Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study

• Type of Material: Article
• Authors: Nicole A Short, University of North Carolina at Chapel Hill; Megan Lechner, UC Health Memorial Hospital; Benjamin S McLean, University of North Carolina at Chapel Hill; Andrew S Tungate, University of North Carolina at Chapel Hill; Jenny Black, Austin SAFE; Jennie A Buchanan, Denver Health; Rhiannon Reese, Crisis Center of Birmingham; Jeffrey D Ho, Hennepin Healthcare; Gordon D Reed, Christiana Care; Melissa A Platt, University of Louisville; Ralph J Riviello, University of Texas Health San Antonio; Catherine H Rossi, Cone Health; Patricia P Nouhan, Wayne State University; Carolyn A Phillips, DC SANE; Sandra L Martin, University of North Carolina; Israel Liberzon, Texas A&M University; Sheila Rauch, Emory University; Kenneth A Bollen, University of North Carolina; Ronald C Kessler, Harvard Medical School; Samuel A McLean, University of North Carolina
• Language: English
• Date: 2020-10-08
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Wiley Periodicals LLC
• Final Published Version (URL): http://dx.doi.org/10.1002/da.23102
• Title of Journal or Parent Work: DEPRESSION AND ANXIETY
• Volume: 38
• Issue: 1
• Start Page: 67
• End Page: 78
• Grant/Funding Information: The funders did not play a role in design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.; This work was supported by funding from the following National Institutes of Health Institutes: NIAMS, NINDS, OD (ORWH), NINR, NIMH, and NICHD (R01AR064700), a supplement from the OD (ORWH), and support from the Mayday Fund.
• Keywords: FOLLOW-UP; Psychology, Clinical; Science & Technology; MENTAL-HEALTH; RAPE; Life Sciences & Biomedicine; VICTIMS; Psychiatry; posttraumatic stress; Social Sciences; NATIONAL SAMPLE; sexual assault; SERVICE UTILIZATION; TREATMENT SEEKING; SOMATIC SYMPTOMS; POSTTRAUMATIC-STRESS-DISORDER; INTERVENTION; Psychology; emergency care; health services utilization

Abstract

Background: Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault. Methods: Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey. Results: Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged. Conclusion: Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.