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Caswell RJ, Ross JD, Bradbury-Jones C. Making sexual and reproductive healthcare environments safe and supportive for disclosure of sexual violence: interview findings from patients and healthcare professionals using a realist approach. Sex Transm Infect 2024:sextrans-2024-056140. [PMID: 38871453 DOI: 10.1136/sextrans-2024-056140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVES Most people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare. Telling someone in healthcare about experiences of SV can be an important step in accessing necessary medical care and being signposted to other services. While recognising healthcare settings are a key place for people to seek support, evidence is lacking about how best to create a safe environment for disclosure to take place, how services can make changes to better facilitate this experience and what changes matter most. DESIGN This study used a realist approach to identify mechanisms that facilitate safe and supported disclosure. Data were generated through three focus groups with Sexual and Reproductive Health Services healthcare professionals in the UK, and one-to-one interviews with survivors of SV who attended healthcare settings (n=18). RESULTS The analysis found that service users needed to feel empowered and recognised as appropriate candidates for care in the material used to promote sexual healthcare services after SV. This promotional material needs to address rape myths, stereotypes and silence surrounding SV, to ensure that all individuals and especially those from diverse groups are empowered to access care. Three fundamental mechanisms for safe and supported disclosure were identified: being listened to, being validated and having choice. Trauma-informed care was identified as being essential for implementing these mechanisms. Healthcare professionals who were confident and competent regarding enquiry about SV and response to disclosures of SV were key. CONCLUSIONS The development of services that are conducive to the disclosure of SV is needed to provide better support for those who have experienced SV and are ready to seek support. Use of appropriate promotional material, specific staff training and a trauma-informed approach are key elements to improve services.
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Affiliation(s)
- Rachel J Caswell
- Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Dc Ross
- Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mirlashari J, Brotto LA, Lyons J, Pederson A. The Wall of Silence: Perceived Barriers to Gender-Based Violence Disclosure among Women in the Perinatal Period. Can J Nurs Res 2024; 56:117-128. [PMID: 38086750 DOI: 10.1177/08445621231220810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
STUDY BACKGROUND Gender-based violence is a global concern. The perinatal period is a crucial time for early identification of the harmful impact of violence on the well-being of both mothers and infants. However, it has been observed that many women choose not to disclose their experiences to their healthcare providers. PURPOSE To gain insight into this issue, a study was conducted to explore the perspectives of both survivors and healthcare providers regarding the barriers to disclosure. METHODS Through the utilization of a thematic analysis approach, a total of 28 interviews were conducted, involving 12 survivors and 16 healthcare providers. RESULTS Data analysis revealed barriers to disclosure at the individual, community, and healthcare system levels. CONCLUSION Health-care providers have a pivotal role in creating an atmosphere where women are encouraged to break the silence and a paradigm shift in the health system approach towards GBV is necessary.
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Affiliation(s)
- Jila Mirlashari
- College of Nursing, Seattle University, Seattle, Washington State, USA
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Women's Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Janet Lyons
- Department of Obstetrics and Gynecology, Women's Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Ann Pederson
- Women's Health Research Institute, University of British Columbia, Vancouver, Canada
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3
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Peeren S, McLindon E, Tarzia L. "Counteract the gaslighting" - a thematic analysis of open-ended responses about what women survivors of intimate partner sexual violence need from service providers. BMC Womens Health 2024; 24:110. [PMID: 38336660 PMCID: PMC10858602 DOI: 10.1186/s12905-024-02943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Intimate partner sexual violence (IPSV) is a prevalent but misunderstood form of gender-based violence with significant impacts women's health and well-being. Research suggests that IPSV has a specific context and unique impacts, but little is known about how to tailor service responses. To address this gap, we explored help-seeking experiences and needs among IPSV survivors after disclosure. METHODS This study draws on qualitative data from a subsample of women who participated in a cross-sectional survey about the service needs of intimate partner violence survivors. Women who reported IPSV and provided information about IPSV-specific help-seeking needs after disclosure were included in the analysis. Open-ended text responses of 37 IPSV survivors were analysed using thematic analysis. RESULTS IPSV was invisible and silenced in service responses. Three themes suggest potential ways forward. In the first theme, 'Don't dismiss it', women needed providers to take their disclosures seriously and listen to the significant impacts of IPSV on their well-being and safety. In the second theme, 'See the bigger picture', women needed service providers to understand that IPSV fits into broader patterns of abuse, and that psychological abuse and coercive control impacts women's ability to consent. In the third theme, 'counteract the gaslighting', women needed providers to educate them about the continuum of IPSV and help them label IPSV as a form of violence. CONCLUSIONS Our exploratory findings extend the limited evidence base on IPSV and highlight a need for further in-depth research to explore a tailored approach to supporting IPSV survivors. To avoid contributing to the silencing of IPSV survivors, service responses should recognise the harmful and sexualised nature of IPSV, challenge cultural stereotypes that minimise IPSV, and understand that co-occurring psychological abuse may exacerbate shame and prevent women from articulating the source of their distress.
