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Miles LW, Valentine JL, Mabey LJ, Hopkins ES, Stodtmeister PJ, Rockwood RB, Moxley ANH. A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims. J Am Psychiatr Nurses Assoc 2024; 30:480-502. [PMID: 38148646 PMCID: PMC11138126 DOI: 10.1177/10783903231216138] [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] [Indexed: 12/28/2023]
Abstract
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.
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Affiliation(s)
- Leslie W. Miles
- Leslie W. Miles, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Julie L. Valentine
- Julie L. Valentine, PhD, RN, SANE-A, FAAN, University of Utah, Salt Lake City, UT, USA
| | - Linda J. Mabey
- Linda J. Mabey, DNP, PMHCNS-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | | | - Paige J. Stodtmeister
- Paige J. Stodtmeister, DNP, PMHNP-BC Brigham Young University College of Nursing, Provo, UT, USA
| | - Reilly B. Rockwood
- Reilly B. Rockwood, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Alyssa N. H. Moxley
- Alyssa N. H. Moxley, DNP, CNM, WHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
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Caro P, Turner W, Caldwell DM, Macdonald G. Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev 2023; 6:CD013361. [PMID: 37279309 PMCID: PMC10243720 DOI: 10.1002/14651858.cd013361.pub2] [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] [Indexed: 06/08/2023]
Abstract
BACKGROUND Following sexual abuse, children and young people may develop a range of psychological problems, including anxiety, depression, post-traumatic stress disorder (PTSD), and a range of behaviour problems. Those working with children and young people experiencing these problems may use one or more of a range of psychological approaches. OBJECTIVES To assess the relative effectiveness of psychological interventions compared to other treatments or no treatment controls, to overcome psychological consequences of sexual abuse in children and young people up to 18 years of age. Secondary objectives To rank psychotherapies according to their effectiveness. To compare different 'doses' of the same intervention. SEARCH METHODS In November 2022 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and two trials registers. We reviewed the reference lists of included studies, alongside other work in the field, and communicated with the authors of included studies. SELECTION CRITERIA We included randomised controlled trials comparing psychological interventions for sexually abused children and young people up to 18 years old with other treatments or no treatments. Interventions included: cognitive behavioural therapy (CBT), psychodynamic therapy, family therapy, child centred therapy (CCT), and eye movement desensitisation and reprocessing (EMDR). We included both individual and group formats. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the risk of bias for our primary outcomes (psychological distress/mental health, behaviour, social functioning, relationships with family and others) and secondary outcomes (substance misuse, delinquency, resilience, carer distress and efficacy). We considered the effects of the interventions on all outcomes at post-treatment, six months follow-up and 12 months follow-up. For each outcome and time point with sufficient data, we performed random-effects network and pairwise meta-analyses to determine an overall effect estimate for each possible pair of therapies. Where meta-analysis was not possible, we report the summaries from single studies. Due to the low number of studies in each network, we did not attempt to determine the probabilities of each treatment being the most effective relative to the others for each outcome at each time point. We rated the certainty of evidence with GRADE for each outcome. MAIN RESULTS We included 22 studies (1478 participants) in this review. Most of the participants were female (range: 52% to 100%), and were mainly white. Limited information was provided on socioeconomic status of participants. Seventeen studies were conducted in North America, with the remaining studies conducted in the UK (N = 2), Iran (N = 1), Australia (N = 1) and Democratic Republic of Congo (N = 1). CBT was explored in 14 studies and CCT in eight studies; psychodynamic therapy, family therapy and EMDR were each explored in two studies. Management as usual (MAU) was the comparator in three studies and a waiting list was the comparator in five studies. For all outcomes, comparisons were informed by low numbers of studies (one to three per comparison), sample sizes were small (median = 52, range 11 to 229) and networks were poorly connected. Our estimates were all imprecise and uncertain. Primary outcomes At post-treatment, network meta-analysis (NMA) was possible for measures of psychological distress and behaviour, but not for social functioning. Relative to MAU, there