PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies

Adult attachment style, perceived social support, and post-traumatic stress among female victims of sexual assault

The present study aimed to investigate the interplay between adult attachment style, perceived social support, and post-traumatic stress (PTS) symptoms among adult female victims of sexual assault)SA(. While prior research has established the link between insecure attachment style and PTS, the underlying mechanisms are not well understood. The potential role of perceived social support as a mediator in this relationship has been largely neglected and there is a dearth of studies investigating this mediation among victims of SA. The present study sought to address this gap in literature. Two hundred twenty-six women who have endured SA completed self-report measures of attachment style, perceived social support, and PTS, using an online survey. The results confirmed the anticipated pattern, showing a positive correlation between insecure attachment styles and PTS, as well as a negative correlation with perceived social support. A mediation analysis indicated that perceived social support may be a mechanism linking attachment styles to PTS. Following SA, insecurely attached women, especially those with avoidant attachment, have difficulties relying on and utilizing support from their environment, which may render them more susceptible to PTS. Nevertheless, the mediation was partial, indicating that attachment anxiety and attachment avoidance independently contribute to the development and maintenance of PTS.

General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention

BACKGROUND

Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care.

METHODS

Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05.

RESULTS

Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001).

CONCLUSION

This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

Longitudinal patterns of posttraumatic stress disorder symptoms among sexual assault survivors: A latent transition analysis

OBJECTIVE

The aim of this study was to identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a community sample of sexual assault survivors whose assaults occurred varying lengths of time in the past and to explore patterns of transition between those latent classes over time.

METHOD

Latent class analysis was used to identify naturally occurring subgroups of PTSD symptoms in a sample of sexual assault survivors who completed two mailed surveys 1 year apart (N = 1,271). Latent transition analysis was then used to examine individuals' probabilities of transitioning into each latent class at Time 2 based on their latent class membership at Time 1.

RESULTS

A four-class model emerged as the best fitting model at both Time 1 and Time 2. Classes demonstrated overall severity and symptom cluster severity differences. Transition into a lower severity class was more common than transition into a higher severity class, though escalation was demonstrated by 6-20% of participants in each latent class.

CONCLUSIONS

The substantial heterogeneity in sexual assault survivors' PTSD symptoms highlights the variety of ways that posttraumatic stress may be experienced years after a sexual assault. Future research should explore factors that affect long-term symptoms, including cumulative lifetime trauma and social support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims

BACKGROUND

Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem.

AIMS

Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes.

METHODS

Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations.

RESULTS

Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored.

CONCLUSIONS

Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.

A qualitative study on the health system-related needs in women survivors of rape

BACKGROUND

Rape, as an adverse incidence, leads to irreparable complications and consequences in women. Provision of health services to women survivors of rape requires catering for their real needs and identifying current deficits as well as barriers. The present study aimed to explore health system-related needs in women survivors of rape.

METHODS

In the present qualitative study, the participants consisted of 39 individuals, including 19 women survivors of rape and 20 individuals with work experience in providing services to women survivors of rape. The participants were selected using the purposive sampling method with a maximum variation in Isfahan, Iran. Data were collected through in-depth interviews as well as field notes and were concurrently analyzed via conventional qualitative content analysis method.

RESULTS

After analyzing the interviews, the health system-related needs of women survivors of rape were classified into two main categories: 1- The need for efficient medical care services with three sub-categories, namely "receiving services with respect for privacy and confidentiality", "non-judgmental behavior and approach", and "the need to receive empathy and the feeling of not being alone", and 2- The need for desirable conditions and structure to provide services with two sub-categories, namely "the need to receive comprehensive and integrated services", and "establishing specialized centers for providing services to survivors".

CONCLUSIONS

Overall, explaining and highlighting the health system-related needs of women survivors of rape could provide a suitable basis for policy-making and planning according to their real needs. Receiving continuous services in separate centers with confidentiality and empathy could reduce the worries and concerns of women survivors of rape and help improve their health.

Exploring the roles of compassion and post-traumatic stress disorder on global distress after sexual trauma

OBJECTIVES

Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables.

METHODS

155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms.

RESULTS

An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution.

CONCLUSIONS

That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.

