Sunday, March 6, 2016

Factors Associated with Follow-Up Attendance among Rape Victims Seen in Acute Medical Care

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.

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.

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.

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.  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 (). 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 (; ); 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:

By:  Doyanne Darnell, PhD,1 Roselyn Peterson, BA,1 Lucy Berliner, MSW,2 Terri Stewart, RN, BSN,2 Joan Russo, PhD,1Lauren Whiteside, MD,3 and Douglas Zatzick, MD1
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

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