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Affiliation(s)
- Síofra Peeren
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Service User Research Enterprise, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
| | - Elizabeth McLindon
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, VIC, Australia
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Salvador Sánchez L, Rodríguez Conesa N, Sánchez Ramón S, Rey Novoa M. [Addressing sexual violence in health services]. Aten Primaria 2024:S0212-6567(23)00270-6. [PMID: 38212181 DOI: 10.1016/j.aprim.2023.102837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024] Open
Abstract
Sexual violence is a very underdetected public health problem, with important short and long-term consequences on physical, mental, social, sexual and reproductive health, which must be taken into account by health services. Health systems are part of the set of resources necessary for a comprehensive approach from the ecological model: prevention and promotion of healthy sexuality with equality, adequate and coordinated care in the event of sexual assault and subsequent support to prevent sequelae. All sexual violence has health consequences, even those that may seem less serious such as sexual harassment or sexual cyberviolence. We must know the needs of the victim and their possible emotional reactions. A risk assessment will be carried out, the victim will be referred to a hospital if necessary and comprehensive and integrated care will be provided. Care and follow-up must focus on the survivor and with professionals trained in trauma to understand the consequences of sexual violence, offer a safe and trusting environment and know how to reinforce their qualities and support.
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Affiliation(s)
| | - Nerea Rodríguez Conesa
- Hospital Universitario Río Hortega, Facultad de Enfermería, Universidad de Valladolid, Valladolid, España
| | - Susana Sánchez Ramón
- Servicio de Urgencias, Hospital Universitario Río Hortega, Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - Modesto Rey Novoa
- Servicio de Ginecología y Obstetricia, Complejo Asistencial Universitario de Burgos, Burgos, España
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Lathan EC, Selwyn CN, Gigler ME, Langhinrichsen-Rohling J, Gilmore AK. College Students' Trust, Betrayal, and Needs During and After Their Worst Nonassault-Related Healthcare Experiences Differ Based on Sexual Violence Exposure. VIOLENCE AND VICTIMS 2023; 38:858-878. [PMID: 37989528 DOI: 10.1891/vv-2022-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
The BITTEN theoretical framework conceptually links patient's past healthcare betrayal and trauma experiences with their current and future healthcare interactions. BITTEN was used to examine whether healthcare experiences, behaviors, and needs differ between those with and without a history of sexual violence exposure. College students at two public universities in the southeastern United States (n = 1,381; 59.5% White, 61.0% women) completed measures about their self-selected worst or most frightening but nonassault-related healthcare experience. Multivariate general linear and mediation models were used to test theory-derived hypotheses. Participants exposed to sexual violence reported greater healthcare institutional betrayal, lower trust, and greater need for tangible aid and trauma-informed care during their worst nonassault-related healthcare experience. They also reported greater current healthcare avoidance alongside increased utilization of more physical and mental healthcare appointments, even after accounting for gender and race differences. These results suggest that, with minimal information about past sexual violence exposure, healthcare providers could be better poised to predict and address vulnerable patients' healthcare needs.
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Affiliation(s)
- Emma C Lathan
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Candice N Selwyn
- Department of Community Mental Health Nursing, University of South Alabama, Mobile, AL, USA
| | - Margaret E Gigler
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Amanda K Gilmore
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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6
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Kamke K, Mullin TM, Goodman KL. Barriers to Seeking Medical Care Among Youth Victims of Sexual Violence. J Adolesc Health 2023; 73:1077-1082. [PMID: 37676193 DOI: 10.1016/j.jadohealth.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Youth victims of sexual violence often experience physical health problems but are unlikely to receive medical care. However, victims' reasons for not accessing medical care have been understudied. We examined barriers to seeking medical care among youth victims who contacted the National Sexual Assault Online Hotline. METHODS We used archival data about one-on-one chat sessions with youth victims between June 2018 and February 2020. Hotline staff described victims' reasons for not accessing medical care via an online assessment. We coded and qualitatively examined these reasons using data about 520 victims with physical health concerns who had not received medical care. RESULTS Victims' barriers were rooted in individual beliefs and contextual realities reflected in three categories: (1) perception that medical care was not needed, (2) anticipated consequences of seeking medical care, and (3) inability to physically access medical care. Victims who perceived care as unnecessary did not understand the health implications of abuse or minimized their need for care. Anticipated consequences included privacy and control over disclosure, stigmatization, retaliation from the perpetrator, family disruptions, and retraumatizing medical treatment. Victims unable to physically access care were uncertain how to access care independently, lacked social support, or were prevented from care by the perpetrator. DISCUSSION Medical treatment can ameliorate acute health concerns and increase safety, but youth victims perceived numerous barriers to care. Several barriers implied unintended consequences of child maltreatment policies, including mandatory reporting. Trauma-informed policy and practice are critical for improving victims' access to medical care and other support services.
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Affiliation(s)
- Kristyn Kamke
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C..