Longitudinal associations among experiences of sexual assault, posttraumatic stress disorder symptoms, and heavy drinking in young adults

Prior research with young adults has demonstrated clear associations between experiences of sexual assault, symptoms of posttraumatic stress disorder (PTSD), and alcohol use, but most studies have been cross-sectional or have not considered multiple theoretical pathways to understand these associations. Using six waves of data from a longitudinal cohort sample of 1,719 young adults, we examined associations among experiences of past-year sexual assault (i.e., rape, unwanted sexual touching, and physical intimidation in a sexual way), PTSD symptoms, and the frequency of binge drinking over time, allowing for the exploration of symptom-induced, interpersonal risk, and substance-induced pathways for male and female participants. For both male, βs = 2.84 to 6.55, and female participants, βs = 2.96 to 10.1, higher prior levels of PTSD symptoms were associated with larger increases in binge drinking over time. For female participants, higher prior levels of sexual assault were associated with larger increases in PTSD symptoms over time, βs = 3.48 to 4.25, whereas for male participants, higher prior levels of past-year binge drinking were associated with decreases in PTSD symptoms over time, βs = -2.75 to -0.53. Continued efforts are needed to prevent sexual assault among young adults and address PTSD symptoms among those who experience sexual assault. Interventions that target binge drinking are also needed for individuals who experience PTSD symptoms, especially young adults, to address potentially hazardous drinking before problems escalate and become chronic.

Reluctance to Make a "Blind Faith Jump": LGBTQ+ College Students' Perspectives on Allies' Barriers to Preventing Sexual Assault

Campus sexual assault is a significant problem across the United States, and research has indicated LGBTQ+ students are at a greater risk of victimization than their straight-cisgender peers. Furthermore, LGBTQ+ students face unique barriers to help-seeking following an assault, including fear of stigmatizing the LGBTQ+ community. We propose that straight-cisgender allies may act as vigilant bystanders who notice signs of sexual assault and offer assistance to prevent assault from happening to LGBTQ+ students and/or to offer support after an assault occurs. Yet, research on the role of bystanders in preventing and alleviating sexual assault has largely overlooked experiences and perspectives of LGBTQ+ students. In this study, we explored LGBTQ+ students' perceptions of the roles straight-cisgender allies may play in alleviating the problem of sexual assault of LGBTQ+ students. We conducted group interviews with 30 LGBTQ+ college students from 19 campuses across the United States, paying attention to what they perceived as barriers to allies' help. Findings illustrate ways that boundaries between LGBTQ+ insiders and outsiders can leave both groups reluctant to make a "blind faith jump" to seek or offer help. We propose suggestions for how sexual assault prevention programming may bridge this gap between LGBTQ+ students and straight-cisgender allies.

The day-to-day relationship between posttraumatic stress symptoms and social support after sexual assault

Background: Experiencing sexual assault is associated with a significant increase in risk for developing posttraumatic stress disorder and related concerns (e.g. alcohol misuse). Cross-sectional and longitudinal evidence suggests that social support may be both broadly protective against and eroded by posttraumatic stress symptoms. However, little is known about how different aspects of social support and posttraumatic stress symptoms influence each other in the weeks and months immediately following sexual assault, when posttraumatic stress (PTS) symptoms first emerge.Objective: The present study assessed the day-to-day relationship between social support and PTS in a sample of distressed, alcohol-using, recently-assaulted female survivors participating in a clinical trial of an app-based intervention (N = 41).Method: Participants completed 3 weeks of daily diaries starting within 10 weeks of sexual assault. Mixed-effects models were used to examine prior-day and same-day relationships between PTS and four social support constructs (social contact, emotional support, pleasantness of social interactions, and talking about sexual assault).Results: Results indicate that higher quantity and pleasantness of social interactions over the full sampling period was associated with lower PTS symptoms on any given day. Experiencing better-than-typical social interactions on one day was associated with lower than typical PTS symptoms on that day and the next day. On days when participants discussed their sexual assault with others, they tended to be having higher than usual PTS symptoms.Conclusions: Findings suggest that increasing the quantity and pleasantness of social interactions soon after sexual assault might protect against worsening posttraumatic stress symptoms.Trial registration: ClinicalTrials.gov identifier: NCT03703258.

Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study

BACKGROUND

Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment.

OBJECTIVE

This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both.

METHODS

Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance).

RESULTS

Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations.

CONCLUSIONS

Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.

Post-exposure prophylaxis, STI testing and factors associated with follow-up attendance: a review of 4159 cases of acute post-sexual assault medical care

BACKGROUND

Sexual assault (SA) is a prevalent issue with enduring consequences. Post-SA medical care mainly focuses on injuries, sexually transmitted infection (STI) prevention and detection, as well as preventing unwanted pregnancies. Swift access to post-SA medical care is vital with sexual assault treatment units (SATUs) streamlining this care. The primary aim of our study is to report on post-SA care provided at the national SATU network in Ireland with a secondary aim of analysing factors associated with follow-up attendance for STI testing.

