries at day 2 were the main factors associated with a PTSD profile.

Risk factors for PTSD diagnosis in young victims of recent sexual assault

BACKGROUND

Sexual assault is associated with a high risk of developing PTSD. Little is known about the PTSD onset in children who have recently been victimized by sexual assault. It is important to identify children at risk for PTSD after sexual assault to prevent chronic problems and revictimization.

OBJECTIVE

The first aim of this study was to describe the development of post-traumatic stress symptoms in the four weeks after sexual assault. The second aim was to analyse whether pre-assault factors, assault-related factors, social support, and post-traumatic stress, measured at two weeks post-assault, were associated with an indication of PTSD.

METHOD

From January 2019 to March 2021, data were collected of victims aged 8-17 years (n = 51; mean age = 15.00; SD = 1.78) who had contacted a Sexual Assault Centre. Severity of post-traumatic stress symptoms was measured at two and four weeks post-assault. The study was designed to use a multivariate logistic regression analysis. The study included female victims only.

RESULTS

Most of the victims (58.8%) showed a decline in the severity of post-traumatic stress symptoms in the four weeks after sexual assault. However, 27.4% showed an increase and 13.7% showed no change in symptoms. More than two-thirds of the children (70.6%) showed severe post-traumatic stress symptoms at four weeks post-assault, i.e. had an indication of PTSD. Since only one significant difference was found, the multivariate analysis was not executed. A significant difference was found between severity of symptoms at two weeks and an indication of PTSD at four weeks (t(49) = -5.79; p < .001).

CONCLUSION

Children with high levels of post-traumatic stress at two weeks post-assault are at risk for PTSD indication at four weeks post-assault. Further research is needed to determine whether early trauma-based treatment for children with high post-traumatic stress symptoms can prevent the development of PTSD.

Post-infection depressive, anxiety and post-traumatic stress symptoms: A prospective cohort study in patients with mild COVID-19

BACKGROUND

It remains unclear whether COVID-19 is associated with psychiatric symptoms during or after the acute illness phase. Being affected by the disease exposes the individual to an uncertain prognosis and a state of quarantine. These factors can predispose individuals to the development of mental symptoms during or after the acute phase of the disease. There is a need for prospective studies assessing psychiatric symptoms in COVID-19 patients in the post-infection period.

METHODS

In this prospective cohort study, nasopharyngeal swabs for COVID-19 tests were collected at patients' homes under the supervision of trained healthcare personnel. Patients who tested positive for COVID-19 and were classified as mild cases (N = 895) at treatment intake were further assessed for the presence of psychiatric symptoms (on average, 56.6 days after the intake). We investigated the association between the number of COVID-19 symptoms at intake and depressive, anxiety and post-traumatic symptoms approximately two months later, adjusting for previous mental health status, time between baseline and outcome, and other confounders. Multivariate logistic regression and generalized linear models were employed for categorical and continuous outcomes, respectively.

RESULTS

A clinically significant level of depressive, anxiety and post-traumatic stress symptoms were reported by 26.2% (N = 235), 22.4% (N = 201), and 17.3% (N = 155) of the sample. Reporting an increased number of COVID-related symptoms was associated with the presence of clinically significant levels of depressive (aOR = 1.059;95%CI = 1.002-1.119), anxiety (aOR = 1.072;95%CI = 1.012-1.134), and post-traumatic stress (aOR = 1.092;95%CI = 1.024-1.166) symptoms. Sensitivity analyses supported findings for both continuous and categorical measures.

CONCLUSION

Exposure to an increased number of COVID-19 symptoms may be associated with depressive, anxiety and post-traumatic symptoms after the acute phase of the disease. These patients should be monitored for the development of psychiatric symptoms after COVID-19 treatment discharge. Early interventions, such as brief interventions of psychoeducation on coping strategies, could benefit these individuals.

Pre-hospital, in-hospital and post-hospital factors associated with sleep quality among COVID-19 survivors 6 months after hospital discharge: cross-sectional survey in five cities in China

BACKGROUND

Understanding factors associated with post-discharge sleep quality among COVID-19 survivors is important for intervention development.

AIMS

This study investigated sleep quality and its correlates among COVID-19 patients 6 months after their most recent hospital discharge.

METHOD

Healthcare providers at hospitals located in five different Chinese cities contacted adult COVID-19 patients discharged between 1 February and 30 March 2020. A total of 199 eligible patients provided verbal informed consent and completed the interview. Using score on the single-item Sleep Quality Scale as the dependent variable, multiple linear regression models were fitted.

RESULTS

Among all participants, 10.1% reported terrible or poor sleep quality, and 26.6% reported fair sleep quality, 26.1% reported worse sleep quality when comparing their current status with the time before COVID-19, and 33.7% were bothered by a sleeping disorder in the past 2 weeks. After adjusting for significant background characteristics, factors associated with sleep quality included witnessing the suffering (adjusted B = -1.15, 95% CI = -1.70, -0.33) or death (adjusted B = -1.55, 95% CI = -2.62, -0.49) of other COVID-19 patients during hospital stay, depressive symptoms (adjusted B = -0.26, 95% CI = -0.31, -0.20), anxiety symptoms (adjusted B = -0.25, 95% CI = -0.33, -0.17), post-traumatic stress disorders (adjusted B = -0.16, 95% CI = -0.22, -0.10) and social support (adjusted B = 0.07, 95% CI = 0.04, 0.10).

CONCLUSIONS

COVID-19 survivors reported poor sleep quality. Interventions and support services to improve sleep quality should be provided to COVID-19 survivors during their hospital stay and after hospital discharge.

