Objective
Rape is associated with
Posttraumatic Stress Disorder and related comorbidities. Most victims do not
obtain treatment for these conditions. Acute care medical settings are
well-positioned to link patients to services; however, difficulty engaging
victims and low attendance at provided follow-up appointments is well
documented. Identifying factors associated with follow-up can inform engagement
and linkage strategies.
Method
Administrative, patient
self-report, and provider observational data from Harborview Medical Center
were combined for the analysis. Using logistic regression, we examined factors
associated with follow-up health service utilization after seeking services for
rape in the emergency department.
Results
Of the 521 diverse female
(n=476) and male (n=45) rape victims, 28% attended the recommended
medical/counseling follow-up appointment. In the final (adjusted) logistic
regression model, having a developmental or other disability, having a current mental illness, and
being assaulted in public were uniquely associated
with reduced odds of attending the follow-up. Having a prior mental health
condition, a completed SANE examination, and social support available to help cope with the assault were associated with an increased odds of attending
the follow-up.
Conclusions
Findings point to relevant
characteristics ascertained at the acute care medical visit for rape that may
be used to identify victims less likely to obtain posttraumatic medical and
mental health services. Efforts to improve service linkage among these patients
is warranted and may require alternative models to engage these patients to
support posttraumatic recovery.
…In our analysis, routine
pre-scheduling of follow-ups in the ED did not appear to result in better
follow-up rates than pre-scheduling follow-ups based on provider judgment or
patient request. It may actually be more important who schedules the follow-up.
At Harborview, ED social workers schedule the follow-up appointments; however,
it is possible that appointments scheduled by SANEs who spend 2-4 hours with
the patient at this vulnerable time would result in greater follow-up. Brown and colleagues (2013) were able to achieve a 50% follow-up
rate after sexual assault using SANEs to schedule follow-ups and contact
patients to remind them of the appointment. Although not tested in this study,
it is likely that having the same providers who saw the patient in the ED see
the patient at follow-up could improve follow-up attendance by capitalizing on
the rapport developed in the ED.
Also of interest are
observations that some of our factors were unrelated to post-rape
medical/counseling appointment follow-up. We did not observe a relationship
between gender and follow-up, which is in contrast to other research indicating
men are less likely to seek services after traumatic events more generally (Elhai, et al., 2005). Although this finding
may be an artifact of the small sample size of males in our study (8.6%), it is
also possible that men who choose to seek acute medical services for rape, are
as likely to pursue additional services as women who pursue these acute medical
services. We also did not observe a relationship between the relationship to
the primary offender and follow-up. Prior research indicates that being raped
by a stranger results in women being more likely to seek acute care
medical/forensic services (Resnick et al., 2000; Starzynski, Ullman, Filipas,
Townsend, 2005); however, our findings suggest that among those who
do seek acute services, being assault by a stranger is not related to obtaining
the recommended follow-up care…
Full article at: http://goo.gl/ydvpof
By:
1Department of Psychiatry & Behavioral
Sciences, University of Washington
2Harborview Center for Sexual Assault and
Traumatic Stress, Seattle, Washington
3Division of Emergency Medicine, University
of Washington
Address correspondence to Doyanne Darnell, PhD, Department
of Psychiatry & Behavioral Sciences, University of Washington, Box 359911,
325 Ninth Avenue, Seattle, WA 98104-2499
More at: https://twitter.com/hiv insight
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