METHODS

This is a retrospective cohort study of all acute attendances (<7 days from incident) at the national SATU network between 1 January 2017 to 31 December 2022.

RESULTS

A total of 4159 acute cases presented during the study period. Emergency contraception (EC) was administered to 53.8% (n=1899/3529) of cases, while postexposure prophylaxis (PEP) for chlamydia was given in 75.1% (n=3124/4159) and for HIV in 11.0% (n=304/3387). Hepatitis B vaccination was initiated in 53.7% (n=2233/4159) of cases. 1.4% (n=59/4159) of the attendees were referred to an emergency department for the treatment of injuries. Follow-up appointments were scheduled for 75.8% (3151/4159) of acute cases. 71.6% (n=2257/3151) attended follow-up.Certain factors were found to correlate with a higher likelihood of attending follow-up appointments: adolescents (p<0.0001), concern about drug-facilitated SA (DFSA) (p=0.01), no consumption of recreational drugs before the incident (p<0.0001), alcohol consumption prior to the incident (p=0.01), and not reporting the crime to the police (p<0.001). However, gender (p=0.06) and the presence of injury at time of primary attendance (p=0.97) were not predictive of likelihood of follow-up attendance.

CONCLUSION

This study demonstrates that EC, chlamydia PEP, HIV PEP and hepatitis B vaccination were all administered at SATU. A small proportion of attenders required emergency injury care. Factors influencing attendance at follow-up include age, drug use, alcohol use and police involvement, highlighting the need for tailored patient-centred support.

"I'm not going to do it alone": A qualitative study of barriers to sexual assault service-seeking among college students

Objective: To understand barriers to seeking post-sexual assault services for students of color and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) students. Methods: Qualitative interviews about campus and community resources for sexual and relationship violence were conducted with 29 undergraduate and graduate students who held diverse sexual, gender, and racial identities (n = 15 disclosed violence-related service-seeking). Results: Organized within trauma-informed care pillars, thematic coding revealed aspects of campus environment/culture that prevent students from accessing support including challenges identifying experiences as violence; limited cultural and identity-affirming care; limited clarity about resources; confidentiality concerns; difficulty accessing resources; and navigating resources alone. Suggestions to address concerns included regular prevention training; better coordinated care and systems with increased accountability, increased survivor support and peer support, and heightened transparency on websites/trainings about processes and confidentiality. Conclusions: Findings suggest promising avenues to improve support, particularly for minoritized survivors of violence, at this campus.

Factors Correlated With Sexual Assault Victimization Among College Students in the United States: A Meta-Analysis

Sexual assault (SA) continues to be a serious problem on college campuses in the United States. This meta-analysis sought to identify correlates for SA victimization on college campuses, as well as examine if there were any differences in correlates for men and women. Database searches utilizing Boolean search terms were used to identify studies to be included in the meta-analysis. Studies were included if they provided quantitative data on correlates for SA victimization among college students. A total of 118 studies yielding 405 unique effect sizes were included in this study. The strongest correlates for SA victimization among college students were physical intimate partner violence (IPV) perpetration, physical IPV victimization, emotional IPV victimization, and prior SA victimization. Other significant correlates were related to mental health (e.g., hopelessness, suicidal ideation, trauma symptoms, anxiety symptoms, depressive symptoms), and factors related to a campus party culture (e.g., binge drinking, alcohol use, drug use, Greek membership). We were able to compare seven correlates between men and women. Results of the meta-analysis also highlight the need for future research to examine additional correlates for SA victimization, as well as examine race/ethnicity and gender as separate categories when trying to further understand correlates for SA victimization.

Epidemical trends and risk factors of PTSD in parents of critically ill children: Evidence from both meta-analysis and subgroup analysis

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) in parents traumatized by a child's critical illness, while differences in prevalence and risk factors for parental PTSD in previous studies. This study aimed to assess trends in the prevalence and risk factors for PTSD in parents of critically ill children.

METHODS

Nine main databases were searched to extract the prevalence, sample size and risk factors from the published literature. Random effects model analysis, I2 statistic, quality assessment, subgroup analysis and sensitivity analysis were performed.