was very low certainty evidence that CCT involving parent and child reduced PTSD (standardised mean difference (SMD) -0.87, 95% confidence intervals (CI) -1.64 to -0.10), and CBT with only the child reduced PTSD symptoms (SMD -0.96, 95% CI -1.72 to -0.20). There was no clear evidence of an effect of any therapy relative to MAU for other primary outcomes or at any other time point. Secondary outcomes Compared to MAU, there was very low certainty evidence that, at post-treatment, CBT delivered to the child and the carer might reduce parents' emotional reactions (SMD -6.95, 95% CI -10.11 to -3.80), and that CCT might reduce parents' stress. However, there is high uncertainty in these effect estimates and both comparisons were informed only by one study. There was no evidence that the other therapies improved any other secondary outcome. We attributed very low levels of confidence for all NMA and pairwise estimates for the following reasons. Reporting limitations resulted in judgements of 'unclear' to 'high' risk of bias in relation to selection, detection, performance, attrition and reporting bias; the effect estimates we derived were imprecise, and small or close to no change; our networks were underpowered due to the low number of studies informing them; and whilst studies were broadly comparable with regard to settings, the use of a manual, the training of the therapists, the duration of treatment and number of sessions offered, there was considerable variability in the age of participants and the format in which the interventions were delivered (individual or group). AUTHORS' CONCLUSIONS There was weak evidence that both CCT (delivered to child and carer) and CBT (delivered to the child) might reduce PTSD symptoms at post-treatment. However, the effect estimates are uncertain and imprecise. For the remaining outcomes examined, none of the estimates suggested that any of the interventions reduced symptoms compared to management as usual. Weaknesses in the evidence base include the dearth of evidence from low- and middle-income countries. Further, not all interventions have been evaluated to the same extent, and there is little evidence regarding the effectiveness of interventions for male participants or those from different ethnicities. In 18 studies, the age ranges of participants ranged from 4 to 16 years old or 5 to 17 years old. This may have influenced the way in which the interventions were delivered, received, and consequently influenced outcomes. Many of the included studies evaluated interventions that were developed by members of the research team. In others, developers were involved in monitoring the delivery of the treatment. It remains the case that evaluations conducted by independent research teams are needed to reduce the potential for investigator bias. Studies addressing these gaps would help to establish the relative effectiveness of interventions currently used with this vulnerable population.
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Affiliation(s)
- Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - William Turner
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Heard E, Walsh D. Group Therapy for Survivors of Adult Sexual Assault: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:886-898. [PMID: 34510985 DOI: 10.1177/15248380211043828] [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: 05/03/2023]
Abstract
Across the world, women experience significant rates of sexual assault and there is a need to strengthen support services offered to survivors. Group therapy could provide an important addition to services that support healing and growth; however, the effectiveness of group therapy interventions with survivors of adult sexual assault is not well understood and clearer insights into designing and running group therapy interventions require further exploration. This review synthesizes literature exploring group therapy for survivors of adult sexual assault to inform future interventions and research implementing group therapy. A systematic approach was used to gather literature describing and evaluating group therapy interventions with survivors of adult sexual assault. Of the initial 466 articles identified through a comprehensive search strategy including database and hand searches, 32 met the inclusion criteria by describing a group therapy intervention conducted with survivors of adult sexual assault. A thematic approach to analysis was conducted to synthesize and collate the literature. Findings explore potentially useful strategies and characteristics of group therapy with survivors of adult sexual assault and make recommendations for the design and evaluation of future interventions. Group therapy has potential as a valuable support service provided to survivors but further rigorous research and evaluations are required to better capture outcomes and understand how to design and implement effective interventions.