Underserved survivors of sexual assault: a systematic scoping review

Background: Despite knowledge about the extensive and often long-lasting consequences of sexual assault, many survivors remain underserved by formal support systems (e.g. medical, mental health and criminal justice systems). Reasons for underutilizing services are as diverse as the survivors themselves, and little is known about which survivors are most underserved and why they are underserved. Objective: To help organize existing findings on this topic, a systematic scoping review was conducted to identify adult survivors of sexual assault, who may be particularly underserved when attempting to obtain services in Western countries. Method: Five databases (PsycINFO, Embase, MEDLINE, Scopus and CINAHL) were systematically searched for studies published in English from 2000 onwards using terms such as 'sexual assault', 'help seeking', 'formal support', 'barriers' and variations thereof. Results: A total of 41 studies were included in the present scoping review, resulting in seven main categories of underserved survivors: Ethnic and cultural minorities, Disabilities, Financial vulnerability, Sexual and gender minorities, Mental health conditions, Problematic substance use, and Older age. Barriers encountered by survivors with these characteristics included limited access to formal supports and insufficient training and awareness among service providers about how to best support survivors. Conclusions: Recommendations include the need for more survivor-centred, culturally appropriate and trauma-informed services and more attention to survivors belonging to underserved groups in policy, practice and research.

Course, Moderators, and Predictors of Acute Coronary Syndrome-Induced Post-traumatic Stress: A Secondary Analysis From the Myocardial Infarction-Stress Prevention Intervention Randomized Controlled Trial

Acute coronary syndromes (ACS) induce post-traumatic stress symptoms (PTSS) in one out of eight patients. Effects of preventive interventions, the course and potential moderators of ACS-induced PTSS are vastly understudied. This study explored whether a preventive behavioral intervention leads to a decrease in myocardial infarction (MI)-induced PTSS between two follow-up assessments. Sociodemographic, clinical and psychological factors were additionally tested as both moderators of change over time in PTSS and predictors of PTSS across two follow-ups. Within 48 h after reaching stable circulatory conditions, 104 patients with MI were randomized to a 45-min one-session intervention of either trauma-focused counseling or stress counseling (active control). Sociodemographic, clinical, and psychological data were collected at baseline, and PTSS were assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale 3 and 12 months post-MI. PTSS severity showed no change over time from 3 to 12 months post-MI, either in all patients or through the intervention [mean group difference for total PTSS = 1.6 (95% CI -1.8, 4.9), re-experiencing symptoms = 0.8 (95% CI -0.7, 2.2), avoidance/numbing symptoms = 0.1 (95% CI -1.6, 1.7) and hyperarousal symptoms = 0.6 (95% CI -0.9, 2.1)]. Patients receiving one preventive session of trauma-focused counseling showed a decrease from 3 to 12 months post-MI in avoidance symptoms with higher age (p = 0.011) and direct associations of clinical burden indices with total PTSS across both follow-ups (p's ≤ 0.043; interaction effects). Regardless of the intervention, decreases in re-experiencing, avoidance and hyperarousal symptoms from 3 to 12 months post-MI occurred, respectively, in men (p = 0.006), participants with low education (p = 0.014) and with more acute stress symptoms (p = 0.021). Peritraumatic distress (p = 0.004) and lifetime depression (p = 0.038) predicted total PTSS across both follow-ups. We conclude that PTSS were persistent in the first year after MI and not prevented by an early one-session intervention. A preventive one-session intervention of trauma-focused counseling may be inappropriate for certain subgroups of patients, although this observation needs confirmation. As predictors of the development and persistence of PTSS, sociodemographic and psychological factors could help to identify high-risk patients yet at hospital admission.

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial

BACKGROUND

About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape.

OBJECTIVE

To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape.

METHOD

This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time.

RESULTS

Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time.

CONCLUSIONS

The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.

Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test

BACKGROUND

Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user.

OBJECTIVE

The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures.

METHODS

MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form).

RESULTS

In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures.

CONCLUSIONS

MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.

Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms

BACKGROUND

Traumatic sexual experiences can negatively affect sexual functioning and increase pelvic floor activity in women, especially when post-traumatic stress disorder (PTSD) is developed. However, little is known about the effect of other types of interpersonal and non-interpersonal, traumatic experiences on sexual function and pelvic floor overactivity.

OBJECTIVE

The aim of this study was to examine the effects of lifetime traumatic experiences and subsequent PTSD symptoms on sexual function and pelvic floor activity and to investigate whether the effects differ for interpersonal and non-interpersonal trauma.

METHODS

Women (N=82) with obesity and a history of infertility, participating in a follow-up study of an RCT investigating a lifestyle intervention programme, completed questionnaires on lifetime exposure to traumatic events (LEC-5), PTSD symptoms (PC-PTSD-5), sexual function (MFSQ) and pelvic floor activity (AOPFS-SV).

RESULTS

A large majority of women (85%) reported exposure to at least one traumatic event during their lifetime. Sexual function and pelvic floor activity did not differ between women who experienced non-interpersonal or interpersonal (including sexual) trauma and those who did not experience traumatic events during their lifetime. Women who had developed PTSD symptoms, however, did have higher pelvic floor activity, but sexual function was not affected. Women with a positive screen for PTSD had the highest pelvic floor activity score, and individual PTSD symptoms nightmares and hypervigilance were associated with significantly higher pelvic floor activity scores.

CONCLUSION

Trauma exposure is associated with pelvic floor overactivity in women with a positive screen for PTSD, such that pelvic floor overactivity is more severe with greater PTSD severity. These findings suggest that the development of PTSD after interpersonal trauma is pivotal in this association. Sexual function was unrelated to trauma exposure and pelvic floor function, perhaps related to the fact that the interpersonal trauma events reported in this study were mainly non-sexual.