| | - Tara M Mullin
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C
| | - Kimberly L Goodman
- Research & Evaluation Team, Department of Victim Services, Rape, Abuse & Incest National Network (RAINN), Washington, D.C
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de Klerk HW, van der Pijl MSG, de Jonge A, Hollander MH, Verhoeven CJ, Montgomery E, Gitsels-van der Wal JT. (Non-)disclosure of lifetime sexual violence in maternity care: Disclosure rate, associated characteristics and reasons for non-disclosure. PLoS One 2023; 18:e0285776. [PMID: 37792790 PMCID: PMC10550179 DOI: 10.1371/journal.pone.0285776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND In maternity care, disclosure of a past sexual violence (SV) experience can be helpful to clients to discuss specific intimate care needs. Little evidence is available about the disclosure rates of SV within maternity care and reasons for non-disclosure. AIM The aim of this study was to examine (1) the disclosure rate of SV in maternity care, (2) characteristics associated with disclosure of SV and (3) reasons for non-disclosure. METHODS We conducted a descriptive mixed method study in the Netherlands. Data was collected through a cross-sectional online questionnaire with both multiple choice and open-ended items. We performed binary logistic regression analysis for quantitative data and a reflexive thematic analysis for qualitative data. RESULTS In our sample of 1,120 respondents who reported SV, 51.9% had disclosed this to a maternity care provider. Respondents were less likely to disclose when they received obstetrician-led care for high-risk pregnancy (vs midwife-led care for low-risk pregnancy) and when they had a Surinamese or Antillean ethnic background (vs ethnic Dutch background). Reasons for non-disclosure of SV were captured in three themes: 'My SV narrative has its place outside of my pregnancy', 'I will keep my SV narrative safe inside myself', and 'my caregiver needs to create the right environment for my SV narrative to be told'. CONCLUSIONS The high level of SV disclosure is likely due to the Dutch universal screening policy. However, some respondents did not disclose because of unsafe care conditions such as the presence of a third person and concerns about confidentiality. We also found that many respondents made a positive autonomous choice for non-disclosure of SV. Disclosure should therefore not be a goal in itself, but caregivers should facilitate an inviting environment where clients feel safe to disclose an SV experience if they feel it is relevant for them.
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Affiliation(s)
- Hannah W. de Klerk
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marit S. G. van der Pijl
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine H. Hollander
- Department of Obstetrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corine J. Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Elsa Montgomery
- Florence Nightingale Faculty of Nursing, Division of Methodologies, Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Janneke T. Gitsels-van der Wal
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Caswell RJ, Ross JDC, Maidment I, Bradbury-Jones C. Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2661-2679. [PMID: 35762535 DOI: 10.1177/15248380221111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: Sexual and reproductive healthcare services (SRHS) are an environment where medical care relevant to sexual violence and abuse (SV) is available. However, barriers to disclosure need to be overcome to allow timely access to this care. There is limited research identifying and explaining how interventions remove barriers and create a safe and supportive environment for disclosure. The purpose of this review was to develop and refine theories that explain how, for whom and in what context SRHS facilitate disclosure. Methods: Following published realist standards we undertook a realist review. After focussing the review question and identifying key contextual barriers, articles pertaining to these were identified using a traditional systematic database search. This strategy was supplemented with iterative searches. Results: Searches yielded 3172 citations, and 28 articles with sufficient information were included to develop the emerging theories. Four evidence-informed theories were developed proposing ways in which a safe and supportive environment for the disclosure of SV is enabled in SRHS. The theories consider how interventions may overcome barriers surrounding SV disclosure at individual, service-delivery and societal levels. Conclusions: Benefits of SRHS engagement with health promotion and health activism activities to address societal level barriers like lack of service awareness and stereotypic views on SV are presented. Although trauma informed practice and person-centred care were central in creating a safe and supportive environment for disclosure the review found them to be poorly defined in this setting.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
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9
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Caswell RJ, Hodson J, Bradbury-Jones C, Ross JDC. Where do those experiencing sexual violence seek help and is routine enquiry acceptable within a sexual healthcare setting? Findings from a population-based survey. BMJ Open 2023; 13:e073204. [PMID: 37673457 PMCID: PMC10496700 DOI: 10.1136/bmjopen-2023-073204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVES Most sexual violence (SV) remains undisclosed to healthcare professionals. The aims of this study were to identify where support would be sought after SV and whether routine enquiry about SV was acceptable in a sexual healthcare setting. DESIGN An online population-based survey collected data on a history of SV and preferences on support after SV, in addition to sociodemographic data. Respondents' views on being routinely asked about SV were sought. SETTING AND PARTICIPANTS This online survey was based in England, UK. There were 2007 respondents. RESULTS The police were the most frequent first choice for support after experiencing SV (n=520; 25.9%); however, this was less common in individuals in younger age groups (p<0.001) and in those with a history of SV (17.2% vs 29.9%, p<0.001). For the 27.1% (532 of 1960) of respondents who reported a history of SV, the first choice of place for support was Rape Crisis or similar third-sector organisation. The majority of respondents supported routine enquiry about SV during Sexual and Reproductive Health Service (SRHS) consultations (84.4%), although acceptability was significantly lower in older age groups. CONCLUSIONS AND STUDY IMPLICATIONS A greater awareness of the influence of sociodemographic factors, including ethnicity, age, gender, disability and a history of SV, when planning and delivering services for those who have experienced SV is needed. A history of SV is common in the general population, and a 'one-size-fits-all' approach to encourage disclosure and access to support is unlikely to be optimal. Routine enquiry about SV is highly acceptable in an SRHS setting and likely to improve disclosure when appropriately implemented.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
| | - James Hodson
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Conley AH, Carlyle KE, Cuddeback G, Kornstein SG. Working with Survivors of Sex Trafficking: Mental Health Implications. Psychiatr Clin North Am 2023; 46:597-606. [PMID: 37500253 DOI: 10.1016/j.psc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Human trafficking is one of the largest criminal enterprises in the world, generating an estimated $150 billion in illegal profits annually. Sex trafficking is the most common form of human trafficking, and survivors experience significant physical, emotional, and sexual trauma that places them at increased risk of poor health outcomes. As sex trafficking continues to disproportionately impact the physical and mental health of individuals belonging to marginalized groups, a multidisciplinary approach to combat trafficking will require collaboration between health services, law enforcement, and social services. Therefore, medical professionals should be familiar with screening protocols for trafficking and evidence based, trauma-informed mental health treatment interventions.