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Affiliation(s)
- Emma Heard
- University of Queensland, Saint Lucia, Queensland, Australia
| | - Deborah Walsh
- University of Queensland, Saint Lucia, Queensland, Australia
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Pognon Q, Tremblay-Perreault A, Hébert M. Efficacité d’une intervention pour les adolescentes victimes d’agression sexuelle. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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5
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Taha PH, Slewa-Younan S. Measures of depression, generalized anxiety, and posttraumatic stress disorders amongst Yazidi female survivors of ISIS slavery and violence. Int J Ment Health Syst 2020; 14:80. [PMID: 33292425 PMCID: PMC7654580 DOI: 10.1186/s13033-020-00412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2014 the Islamic State of Iraq and Syria (ISIS) undertook a systematic and deliberate campaign against minority groups and non-Sunni Muslim communities. Amongst some of the greatest atrocities were those targeted towards Yazidi communities and in particular their women. The mental health outcomes of those women held in captivity requires investigation. This study sought to examine and compare levels of general psychological distress, depression, generalized anxiety, posttraumatic stress disorder (PTSD) and self-reported suicidal thoughts and behaviors amongst Yazidi women held in captivity compared with those without such experiences. METHOD Between January to May 2019, a total 348 Yazidi women located in internal displaced person (IDP) camps were interviewed. Of these 348, 139 females were survivors of ISIS captivity. Measures used included Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Harvard Trauma Questionnaire part IV (HTQ part IV). RESULTS Formerly enslaved Yazidi females showed a significantly higher prevalence of severe mental distress (97.1%; P < 0.001), more severe levels of depression (36.7%; P < 0.001) and general anxiety symptoms (37.4%; P < 0.001), greater rates of PTSD (90.6%; P < 0.001) and higher reported rates of suicidal ideation (38.1%; P < 0.001). Logistic regression analysis undertaken to examine the role of sociodemographic factors as predictors of the assessed mental health conditions. Amongst the formerly enslaved group, no such significance was found, however amongst the non-enslaved group, unemployment was found to statistically determine depression, generalized anxiety and PTSD. Specifically, women from the non-enslaved group who were unemployed were 2.5 times more likely to have depression, 3 times more likely to have generalized anxiety and 3.3 times more likely to have PTSD. Finally, amongst the non-enslaved group, those women with between 5 to 8 siblings were significantly less likely to have depression than those with fewer siblings. CONCLUSION Rates of distress and trauma related symptomology were significantly higher amongst those with history of enslavement. Sociodemographic factors and duration of enslavement do not seem to predict mental disorders among enslaved females.
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Affiliation(s)
| | - Shameran Slewa-Younan
- School of Medicine, Humanitarian and Development Research Initiative, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South DC NSW, Sydney, 1797 Australia
- Honorary Senior Research Fellow, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Louison Vang M, Ali SA, Christiansen DM, Dokkedahl S, Elklit A. The role of age and mode of delivery in the STEPS intervention: a longitudinal pilot-study in treatment of posttraumatic stress symptoms in Danish survivors of sexual assault. Eur J Psychotraumatol 2020; 11:1701778. [PMID: 32082508 PMCID: PMC7006682 DOI: 10.1080/20008198.2019.1701778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The STEPS programme has been succesfully implemented as a group-based treatment of trauma symptoms after rape for adolescents. The STEPS intervention was translated from Dutch to Danish and offered to adults in addition to adolescents as well as an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. The programme was translated from Dutch to Danish and expanded to adults in addition to adolescents as well as to an individual intervention in addition to a group-based intervention at a Danish Centre for Rape Victims through 2011 to 2014. Objective: The present study observes development in trauma symptoms and ICD-11 diagnostic status during an adapted version of the intervention programme 'STEPS' for survivors of sexual assault. Methods: A prospective uncontrolled study was conducted, monitoring symptoms of posttraumatic stress and other trauma-related symptomatology before treatment, after treatment and at 6 and 12 months' follow up for 103 referrals receiving individual or group-based STEPS. Tentative diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD were assigned to participants according to the ICD-11 to observe the development in diagnostic status across time, and multilevel modelling was used to assess the development of symptom severity and to assess the moderating effect of age-group and mode of delivery. Results: A loglinear function representing large and statistically significant decline in symptomatology over time provided the best fit for all measures of trauma-related symptomatology. The decline was not moderated by age-group or mode of intervention. Dropout rates were independent of mode of intervention and age. Conclusion: The adaption of the STEPS programme to adults and as an individual intervention is feasible and maintains effect sizes comparable to those observed in the original intervention. Further research using randomized controlled trials is needed to ascribe the observed effect to the STEPS programme.