RESULTS

Twenty-five studies met the inclusion criteria, with pooled prevalence rates of 13.8 % (95 % CI: [confidence interval, CI] 10.0 %-17.7 %) in fathers and 20.2 % (95 % CI:16.1 %-24.3 %) in mothers. Mothers had a significantly higher prevalence of PTSD compared to fathers. The prevalence of PTSD generally increased after discharge, with the highest prevalence at 6 months, but then decreased (fathers: 18.0 %, CI: 6.1 %-29.9 %; mothers: 20.2 %, CI: 12.8 %-27.6 %), respectively. The results showed five risks, positive acute stress disorder (ASD) screening (OR [odds ratio, OR] =2.45), disease severity (OR = 3.78), perceived stress (OR = 1.44), unemployed status (OR = 2.52) and length of hospital stay (OR = 1.01).

LIMITATIONS

Due to the limitations of the original study, we could not explore trends in the prevalence of PTSD in this particular population over a more extended period after hospital discharge.

CONCLUSION

The prevalence of PTSD among parents of critically ill children is high and significantly different. Therefore, it is crucial to focus on this vulnerable group, providing them with essential psychological counseling and comprehensive social support to reduce the occurrence of PTSD.

Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

What are ambulance personnel experiences of sexual harassment and sexual assault in the workplace? A rapid evidence review

INTRODUCTION

Sexual assault and harassment of ambulance personnel in the workplace is widespread. Prevention via body worn cameras and legal efforts have been positive, however improvement is still needed to ensure the protection of staff from the negative impact of sexual violence at work.

METHODS

A rapid evidence review was conducted following the Cochrane Rapid Review guidance. MEDLINE and CINAHL Complete were searched from inception to February 2023. Screening and data extraction was conducted by one author and verified by the other. Included studies were appraised using a variety of critical appraisal checklists and a narrative synthesis was conducted.

RESULTS

From 46 articles screened, 7 were included in the review representing 3994 ambulance personnel from Australia, Canada, the United States, the United Kingdom and South Korea. Seven themes were identified, including a need for more training, education and resources regarding sexual assault and harassment, differences in perpetrators, poor experiences with organisations, effects on victims outside the workplace, effects on victims within the workplace, barriers to reporting, and increased prevalence of sexual assault and harassment against women.

CONCLUSION

The effect of sexual assault and harassment has far-reaching negative impact on victims' lives. More training and resources are recommended.

The Factors Affecting Longitudinal Course of Posttraumatic Stress Disorder Symptoms in Sexual Assault Victims

OBJECTIVE

This study aimed to identify the factors affecting posttraumatic stress disorder (PTSD) symptom remission prospectively through a 1-year follow-up of sexual assault (SA) victims.

METHODS

A total 65 female SA victims who visited the crisis intervention center were included. Self-administered questionnaires regarding PTSD symptoms and PTSD related prognostic factors were conducted at both recruitment (T1) and 1 year after recruitment (T2). The multivariate analyses were used to determine the significant predictors of PTSD remission/non-remission state 1 year after SA.

RESULTS

In logistic regression analysis, both anxiety and secondary victimization were identified as significant factors explaining the results on PTSD remission/non-remission state at T2 (Beck's Anxiety Inventory [BAI], p=0.003; Secondary Victimization Questionnaire, p=0.024). In a linear mixed analysis, both depression and anxiety were found to be significant variables leading to changes in Posttraumatic Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition from T1 to T2 (BAI, p<0.001; Center for Epidemiological Studies Depression Scale, p<0.001).

CONCLUSION

Depression, anxiety symptoms, and secondary victimization after SA were associated with PTSD symptom non-remission 1 year after SA.

Event-level positive and negative reinforcement risk factors for alcohol use: Moderation by individual-level alcohol consequences and post-traumatic stress disorder symptom severity

BACKGROUND

The multistage model of drug addiction posits that risk processes contributing to alcohol use change as individuals develop alcohol use disorders. However, few studies have tested this theory outside of the lab or at the event level. We assessed whether event-level associations between positive reinforcement (e.g., positive affect, sociability expectancies) and negative reinforcement risk factors (e.g., negative affect, tension reduction expectancies) and same-/next-day alcohol consumption varied as a function of an individual's level of alcohol consequences. Given elevated alcohol use consequences among individuals with post-traumatic stress disorder (PTSD) and disruptions in reward processing that affect this population, we also tested whether these processes differed based on the presence and severity of PTSD.

METHODS

We used data from a 30-day ecological momentary assessment study with 174 undergraduate women who regularly engaged in heavy episodic drinking. A majority (78%) of the sample had experienced sexual assault and 44% had current PTSD. Analyses used Bayesian multilevel structural equation modeling with diffuse (non-informative) priors. We used markov chain monte carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model.