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Affiliation(s)
- Abigail H Conley
- Department of Counseling and Special Education, Virginia Commonwealth University, 1015 West Main Street, Richmond, VA 23284, USA.
| | - Kellie E Carlyle
- Department of Social and Behavioral Health, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, 4th Floor, Room 4-120, Richmond, VA 23219, USA
| | - Gary Cuddeback
- School of Social Work, Virginia Commonwealth University, Academic Learning Commons, 1000 Floyd Avenue, Box 842027, Richmond, VA 23284, USA
| | - Susan G Kornstein
- Department of Psychiatry and Institute for Women's Health, Virginia Commonwealth University School of Medicine, PO Box 980319, Richmond, VA 23298, USA
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11
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Wiener SJ, Porter JJ, Paydar-Darian N, Monuteaux MC, Hudgins JD. Emergency Care Utilization for Mental and Sexual Health Concerns Among Adolescents Following Sexual Assault: A Retrospective Cohort Study. J Adolesc Health 2023; 73:486-493. [PMID: 37294253 DOI: 10.1016/j.jadohealth.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This study aimed to explore the health outcomes of adolescent survivors of sexual assault, as measured by subsequent emergency department (ED) utilization for mental and sexual health concerns. METHODS This retrospective cohort study used the Pediatric Health Information System (PHIS) database. We included patients aged 11-18 years seen at a PHIS hospital with a primary diagnosis of sexual assault. The control group included age- and sex-matched patients seen for an injury. Participants were followed in PHIS for 3-10 years; subsequent ED visits for suicidality, sexually transmitted infection, pelvic inflammatory disease (PID), or pregnancy were identified, and likelihoods of each were compared using Cox proportional hazards models. RESULTS The study population included 19,706 patients. ED return visit rates in the sexual assault and control groups were 7.9% versus 4.1% for suicidality, 1.8% versus 1.4% for sexually transmitted infection, 2.2% versus 0.8% for PID, and 1.7% versus 1.0% for pregnancy, respectively. Compared to controls, sexual assault patients were significantly more likely to return to the ED for suicidality throughout the follow-up period, with the highest hazard ratio of 6.31 (95% confidence interval 4.46-8.94) during the first 4 months. Sexual assault patients also had higher likelihood of returning for PID (hazard ratio 3.80, 95% confidence interval 3.07-4.71) throughout the follow-up period. DISCUSSION Adolescents seen in the ED for sexual assault were significantly more likely to return to the ED for suicidality and sexual health concerns, highlighting the need for increased allocation of research and clinical resources to improve their care.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - John J Porter
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Joel D Hudgins
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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12
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Goldner L, Lev-Wiesel R, Bussakorn B. "I'm in a Bloody Battle without Being Able to Stop It": The Dissociative Experiences of Child Sexual Abuse Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7941-7963. [PMID: 36799511 DOI: 10.1177/08862605231153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim-aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism.
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Affiliation(s)
- Limor Goldner
- Faculty of Welfare and Health Sciences, The Emili Sagol CATs Research Center, University of Haifa, Israel
| | - Rachel Lev-Wiesel
- Faculty of Welfare and Health Sciences, The Emili Sagol CATs Research Center, University of Haifa, Israel
- Tel Hai College, Upper Galilee, and the Emili Sagol CATs Research Center, University of Haifa, Israel
| | - Binson Bussakorn
- Faculty of Fine Arts, FAA-Emili Sagol Creative Arts Research and Innovation for Well-being Center, Chulalongkorn University, Bangkok, Thailand
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13
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Lanthier S, Mason R, Logie CH, Myers T, Du Mont J. "Coming out of the closet about sexual assault": Intersectional sexual assault stigma and (non) disclosure to formal support providers among survivors using Reddit. Soc Sci Med 2023; 328:115978. [PMID: 37276773 DOI: 10.1016/j.socscimed.2023.115978] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Sexual assault is a pervasive, violent and often gendered crime that can result in significant negative consequences. Many sexual assault survivors consider disclosing to health and social care providers, therapists, and others who collectively fall under the banner of formal support, in order to access information, referrals, treatment and/or emotional support, however barriers to disclosure remain. This qualitative study is unique in its application of an intersectional sexual assault stigmatization framework to understand (non)disclosure to formal support providers among diverse sexual assault survivors. Through anonymous online narratives posted to the platform Reddit, survivors documented experiences of intersectional sexual assault stigma (perceived, internalized, anticipated, experienced) showing that they were not only stigmatized through negative gender stereotyping, but they were also marginalized through other structural inequities. The experience of multiple marginalization that arose from intersectional sexual assault stigma often impeded survivors in accessing and/or utilizing the formal support they wished for. The findings suggest that formal support providers could benefit from stigma reduction training related specifically to sexual assault survivors and that current models of stigma and discrimination training need to be expanded to include intersectional stigma. Further, the findings suggest that beyond training at an organizational level, a broader intervention aimed at reducing structural stigma and discrimination toward sexual assault survivors at a societal level appears warranted. Implications for future research related to the unique disclosure, health, and social care needs of diverse sexual assault survivors and support-seeking online alongside or in lieu of formal support are discussed.
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Affiliation(s)
- Stephanie Lanthier
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Robin Mason
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Canada; Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
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Isaac S, McLindon E, Hegarty K, Tarzia L. Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood. Violence Against Women 2023:10778012231176198. [PMID: 37203171 DOI: 10.1177/10778012231176198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.