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Affiliation(s)
- M Louison Vang
- School of Psychology, Ulster University, Northern Ireland, UK.,The Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT).,National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - S A Ali
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - D M Christiansen
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - S Dokkedahl
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - A Elklit
- National Center for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
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7
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Quidé Y, Andersson F, Dufour-Rainfray D, Descriaud C, Brizard B, Gissot V, Cléry H, Carrey Le Bas MP, Osterreicher S, Ogielska M, Saint-Martin P, El-Hage W. Smaller hippocampal volume following sexual assault in women is associated with post-traumatic stress disorder. Acta Psychiatr Scand 2018; 138:312-324. [PMID: 29952088 DOI: 10.1111/acps.12920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Exposure to sexual assault is a significant risk factor to develop post-traumatic stress disorder (PTSD) in females. The early neurobiological changes leading to the development of PTSD remain understudied and unclear in this population. METHODS Participants were 27 adult females recruited within a month following exposure to sexual assault (T1) and 20 age-matched non-exposed controls. Among the victims, 10 participants met (PTSD+) and 15 did not meet (PTSD-) DSM-IV criteria for PTSD 6 months post-trauma (T2). At both visits, hippocampal and amygdala volumes were extracted from magnetic resonance imaging scans, and indices of total diurnal cortisol changes were derived from individual areas under the curve relative to the ground (AUCg). Measures at T1 were compared between groups at T1, measures at T2 between groups at T2, and measures at T1 between groups at T2. RESULTS At T1, victims had significantly smaller bilateral hippocampal volumes, but not AUCg, than controls. At T2, neither hippocampal volume nor AUCg significantly differed among the groups. However, the PTSD+ group had significantly smaller hippocampal volumes at T1 than the control group, but not compared to the PTSD- group. CONCLUSIONS This study indicates that having smaller hippocampal volumes is a risk factor to develop PTSD in females exposed to sexual assault.
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Affiliation(s)
- Y Quidé
- School of Psychiatry, University of New South Wales (UNSW), Randwick, NSW, Randwick, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - F Andersson
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - D Dufour-Rainfray
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | - C Descriaud
- Centre for Victims of Sexual Assault, CHRO, Orléans, France
| | - B Brizard
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - V Gissot
- CIC 1415, Inserm, Clinical Investigation Centre, CHRU de Tours, Tours, France
| | - H Cléry
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - M-P Carrey Le Bas
- Departmental Association for Assistance to Victims of Criminal Offenses, ADAVIP 37, France Victims 37, Tours, France
| | - S Osterreicher
- Centre for Victims of Sexual Assault, CH de Blois, Blois, France
| | | | | | - W El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France.,CIC 1415, Inserm, Clinical Investigation Centre, CHRU de Tours, Tours, France
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Villalta L, Smith P, Hickin N, Stringaris A. Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review. Eur Child Adolesc Psychiatry 2018; 27:527-544. [PMID: 29380069 DOI: 10.1007/s00787-018-1105-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/03/2018] [Indexed: 11/27/2022]
Abstract
This article provides a quantitative and conceptual review of emotion regulation difficulties in trauma-exposed young people, and informs future directions in the field. Despite long-standing interest in the influence of emotion regulation difficulties on different internalizing and externalizing psychiatric disorders in childhood, several questions remain unresolved with respect to children and adolescents with PTSD (post-traumatic stress disorder). Meta-analytic data from adult victims suggest that emotion regulation problems are associated with PTSD, but this has never been studied in children and young people. We therefore provide a conceptual review of features related to the phenomenology, assessment, severity and treatment of emotion regulation difficulties in trauma-exposed children and young people. We combine this with a meta-analysis of published literature. We searched studies in Medline, PsychINFO, and Embase databases based on pre-selected criteria. Eight hundred and eighty-six papers were identified and 41 were included. We found that children and adolescents with a diagnosis of PTSD reported more emotion regulation difficulties than those who did not develop PTSD, and that the overall association between the two symptom dimensions was moderately strong. We identify a number of research priorities: the development of instruments to assess emotion regulation difficulties in children, the design of studies that describe its prevalence in young epidemiological traumatized samples, its predictive role in the onset, severity and persistence of post-traumatic symptoms, and its relevance as a moderator, outcome or treatment target for young survivors.
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Affiliation(s)
- L Villalta
- Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Passeig de Sant Joan de Déu, 2, Esplugues de Llobrega, 08950, Barcelona, Spain.
| | - P Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Hickin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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