RESULTS

Results partially supported the multistage model. Event-level negative reinforcement risk factors only predicted more alcohol consumption among individuals who experienced more alcohol consequences. Findings for positive reinforcement risk factors were partially consistent with hypotheses. Overall, findings appear to operate similarly across PTSD symptom severity.

CONCLUSIONS

Results suggest that interventions for heavy episodic drinking could benefit from attending to an individual's level of alcohol consequences. For example, preventive interventions for individuals who tend to experience few consequences may benefit more from addressing positive reinforcement risk factors, while treatment interventions for those who experience more consequences may benefit from attending to both positive and negative reinforcement.

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.

Online Social Reactions to Disclosure of Sexual Victimization via #MeToo and Symptoms of Post-Traumatic Stress Disorder

Sexual victimization is a major public health concern with significant consequences for survivors, their families, and society at large. Studies examining in-person disclosure of sexual victimization suggest that the way others respond to disclosure has a significant impact on survivors' well-being. With the advent of social media, more survivors are choosing to disclose their experience online. Research is needed to understand how social reactions to online disclosure of sexual victimization impact survivors. Accordingly, the current study examined the association between online social reactions to the disclosure of sexual victimization and symptoms of post-traumatic stress disorder (PTSD) symptoms in a sample of 195 individuals who disclosed their experience online via the hashtag #MeToo. Symptoms of PTSD were positively associated with the level of assault severity reported by the survivor, as well as receipt of online social reactions to disclosure via #MeToo that made fun, insulted, or said something to hurt the survivor. Online social reactions to disclosure via #MeToo that involved turning away from the survivor or providing unsupportive acknowledgment of the experience were unrelated with PTSD symptoms. PTSD symptoms were also not associated with the receipt of positive online social reactions to disclosure via #MeToo. Like research addressing in-person social reactions to disclosure of sexual victimization, some forms of online negative social reactions to disclosure of sexual victimization via #MeToo appear to be associated with worse psychological outcomes among survivors. Thus, online disclosure of sexual victimization and its impact needs to be attended to in clinical and research settings.

Providing a Supportive Environment for Disclosure of Sexual Violence and Abuse in a Sexual and Reproductive Healthcare Setting: A Realist Review

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.

Exploring Sociocultural Influences Affecting Body Image in Survivors of Childhood Sexual Assault

This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant's internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.

Cerebral cortical thinning in brain regions involved in emotional regulation relates to persistent symptoms in subjects with posttraumatic stress disorder

A considerable proportion of individuals exposed to trauma experience chronic and persistent posttraumatic stress disorder (PTSD). However, the specific brain and clinical features that render trauma-exposed individuals more susceptible to enduring symptoms remain elusive. This study investigated 112 trauma-exposed participants who had been diagnosed with PTSD and 112 demographically-matched healthy controls. Trauma-exposed participants were classified into those with current PTSD (persistent PTSD, n = 78) and those without (remitted PTSD, n = 34). Cortical thickness analysis was performed to discern group-specific brain structural characteristics. Coping strategies and resilience levels, assessed as clinical attributes, were compared across the groups. The persistent PTSD group displayed cortical thinning in the superior frontal cortex (SFC), insula, superior temporal cortex, dorsolateral prefrontal cortex, superior parietal cortex, and precuneus, relative to the remitted PTSD and control groups. Cortical thinning in the SFC was associated with increased utilization of maladaptive coping strategies, while diminished thickness in the insula correlated with lower resilience levels among trauma-exposed individuals. These findings imply that cortical thinning in brain regions related to coping strategy and resilience plays a vital role in the persistence of PTSD symptoms.

Trauma-Related Shame Mediates the Associations Between Self-Blame, Bisexual Minority Stress, and Rape-Related PTSD Symptoms

Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.

An ecological approach to understanding the impact of sexual violence: a systematic meta-review

Aim

A systematic meta-review was conducted to examine (1) the broad range of negative and positive individual and interpersonal changes following adult sexual violence, as well as (2) the risk/protective factors at multiple levels of the social ecology (e.g., individual, assault, and micro/meso/exo/macro/chronosystem factors)-influencing the impact of sexual violence.

Methods

Searches of Web of Science, Pubmed, and ProQuest resulted in inclusion of 46 systematic reviews or meta-analyses. Review findings were extracted for summary and a deductive thematic analysis was conducted.

Results

Experiencing sexual violence is associated with many negative individual and sexual difficulties as well as revictimization risk. Only a limited number of reviews reported on interpersonal and positive changes. Factors at multiple levels of the social ecology play a role in the intensity of these changes. Reviews including macrolevel factors were non-existent, however.