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Affiliation(s)
- Sandra Isaac
- The University of Melbourne, Victoria, Australia
| | - Elizabeth McLindon
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Kelsey Hegarty
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
| | - Laura Tarzia
- The University of Melbourne, Victoria, Australia
- The Royal Women's Hospital, Victoria, Australia
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15
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Snow MD, Brubacher SP, Malloy LC, Luther K. Perceptions of Allegations of Repeated Victimization: The Roles of Event Frequency, Language Specificity, and Disclosure Delay. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4925-4944. [PMID: 36068949 PMCID: PMC9900688 DOI: 10.1177/08862605221120903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although many forms of victimization are repeated (e.g., domestic violence), we know relatively little about the perceived credibility of adult claimants who allege repeated maltreatment. We examined the effects of Event Frequency (Single vs. Repeated), Language Specificity (Episodic vs. Generic), and Disclosure Delay (Immediate vs. Delayed) on laypersons' perceptions of claimant credibility. Participants (N = 649) read a mock interview transcript and provided subjective ratings (e.g., credibility, likelihood of suspect guilt, claimant responsibility). When the alleged abuse occurred a single time (vs. repeatedly), participants rated the interviewee as less blameworthy but no more (or less) credible. Exploratory findings indicated that female participants viewed the interviewee as more credible and less responsible than did male participants.
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Affiliation(s)
| | - Sonja P. Brubacher
- Centre for Investigative Interviewing,
Griffith Criminology Institute, Griffith University, Australia
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16
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Brown HK, Saunders N, Chen S, Leslie K, Vigod SN, Fung K, Guttmann A, Havercamp SM, Parish SL, Ray JG, Lunsky Y. Disability and Interpersonal Violence in the Perinatal Period. Obstet Gynecol 2022; 140:797-805. [PMID: 36201763 PMCID: PMC9588770 DOI: 10.1097/aog.0000000000004950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the risk of interpersonal violence experienced by pregnant and postpartum individuals with physical disabilities, sensory disabilities, or intellectual or developmental disabilities with those without disabilities, and to examine whether a prepregnancy history of interpersonal violence puts individuals with disabilities, at excess risk of interpersonal violence in the perinatal period. METHOD This population-based study included all individuals aged 15-49 years with births in Ontario, Canada, from 2004 to 2019. Individuals with physical (n=147,414), sensory (n=47,459), intellectual or developmental (n=2,557), or multiple disabilities (n=9,598) were compared with 1,594,441 individuals without disabilities. The outcome was any emergency department visit, hospital admission, or death related to physical, sexual, or psychological violence between fertilization and 365 days postpartum. Relative risks (RRs) were adjusted for baseline social and health characteristics. Relative excess risk due to interaction (RERI) was estimated from the joint effects of disability and prepregnancy violence history; RERI>0 indicated positive interaction. RESULTS Individuals with physical (0.8%), sensory (0.7%), intellectual or developmental (5.3%), or multiple disabilities (1.8%) were more likely than those without disabilities (0.5%) to experience perinatal interpersonal violence. The adjusted RR was 1.40 (95% CI 1.31-1.50) in those with physical disabilities, 2.39 (95% CI 1.98-2.88) in those with intellectual or developmental disabilities, and 1.96 (95% CI 1.66-2.30) in those with multiple disabilities. Having both a disability and any violence history produced a positive interaction for perinatal interpersonal violence (adjusted RERI 0.87; 95% CI 0.47-1.29). CONCLUSION The perinatal period is a time of relative high risk for interpersonal violence among individuals with pre-existing disabilities, especially those with a history of interpersonal violence.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Natasha Saunders
- ICES, Toronto, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Kelly Leslie
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Simone N. Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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17
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Hegarty KL, Andrews S, Tarzia L. Transforming health settings to address gender‐based violence in Australia. Med J Aust 2022; 217:159-166. [PMID: 35796723 PMCID: PMC9546247 DOI: 10.5694/mja2.51638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022]
Abstract
Gender‐based violence includes intimate partner violence, sexual violence and other harmful acts directed at people based on their gender. It is common in Australia and causes great ill health, especially for women victims/survivors, with Indigenous women particularly affected. Health services are an opportune place for early intervention for victims/survivors of gender‐based violence as they attend frequently. Interventions that are evidence‐based and respond to consensus from victim/survivor voices include universal education, screening in antenatal care, first line supportive care, and referral for advocacy and psychological interventions, including mother–child work. Health care staff require training, protocols, scripts, referral pathways, understanding of cultural safety and antiracist practice in service delivery, and leadership support to undertake this sensitive work, including support, if needed, for their own experiences of gender‐based violence. Using a trauma‐, violence‐ and gender‐informed approach across health systems, taking into account structural inequities, is essential to sustain the gender‐based violence work in health services. Gender‐based violence experienced by Indigenous women is distinct and of urgent concern as rates rapidly increase. Inequities across the health system are pronounced for Indigenous women.
