1. Factors Associated with Follow Up Care Use After Sexual Assault
Samantha K. Rifkin, MS Candidate
Dr. Christina Lattner and Dr. Barb Harris
Factors Associated with Follow Up Care Use After Sexual Assault
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Send to dropbox and printer on Oct. 8th and due date on Oct. 20th
Depaul Nursing, poster session, poster, 48 by 36, DePaul Nursing School Thesis Presentation
Introduction:
A sexual assault occurs once every 98 seconds in the United States. Although women are at a very high risk for sexual assault and rape, one out of every 10 rape victims are male. Gender queer individuals are at high risk for sexual assault as well. Although the terms “sexual assault” and “rape” are oftentimes used interchangeably, sexual assault refers to sexual contact that happens without the consent of the victim, while rape is a form of unwanted sexual contact involving forced and unwanted vaginal, anal, and/or oral penetration by the offender or a foreign object. The act of sexual assault, particularly rape, is an unpredictable and life threatening violation of the body and the mind that is pervasive to the victim’s sense of self and of well-being. Sexual violence is considered to be one of the most severe forms of trauma. Sexual assault carries both short and long term health consequences for the victim.
Purpose: The purpose of this integrated literature review is to identify factors associated with adult sexual assault and rape victims attending follow up care.
Results & Discussion:
The studies showed that the following characteristics were associated with attending follow up care status post sexual assault; being a younger age, amnesia surrounding the assault, alcohol use around the time of assault, genital trauma, receiving prophylactic pharmacological treatment at the initial treatment post assault, being assaulted in the home, having a social support network, expressing interest in counseling, being treated by a sexual assault nurse examiner during the initial visit post assault, a history of previous mental healthcare service use, having insurance coverage, a history of depression, and a history of prior treatment for alcohol abuse. The following characteristics were associated with decreased use of follow up care; homelessness, a diagnosis of a mental or physical disability, a psychiatric health diagnosis, cocaine use, intimate partner violence, the victim expressing doubt about their assault, amnesia surrounding the assault, a positive syphilis test during the initial treatment post assault, and alcohol or drug use by the assailant.
Conceptual Framework – Whittemore & Knafl 2
Nursing Implications:
Despite the high prevalence of sexual assault and rape in the United States, the number of victims who seek initial treatment following assault is low. The number of victims attend follow up care post assault is even lower. By identifying factors associated with use or non-use of follow up care, nurses, sexual assault nurse examiners, and other healthcare professionals can begin to identify barriers which prevent sexual assault victims from receiving the long term care they need to have a full physical and psychological recovery from their trauma. Addressing and removing barriers has the potential to improve both access to quality long term care and the victim’s physical, emotional, and psychological wellbeing.
Background/Significance:
Sexual assault victims may experience chronic pain, fibromyalgia, gastrointestinal disorders, headaches, and eating disorders. They also have a higher likelihood of developing cardiovascular disease, depression, anxiety, diabetes, and metabolic syndrome. Due to the violence of sexual trauma, victims are more likely to engage in self-harming and other unhealthy behaviors, such as high risk sexual activities and smoking. A sexual assault victim with post traumatic stress disorder is 13 more times likely to engage in alcohol abuse and 26 times more likely to develop drug abuse than those without a history of sexual assault. Despite the importance of disclosure and long-term treatment, the number of victims who seek services is low. Out of the 9.3 to 60 percent of victims who seek initial physical or mental healthcare, only 10 to 50 percent of those victims actually attend follow up care.
Methods:
Peer reviewed articles published between 1998 and 2018 were included in the literature review. The following databases were searched; CINAHL, Colchrane Library, ProQuest Nursing & Allied Health Source, and PubMed. Keywords used to search the database included; “sexual assault”, “rape”, “rape victim”, “follow up care”, “follow-up care”, “follow up treatment”, and “follow-up treatment”. Articles were excluded if they were from countries outside of North America, focused on initial treatment status post sexual assault, did not include rape victims, solely focused on military personnel, and solely focused on children under the age of 18 years.
Conclusion:
In order to ameliorate quality and access to long term care for sexual assault victims, it is crucial that healthcare professionals address and remove barriers that prevent victims from seeking and receiving the care they need. There have been a small number of studies which examine factors associated with follow up care. This literature review can serve as a guiding point for future research. By identifying factors associated with follow up care use, this may serve as a guide for future investigators to identify barriers which prevent sexual assault victims from seeking and accessing follow up care to promote physical and psychological healing.
References:
Ackerman, D.R., et al (2006). Sexual assault victims: factors associated with follow-up care. American Journal of Obstetrics and Gynecology. 194(6); ; Beyer Blodget, J. (2015). Sexual assault – a guide for primary care providers. Clinical Advisor. (Sept), 34-40; Boykins, A.D., Mynatt, S. (2007). Assault history and follow-up contact of women survivors of recent sexual assault. Issues in Mental Health Nursing. 28: ; Brown, R., et al (2013). A comparative analysis of victims of sexual assault with and without mental health histories; acute and follow-up care characteristics. Journal of Forensic Nursing. (9)2; 76-83; Darnell, D., et al (2015). Factors associated with follow-up attendance among rape victims seen in acute medical care. Psychiatry. 78(1); DOI: / ; Holmes, M.M., Resnick, H.S., Frampton, D. (1998). Follow-up of sexual assault victims. American Journal of Obstetrics and Gynecology. 179(2): ; Kalmakis, K.A., Banning, L.J. (2012). Web-based follow-up information for and research on victims of sexual assault. Online Journal of Nursing Informatics. 16(1). Retrieved 20 Feb 2018 from Price, M., et al (2014). Predictors of using mental health services after sexual assault. Journal of Traumatic Stress. 27(3): 331-7; Rape and sexual assault (2016). Bureau of Justice Statistics. Retrieved 4/1/2017 from Sachs-Ericsson, N., et al (2014). The influence of prior rape on the psychological and physical health functioning of older adults. Aging & Mental Health. 18(6); ; Statistics about sexual violence (2015). National Sexual Violence Resource Center. Retrieved 4/3/2017 from The psychological adjustment of the rape victim (2015). South Eastern Centre Against Sexual Assault & Family Violence. Retrieved 4/15/2017 from Whitemore, R., Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing. 52(5);