Conclusion

Reviews on sexual violence are fragmented in nature. Although the use of an ecological approach is often lacking, adopting such a perspective in research is necessary for a fuller understanding of the multiple influences on survivor outcomes. Future research should evaluate the occurrence of social and positive changes following sexual violence, as well as the role of macrolevel factors in influencing post-assault outcomes.

Pilot randomized clinical trial of an app-based early intervention to reduce PTSD and alcohol use following sexual assault

OBJECTIVE

Sexual assault is associated with high risk for posttraumatic stress disorder (PTSD), and PTSD often co-occurs with alcohol misuse. Most sexual assault survivors do not access early preventative interventions for such conditions. App-based interventions are a promising means to extend the reach of early interventions and thereby reduce risk of chronic PTSD and alcohol misuse.

METHOD

This study was a pilot randomized clinical trial of an app-based early intervention with phone coaching (THRIVE) for survivors of past-10-week sexual assault (NCT#: NCT03703258). Intended active components of the THRIVE app are daily cognitive restructuring, daily activity scheduling, and as-needed relationally focused exercises, supported by coaching calls. Forty-one adult female survivors of recent sexual assault with elevated posttraumatic stress and drinking were randomized to intervention or control (symptom-monitoring app with phone coaching). Participants in both conditions were encouraged to use their respective app for 21 days and completed self-report symptom assessments at baseline, postintervention, and 3-month follow-up.

RESULTS

At 3-month follow-up, the between-group effect size favored intervention for posttraumatic stress (d = -0.70), intoxication frequency (d = -0.62), and drinking hours per week (d = -0.39). More participants evidenced reliable change in intervention versus control for posttraumatic stress (OR = 2.67) and alcohol problems (OR = 3.05) at 3 months.

CONCLUSIONS

The general direction of effects indicates that THRIVE, coupled with coaching, reduces risk for PTSD and alcohol outcomes beyond coached monitoring. These findings suggest that apps like THRIVE may provide an option for early intervention for sexual assault survivors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reassessing the Confluence Model of Men's Risk for Sexual Aggression

Reassessing the confluence model of men's risk for sexual aggression-the confluence model of sexual aggression has been widely used to study men's risk for perpetrating sexual violence. Over time, researchers have attempted to expand this model to improve its predictive utility. Unfortunately, this work has continued to produce similar results with only slight improvements in prediction at best. One explanation for the inability to enhance the model could be due to changes in the dating landscape and shifts in beliefs about gender roles. Therefore, the current study aims to reassess the confluence model using a more contemporary construct, hostile sexism, in an effort to improve the predictive utility of the confluence model of sexual aggression. Participants were 258 college men recruited from a medium-sized public university in the northeastern United States, using an online participant pool of students who volunteered to participate as part of a requirement for a psychology course. Structural equation modeling using mean- and variance-adjusted weighted least squares estimation indicated that the confluence of hostile sexism and impersonal sex appears to be a better predictor of sexual aggression in comparison to the confluence of hostile masculinity and impersonal sex. The results suggest that replacing hostile masculinity with hostile sexism may produce a model that is better able to predict men's risk for perpetrating sexual aggression. These results can provide insight for future iterations of the confluence model, which may include hostile sexism as a core construct. Attitudes that stem from hostile sexism may be a beneficial target for future interventions designed to decrease the frequency of perpetration.

"It is Hard to Think About": A Mixed-Method Exploration into the Application of the Theory of Compassion Collapse to the #MeToo Movement

After the popularization of #MeToo in 2017, the conversation around sexual violence was brought to global attention. The collapse of compassion theory is proposed to occur in situations where individuals no longer feel increased levels of empathy due to an increase in the number of victims. This theory was employed to attempt to understand negative responses to #MeToo. The current study used a mixed methods exploratory approach to understand how exposure to multiple versus single victim(s) (image(s) and vignette) of sexual violence may affect participants' perception of survivors of sexual violence. We hypothesized that individuals who were exposed to multiple victims would demonstrate less compassion, higher levels of distance, more diffusion of responsibility, lower perceived efficacy, and less belief of the victim's story compared to individuals who were exposed to a single victim. We hypothesized that individuals with higher levels of rape myth acceptance (RMA) would endorse greater rates of distance and diffusion, and lower rates of compassion, efficacy, and belief. Participants, recruited via MTurk, were randomized into a single-image group or an eight-image group accompanied by a vignette explaining that the woma(e)n were victim(s) of sexual violence and naming the #MeToo movement. Participants in the single-image group expressed more belief in the victim's story and endorsed higher levels of psychological distance than the eight-image group. Higher rates of RMA related to less belief and compassion for victims and increased distance. In the qualitative analysis, three content areas were identified: (a) comments on woman(en), (b) comments on #MeToo, and (c) comments on sexual violence. The majority of responses expressed support for the #MeToo movement, with a smaller percentage expressing highly critical views including questions on the inclusivity of #MeToo and sexualization of the woman(en) in the vignettes. Implications and integration of results are discussed.

Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization. Integrated interventions aimed at reducing PTSD and AUD symptoms following recent sexual assault are needed and should address barriers to care and early treatment termination. The proposed study will test a novel, brief (5 to 7 sessions) intervention that integrates Written Exposure Therapy for PTSD and Cognitive Behavioral Therapy for AUD, and is initiated within the first six weeks post-assault. In Phase 1, qualitative analysis of content gathered during focus groups with treatment providers will be conducted to inform intervention development. In Phase 2, a proof-of-concept pilot study (n = 10) of the intervention, Substance Use Skills Training and Exposure Post-Sexual Assault (STEPS), will be conducted. In Phase 3, a pilot randomized controlled trial (RCT) among 54 recent sexual assault survivors will be implemented using the updated manualized STEPS intervention to evaluate feasibility and preliminary efficacy in reducing PTSD and AUD symptoms. Ecological momentary assessments will be used to assess daily alcohol use, craving, affect, intrusions and avoidance. The effects of STEPS on commonly associated symptoms (e.g., depression, substance use) will be examined. The proposed study has the potential to make a significant public health impact by advancing knowledge on the link between sexual assault and co-occurring PTSD and AUD and informing early intervention efforts for this high-risk population.

Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape

Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R² = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R² = .619; p < .001) and depressive symptoms (R² = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.

Comorbid posttraumatic stress disorder and alcohol use disorder in low- and middle-income countries: A narrative review

Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.

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.

Disclosure Recipients' Perceptions Related to Helping Victims of Dating and Sexual Violence

To date, research on social reactions to dating and sexual violence (DSV) disclosure has largely neglected the perspective of disclosure recipients. Moreover, few studies have explored disclosure recipients' perceptions of the victim and perceptions of their own effectiveness in helping as well as the correlates of these perceptions. The purpose of this study was to address these gaps in the literature. Participants were 783 college students (73.0% female) who reported receiving a DSV disclosure in the past 6 months. Participants who provided more negative social reactions to victim disclosures were less likely to empathize with the victim and more likely to feel victim blame/burdensomeness and confusion/ineffectiveness in their responses. Conversely, those providing more positive social reactions were more likely to empathize with the victim and were less likely to report victim blame/burdensomeness and confusion/ineffectiveness. Further, recipients with a DSV victimization history were more likely to report empathy for the victim. Being a man and having higher post-traumatic stress symptoms were associated with greater victim blame/burdensomeness, while the victim approaching the recipient to disclose and DSV experiences that occurred long ago were associated with lower victim blame/burdensomeness. Finally, depressive symptoms, receiving disclosures from a stranger/casual friend, and less frequent discussion about the incident were significantly associated with increased confusion/ineffectiveness. These findings suggest that perceptions of the victim and helping effectiveness, and factors associated with them, may be promising targets of programs seeking to reduce negative and increase positive social reactions to DSV disclosures.

Increased immuno-inflammatory mediators in women with post-traumatic stress disorder after sexual assault: 1-Year follow-up

BACKGROUND

Sexual violence is a traumatic event that can trigger post-traumatic stress disorder (PTSD) and generate biological responses to stress characterized by inhibiting the hypothalamic-pituitary axis (HPA), altering immune activity, and changing the structure and function of the brain. PTSD is associated with increased levels of inflammatory markers. This study aimed to measure differences in inflammatory markers and HPA hormone levels between women with PTSD due to sexual violence and controls at baseline and after 1-year follow-up.

METHODS

Fifty-eight women with PTSD resulting from sexual assault occurring up to 6 months prior were compared to 41 female controls. The patients were followed for 1 year. At baseline (T1), we measured inflammatory biomarkers. We also applied the Mini International Neuropsychiatric Interview (MINI), the Clinician-Administered Post-Traumatic Stress Disorder Scale-5, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Childhood Trauma Questionnaire. The patients were randomized to receive treatment with sertraline or interpersonal psychotherapy for 14 weeks (T2) and then continued the usual treatment if deemed necessary for 1 year. The same interviews and examinations were repeated after 1 year (T3).