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Affiliation(s)
- Kelsey L Hegarty
- Safer Families Centre University of Melbourne Melbourne VIC
- Centre for Family Violence Prevention, Royal Women’s Hospital Melbourne VIC
| | - Shawana Andrews
- Safer Families Centre University of Melbourne Melbourne VIC
- Melbourne Poche Centre for Indigenous Health University of Melbourne Melbourne VIC
| | - Laura Tarzia
- Safer Families Centre University of Melbourne Melbourne VIC
- Centre for Family Violence Prevention, Royal Women’s Hospital Melbourne VIC
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18
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Lomax J, Meyrick J. Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault. J Health Psychol 2022; 27:305-331. [PMID: 32838568 PMCID: PMC8777327 DOI: 10.1177/1359105320950799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
| | - Jane Meyrick
- University of the West of England
Bristol, Bristol, UK
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19
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Yuen B, Billings J, Morant N. Talking to Others About Sexual Assault: A Narrative Analysis of Survivors' Journeys. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP9714-NP9737. [PMID: 31288608 DOI: 10.1177/0886260519861652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Previous research suggested the benefits for sexual assault survivors to talk about their trauma and its mental health implications, but it remained unclear what steps sexual assault survivors need to take to be able to have these conversations. To address this gap in the literature, this study aims to explore the journeys of sexual assault survivors with the use of narrative interviews to retain the richness of the data. This study reports the findings of a narrative analysis of the accounts of six female sexual assault survivors aged between 20 and 38. The analysis provides an individual case profile for each participant, the core aspects and tone of each narrative, and a cross-case analysis. The cross-case analysis reveals an overarching theme of "the bumpy journey" within which the individual difficulties encountered are examined. The analysis also reveals the two main factors that motivated the participant to strive to make a difference for other sexual violence survivors and to improve their mental health through talking about their experiences. The implications for services providing continuous and long-term support to sexual assault survivors and clinical practices are discussed.
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20
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Nabi AG, Mateen RM, Khalid A, Tariq A, Parveen R. Persistence of Semen on five different fabric types in various water environments. Forensic Sci Int 2021; 327:110944. [PMID: 34419677 DOI: 10.1016/j.forsciint.2021.110944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Evidence collected from biological fluids obtained from a crime scene is essentially important in forensic cases. A potential profile can be generated from these obtained samples and this can help in identifying the victims and/or suspects of sexual assault. The water environments selected for this study are all related to the potential crime scenes from which there is a possibility of finding a dead body or clothing of a sexual assault victim. Tap water, River water, Swimming pool water, and Canal water were selected. Fabric types selected were khaddar, linen, silk, polyester, and chiffon. Detection of seminal stains was carried out by three methods; Alternate Light Source (ALS), Acid phosphatase (AP) testing, and Kernechtrot-Picro-indigo-carmine (KPIC) testing. These tests were performed for each fabric type in each water environment after regular intervals, 24 h, 48 h, 72 h, 4 days, 7 days, and 14 days. This study aimed to compare the ability of five types of fabrics to retain seminal material after immersion in four different types of water environments. Fluorescence was only detected in tap water-soaked silk fabric after 14 days of immersion. Seminal fluid was detected in khaddar, chiffon, silk, and polyester in samples immersed for 14 days in tap water. Spermatozoa were retained by khaddar and silk immersed in tap water, Polyester fabric in tap and river water, Chiffon in only river water and Linen in swimming pool water when immersed for 14 days. However, fluorescence, seminal fluid or spermatozoa were not detected in linen fabric regardless of all the afore mentioned variables.
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Affiliation(s)
- Ahmed Ghulam Nabi
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan.
| | - Rana Muhammad Mateen
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan; Center for Applied Molecular Biology, CAMB, University of the Punjab, Lahore, Pakistan.
| | - Aqsa Khalid
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan.
| | - Asma Tariq
- Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan.
| | - Rukhsana Parveen
- Center for Applied Molecular Biology, CAMB, University of the Punjab, Lahore, Pakistan.
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21
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Wiener SJ, Fitzgerald S, Einhorn H. A trauma-informed guide to caring for adolescents following sexual assault. Curr Opin Pediatr 2021; 33:354-360. [PMID: 34039900 DOI: 10.1097/mop.0000000000001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexual assault is common among adolescents worldwide. Survivors of sexual assault may experience various immediate and long-term effects on their physical and mental health. It is important that pediatric healthcare providers (HCPs) are aware of the high prevalence of sexual assault and recognize the impact on their adolescent patients. The aim of this update is to discuss how pediatric HCPs can embody a trauma-informed approach when caring for survivors of sexual assault across various settings. RECENT FINDINGS All adolescent patients should be screened for sexual assault during routine clinical visits; in responding to a disclosure, providers should exhibit compassion, express validation, and help connect the patient to resources to aid in healing. Caring for survivors of sexual assault should ideally be multidisciplinary, involving treatment of the medical complications (including the possibility of pregnancy or infection) and mental health sequelae (including increased likelihood of depression, posttraumatic symptoms, and suicidality). SUMMARY A trauma-informed approach can be applied to all aspects of caring for survivors of sexual assault, from screening for sexual assault and responding to disclosure, to providing acute and longitudinal care following sexual assault.
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Affiliation(s)
- Susan J Wiener
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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22
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Palmieri J, Valentine JL. Using Trauma-Informed Care to Address Sexual Assault and Intimate Partner Violence in Primary Care. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Mason R, Du Mont J, Lanthier S, Macdonald S, Hyman I. Recognizing and Responding to the Commonly Misunderstood Reactions to Sexual Assault: Evaluation of an Online Curriculum. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:318-325. [PMID: 33786495 PMCID: PMC7784725 DOI: 10.1089/whr.2020.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/20/2022]
Abstract
Background: Sexual assault remains a serious public health issue with significant impacts on the health and well-being of individual women. Many women's reactions and behaviors post sexual assault are not well understood by the general public, or more worrying, among professionals to whom women frequently turn to for help. An innovative and evidence-informed online curriculum was developed to educate health and social service providers about the range of possible psychological responses and associated behaviors post sexual assault and to better equip them in supporting survivors in their recovery. Methods: The curriculum was evaluated using pre- and post-training tests designed to measure changes in fact-based knowledge, self-assessed knowledge, and procedural knowledge, that is, perceived competency. Results: A total of 759 participants registered to complete the curriculum between July 2018 and July 2019 and 175 completed both the pre- and post-training surveys. Data analyses showed significant improvement in the mean number of correct answers to the fact-based knowledge, self-reflection, and procedural knowledge questions from pre- to post-training. The response to the training was also very positive. Conclusions: The online curriculum was effective in improving participants' knowledge about and response to women who, in the aftermath of a sexual assault, may exhibit reactions or behaviors that are commonly misunderstood.
