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

Short, Nicole A.; Lechner, Megan; McLean, Benjamin; Tungate, Andrew S.; Black, Jenny; Buchanan, Jennie; Reese, R. Matthew; Ho, Jeffrey D.; Reed, Gordon; Platt, Melissa; Riviello, Ralph; Rossi, Catherine; Nouhan, Patricia; Phillips, Carolyn; Martin, Sandra L.; Liberzon, Israel; Rauch, Sheila A.M.; Bollen, Kenneth A.; Kessler, Ronald C.; McLean, Samuel A.

doi:10.1002/da.23102

Cited by 20 publications

(26 citation statements)

References 55 publications

(82 reference statements)

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“…Examination of specific postevent responses that have been linked to pain in prior work should also be captured in future analyses as a mediating mechanism between exposure to trauma and pain sensitivity. 122 In conclusion, this meta-analysis found an overall pattern of trauma-related pain sensitization and implicates CS as a key mechanism by which experiencing trauma lead to altered pain processing. These mechanistic relationships highlighting how psychological experience may impact physiological pain processing can inform clinical assessments and treatments of comorbid trauma-pain conditions.…”

Section: Discussionmentioning

confidence: 64%

“…In addition, there are individuals who may be experiencing traumatic distress related to potentially traumatic events (eg, experiences of racism, police brutality, sexual harassment) that are not currently captured in traditional trauma assessments, who are missing from research, and whose pain risk may be clinically overlooked. Type of trauma is important to consider, as both pre-event factors (eg, preexisting psychological distress, psychosocial factors, adverse childhood experiences)121 and postevent distress61,121 as well as general psychosocial factors (eg, access to health care, diagnostic validity, available coping strategies)122 are likely to play a role. Examination of specific postevent responses that have been linked to pain in prior work should also be captured in future analyses as a mediating mechanism between exposure to trauma and pain sensitivity 122…”

Section: Discussionmentioning

confidence: 99%

“…Type of trauma is important to consider, as both pre-event factors (eg, preexisting psychological distress, psychosocial factors, adverse childhood experiences)121 and postevent distress61,121 as well as general psychosocial factors (eg, access to health care, diagnostic validity, available coping strategies)122 are likely to play a role. Examination of specific postevent responses that have been linked to pain in prior work should also be captured in future analyses as a mediating mechanism between exposure to trauma and pain sensitivity 122…”

Section: Discussionmentioning

confidence: 99%

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Traumatic Life Experience and Pain Sensitization

Nanavaty

Thompson²,

Meagher

et al. 2022

The Clinical Journal of Pain

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Objectives: Psychological trauma often co-occurs with pain. This relationship has been explored using laboratory pain measures; however, findings have been mixed. Previous studies have limited operationalization of trauma (eg, posttraumatic stress disorder) or pain (eg, pain thresholds), which may contribute to conflicting results. Further, prior reviews likely underrepresent trauma experiences among people who are not receiving clinical care, limiting generalizability. Materials and Methods:We systematically reviewed the existing literature on the relationship between psychological trauma (eg, car accidents, sexual assault, childhood abuse, neglect) and laboratory pain (ie, quantitative sensory testing measures of pain threshold, intensity, summation, modulation), using inclusive criteria. The direction of the relationship between psychological trauma and pain sensitivity was evaluated, and moderation by purported pain mechanism (ie, pain detection, suprathreshold pain, central sensitization, inhibition) was explored.Results: Analyses were conducted using 48 studies that provided 147 effect sizes. A multivariate random-effects model with robust variance estimation resulted in a small but statistically significant overall effect size of g = 0.24 (P = 0.0002), reflecting a positive association between psychological trauma and enhanced laboratory pain sensitivity. Upon examination of mechanistic moderators, this relationship appears driven by effects on pain detection (g = 0.28, P = 0.002) and central sensitization (g = 0.22, P = 0.04). While effect sizes were similar across all moderators, effects on suprathreshold pain and inhibition were not statistically significant.Discussion: Findings demonstrate an overall pattern of traumarelated pain enhancement and point to central sensitization as a key underlying mechanism.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Traumatic Life Experience and Pain Sensitization

Nanavaty

Thompson²,

Meagher

et al. 2022

The Clinical Journal of Pain

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“…A recent study analyzing healthcare utilization in the 6-week period after presenting to the ED for post-assault care showed that, despite 76% of survivors reporting posttraumatic stress, depression, or anxiety, less than 40% saw a medical provider (Short et al, 2021). While lack of access to longitudinal care is a contributing factor, qualitative studies show that major reasons why survivors do not seek help or disclose their assault history to providers are shame, embarrassment, or fear of being judged or not believed (Patterson et al, 2009; Price et al, 2014; Short et al, 2021). Specifically, survivors who did not perceive their experience as matching stereotypical societal conceptions of sexual assault are hesitant to seek help (Patterson et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

Chalmers

Parameswaran

Dussault

et al. 2022

J Interpers Violence

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Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors’ mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors’ future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

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“…Sexual assault (SA) is common, with an estimated 19% of United States (US) women reporting rape and 43% reporting other forms of sexual contact during their lifetime 1 . Approximately 100,000 US women present for emergency care after SA each year, 2 yet opportunities to gain insights into the lives of women who present for emergency care after sexual assault (SA) are limited, both because such women rarely return for care or self‐identify when receiving further care, 3–5 and because few studies have assessed the life experiences of women SA survivors after SA nurse examiner (SANE) care. Qualitative studies of SA have focused largely on the receipt of health care services, 7–11 with less attention paid to survivors’ broader life experiences.…”

Section: Introductionmentioning

confidence: 99%

“I still feel so lost”: experiences of women receiving SANE care during the year after sexual assault

et al. 2021

Self Cite

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Objective Emergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them. Methods English‐speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi‐site observational study. We qualitatively analyzed responses to the open‐ended question: “What do you think is most important for researchers to understand about your experience since the assault?” asked 1 week, 6 weeks, 6 months, and 1 year after enrollment. Results Themes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors’ daily lives. Conclusions Qualitative analyses of open‐ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.

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

Cited by 20 publications

References 55 publications

Traumatic Life Experience and Pain Sensitization

Traumatic Life Experience and Pain Sensitization

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

“I still feel so lost”: experiences of women receiving SANE care during the year after sexual assault

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