RESULTS

At baseline, the patients had significantly higher adrenocorticotropic hormone levels, compared to controls; however, there was no baseline difference in inflammatory markers or cortisol. After 1 year, there were significantly higher levels of interleukin-1β (p < 0.0001), monocyte chemoattractant protein-1 (p < 0.0001), tumor necrosis factor-α (p < 0.0001), c-reactive protein (p < 0.0001), and cortisol (p = 0.046) in the patient group. In addition to PTSD, 56 patients presented with a major depressive episode at T1 (according to the MINI). At the end of 1 year, there was a significant improvement in depressive (p < 0.001), anxiety (p = 0.03), and PTSD symptoms (p < 0.001) regardless of the treatment received.

DISCUSSION

The increase of the inflammatory markers after 1 year, even with symptomatic improvement, may indicate that PTSD following sexual violence is associated with high depressive symptoms. This association may have a different pattern of immunoendocrine alterations than PTSD only. Furthermore, these alterations may persist in the long term, even with the improvement of the symptoms, probably generating an immunological imprint that can lead to future clinical consequences. This study adds to the current knowledge of PTSD neurobiology and contributes to broadening approaches to this disorder.

The Involvement of Past Traumatic Life Events in the Development of Postpartum PTSD after Cesarean Delivery

Background: Although childbirth is considered a natural process, a high percentage of postpartum women consider it traumatic. Any previous traumatic event in a woman’s life can be revived through a traumatic birth experience, especially after a complicated vaginal delivery or cesarean delivery. The purpose of this study was to clarify the relationship between previous traumatic life events and posttraumatic stress disorder (PTSD) in postpartum women after cesarean section and which specific events exerted the greatest influence. Methods: A sample of 469 women who had undergone cesarean sections at a Greek university hospital consented to participate in this prospective study. Data from a medical/demographic questionnaire, life events checklist, perinatal stressor criterion A, and posttraumatic stress checklist were used to evaluate past traumatic life events and diagnose postpartum posttraumatic stress. Results: Out of 469 women, 25.97% had PTSD and 11.5% a PTSD profile, while 2.7% had PTSD and 2.7% a PTSD profile. Also, it appeared that only specific direct exposure to a traumatic event and/or witnessing one were predictors of postpartum PTSD. Conclusions: This survey identified specific traumatic life events, psychiatric history, stressor perinatal criterion A, preterm birth, and emergency cesarean section as risk factors for the development of PTSD or a PTSD profile in women after cesarean delivery.

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.

Adiponectin gene polymorphisms and posttraumatic stress disorder symptoms among female rape survivors: an exploratory study

Background: Rape is a common traumatic event which may result in the development of posttraumatic stress disorder (PTSD), yet few studies have investigated risk biomarkers in sexually traumatised individuals. Adiponectin is a novel cytokine within inflammatory and cardiometabolic pathways with evidence of involvement in PTSD. Objective: This prospective exploratory study in a sample of female rape survivors investigated the association of single nucleotide polymorphisms (SNPs) in the adiponectin gene (ADIPOQ) and posttraumatic stress symptom (PTSS) severity, and the interaction of these SNPs of interest with childhood trauma in modifying the association with PTSS severity. Method: The study involved 455 rape-exposed black South African women (mean age (SD), 25.3 years (±5.5)) recruited within 20 days of being raped. PTSS was assessed using the Davidson Trauma Scale (DTS) and childhood trauma was assessed using a modified version of the Childhood Trauma Scale-Short Form Questionnaire. Eight ADIPOQ SNPs (rs17300539, rs16861194, rs16861205, rs2241766, rs6444174, rs822395, rs1501299, rs1403697) were genotyped using KASP. Mixed linear regression models were used to test additive associations of ADIPOQ SNPs and PTSS severity at baseline, 3 and 6 months following rape. Results: The mean DTS score post-sexual assault was high (71.3 ± 31.5), with a decrease in PTSS severity shown over time for all genotypes. rs6444174TT genotype was inversely associated with baseline PTSS in the unadjusted model (β = -13.6, 95% CI [-25.1; -2.1], p = .021). However, no genotype was shown to be significantly associated with change in PTSS severity over time and therefore ADIPOQ SNP x childhood trauma interaction was not further investigated. Conclusion: None of the ADIPOQ SNPs selected for investigation in this population were shown to be associated with change in PTSS severity over a 6-month period and therefore their clinical utility as risk biomarkers for rape-related PTSD appears limited. These SNPs should be further investigated in possible gene-gene and gene-environment interactions.