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Affiliation(s)
- Robin Mason
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephanie Lanthier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ilene Hyman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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24
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Caswell RJ, Maidment I, Ross JDC, Bradbury-Jones C. How, why, for whom and in what context, do sexual health clinics provide an environment for safe and supported disclosure of sexual violence: protocol for a realist review. BMJ Open 2020; 10:e037599. [PMID: 32554729 PMCID: PMC7304828 DOI: 10.1136/bmjopen-2020-037599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services. METHODS AND ANALYSIS To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories. DATA ANALYSIS A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field. ETHICS AND DISSEMINATION This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies. PROSPERO REGISTRATION DETAILS CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.
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Affiliation(s)
- Rachel J Caswell
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jonathan D C Ross
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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25
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Trentin D, Vargas MADO, Leal SMC, Vargas CP, Ferreira ML, Neves FBD. Women in situations of sexual violence: potentialities and weaknesses of the intersectoral network. Rev Bras Enferm 2020; 73:e20190856. [PMID: 32428122 DOI: 10.1590/0034-7167-2018-0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/14/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify potentialities and weaknesses of the intersectoral network for women in situations of sexual violence, from the perspective of Intervention Bioethics and the Universal Declaration on Bioethics and Human Rights. METHODS qualitative study conducted with multidisciplinary team members who work in intersectoral care services for women subject to sexual violence. It was held in a municipality in southern Brazil. An intentional sample, totaling 30 professionals. Semi-structured interview was used from January to April 2016. Interviews were analyzed by Thematic Analysis. RESULTS two categories emerged: potentialities and weaknesses related to the intersectoral network. Potentialities confirm the importance of the articulated intersectoral network; weaknesses such as lack of organized flow and disarticulation of services result in women revictimization and care fragmentation. Final Considerations: it is necessary to articulate services and qualify professionals. The Intervention Bioethics and the Universal Declaration on Bioethics and Human Rights foster discussions that contribute to how to organize and sustain the intersectoral network.
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Affiliation(s)
- Daiane Trentin
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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26
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Abavi R, Branston A, Mason R, Du Mont J. An Exploration of Sexual Assault Survivors' Discourse Online on Help-Seeking. VIOLENCE AND VICTIMS 2020; 35:126-140. [PMID: 32015073 DOI: 10.1891/0886-6708.vv-d-18-00148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although sexual assault is associated with significant negative psychological health outcomes, few survivors seek support from formal providers. This study explored the barriers to accessing and benefitting from services for sexual assault, as disclosed in narrative posts on social media, using qualitative methodology. Of the 1,179 narratives posted to the subreddit'r/rapecounseling' that were reviewed, 81 data extracts from 52 women were included in this study based on predefined inclusion/exclusion criteria. Six themes were identified that prevented survivors from accessing or benefitting from help. Internal barriers included feeling overwhelmed and avoidance-based coping. External barriers included availability of services, suitability of services, and therapist-caused harms. Stigma was the only barrier that was experienced both internally and externally. These findings suggest a need for more supportive mental health services.
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Affiliation(s)
- Rebecca Abavi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Allison Branston
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Robin Mason
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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27
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Recent trends in child rape crisis in Delhi (India): A forensic overview. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2019. [DOI: 10.1016/j.fsir.2019.100047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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28
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Ades V, Goddard B, Pearson Ayala S, Greene JA. Caring for long term health needs in women with a history of sexual trauma. BMJ 2019; 367:l5825. [PMID: 31640984 DOI: 10.1136/bmj.l5825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Veronica Ades
- NYU School of Medicine, Department of Obstetrics & Gynecology, New York, NY, USA
| | | | | | - Judy A Greene
- NYU School of Medicine, Department of Psychiatry, New York, NY, USA
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29
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Ullman SE, Lorenz K. Correlates of African American sexual assault survivors' medical care seeking. Women Health 2019; 60:502-516. [PMID: 31587625 DOI: 10.1080/03630242.2019.1671947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women's sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010-2011) to understand better African American women's sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.
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Affiliation(s)
- Sarah E Ullman
- Department of Criminology, Law and Justice, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine Lorenz
- Department of Criminology and Justice Studies, California State University, Northridge, USA
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Saberi HR, Motalebi Kashani M, Dehdashti A. Occupational violence among female workers in an Iranian industrial area. Women Health 2019; 59:1075-1087. [PMID: 30913999 DOI: 10.1080/03630242.2019.1593285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
Few studies have examined violence against female workers in the industrial sector. This study explored the prevalence of various types of violence and associated factors among female workers in the industrial sector. This descriptive survey was conducted in eleven industrial sites in Kashan, Iran, from April through September 2014. We used a 78-item questionnaire to obtain data from 817 female workers. More than half of the participants reported having experienced at least one type of violence. The prevalence rates of verbal aggression, sexual harassment, and physical violence were 52.5%, 12% and 11.5%, respectively. Single female workers (adjusted odds ratio [AOR] = 2.06, 95% CI = 1.09-4.27), and age older than 35 years were (AOR = 2.37, 95% CI = 1.26-2.93) each significantly related to increased odds of verbal violence. Short duration of employment (≤ five years) was the most strongly associated factor for sexual harassment (AOR = 2.82, 95% CI = 1.7-2.94). Working the night shift was significantly associated with encountering verbal violence (AOR = 2.79, 95% CI = 1.69-3.06). The high prevalence of violence suggests that management in industrial workplaces should invest time and resources in addressing violence. Developing a reporting procedure and training programs are recommended in dealing with workplace violence risk.
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Affiliation(s)
- Hamid Reza Saberi
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences , Kashan , Iran
| | - Masoud Motalebi Kashani
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences , Kashan , Iran
| | - Alireza Dehdashti
- Social Determinants of Health Research Center, Semnan University of Medical Sciences , Semnan , Iran
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Coker AL, Bush HM, Brancato CJ, Sprang G. Can the Impact of Interpersonal Violence on Current Health-Related Quality of Life Be Mitigated? J Womens Health (Larchmt) 2019; 28:1355-1367. [PMID: 30882265 DOI: 10.1089/jwh.2018.7017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: Interpersonal violence continues to affect health long after violence has ended. This analysis investigated stress, support, and health behaviors as mediators potentially explaining persistent health impacts of violence. Methods: Using a cross-sectional analysis of 12,594 women "Wellness, Health & You" (WHY) participants, authors measured violence as intimate partner violence (IPV), sexual assaults (SA), and childhood abuse (CA) by recency (current, past as an adult, or child) and number of violence forms. Current health-related quality of life (HR-QOL) was defined using the most recent survey as physical and mental health limiting usual activities for at least 4 days in the past 30 days. Adjusted prevalence rate ratios (aPRRs) for violence and HR-QOL were obtained using multiple variable log binomial regression where each mediator was included in separate models with demographic attributes. Results: In this sample of middle-aged women, half (n = 6307) had ever experienced violence (38.3% IPV, 12.9% SA, and 24.6% CA) and 19.9% reported multiple forms. IPV, SA, and CA were each associated with poorer current HR-QOL, yet, WHY participants experiencing all three forms had a sixfold increased rate of poor mental HR-QOL (Model 1: aPRRs = 6.23 [95% confidence interval, 95% CI: 4.87-7.97]) versus no violence. Stress was the mediator associated with the greatest change in aPRRs (-34.7%; Model 2: aPRR = 4.07 [95% CI: 3.13-5.30]). When all mediators were included (Model 5: aPRR = 3.01 [95% CI: 2.29-3.96]), partial mediation was observed, evidenced by nonoverlapping CIs between Models 1 and 5. Conclusions: Of relevance for interventions are findings that current health impacts of past violence may be mitigated through reducing current stress.
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Affiliation(s)
- Ann L Coker
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Heather M Bush
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Candace J Brancato
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Ginny Sprang
- Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.,Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, Kentucky.,Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, Kentucky.,Center on Trauma and Children, University of Kentucky, Lexington, Kentucky
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Changes in Psychiatric and Medical Conditions and Health Care Utilization Following a Diagnosis of Sexual Assault: A Retrospective Cohort Study. Med Care 2019; 56:649-657. [PMID: 29781924 DOI: 10.1097/mlr.0000000000000930] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sexual assault (SA) is alarmingly common and is associated with higher prevalence of psychiatric and medical conditions. However, many prior studies are limited to cross-sectional designs. Health care systems with electronic health records provide unique longitudinal data to examine whether SA is associated with changes in health and health care utilization. METHODS The sample included 1350 Kaiser Permanente Northern California adult female patients with a SA diagnosis from 2009 to 2015 and 4050 adult female patients without a SA diagnosis, matched on age, medical facility, and continuous enrollment during the study period. Using a retrospective cohort design, we tested whether a SA diagnosis was associated with 12-month changes in psychiatric and medical comorbidities and health care utilization using difference-in-difference models. Analyses were conducted in 2017. RESULTS Patients with a SA diagnosis had a higher prevalence of psychiatric and medical comorbidities and greater health care utilization than matched patients without SA in the 12 months before the SA diagnosis, and greater increases in the prevalence of psychiatric disorders and stress-related somatic conditions, and psychiatry and obstetrics/gynecology utilization (all P<0.001), 12 months after the SA diagnosis, relative to matched non-SA patients during this time. DISCUSSION SA is associated with increases in psychiatric disorders and stress-related somatic conditions as well as increases in utilization of psychiatry and obstetrics/gynecology. Clinicians should be trained in how to inquire about, respond to, and refer women who have experienced SA.
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Du Mont J, Kosa D, Macdonald S, Mason R. The promise of an interactive, online curriculum in improving the competence of those working in healthcare settings to address sexual assault. J Multidiscip Healthc 2017; 10:425-427. [PMID: 29270017 PMCID: PMC5729186 DOI: 10.2147/jmdh.s148075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Janice Du Mont
- Women's College Research Institute, Women's College Hospital.,Dalla Lana School of Public Health, University of Toronto
| | - Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Robin Mason
- Women's College Research Institute, Women's College Hospital.,Dalla Lana School of Public Health, University of Toronto
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