A Systematic Literature Review Stephanie Lanthier, Janice Du Mont and Robin Mason
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Transcript of A Systematic Literature Review Stephanie Lanthier, Janice Du Mont and Robin Mason
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Determining “best” practices in responding to delayed disclosure by
female sexual assault victims in health care settings
A Systematic Literature ReviewStephanie Lanthier, Janice Du Mont and
Robin Mason
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Background: Disclosure of Sexual Assault
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• Sexual assault is a pervasive yet underreported violent crime (Du Mont & White, 2007). Less than 10% of sexual assaults are formally reported to the police (Brennan & Taylor Butts, 2010; Sinha, 2013).
• Research shows that the majority of women do eventually disclose to someone (Ahrens et al., 2010; Golding et al., 1989; Neville & Pugh, 1997).
• Disclosure often occurs weeks, months or years after the assault (Dunleavy 2012; Esposito, 2006; Filipas & Ullman, 2001).
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Background: Health Consequences
and Health Seeking
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• Sexual assault victims report poorer health and use medical services more frequently than non-victims (Golding et al., 1989; Resnick et al., 2000; Ullman & Brecklin, 2003; Ullman & Siegel, 1995).
• They can present with a variety of physical, uro-gynaecological, obstetric and/or mental health issues (Taylor et al., 2012).
• It is important that health care providers in a variety of settings are able to respond appropriately to the delayed disclosure of sexual assault.
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Purpose
To determine “best” practices in responding to delayed disclosure of sexual assault by examining helpful and unhelpful responses by health care providers.
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Image: The Awareness Center Inc.
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Methods: Search Strategy(April 2013)
Key Terms• “sexual assault”,
“disclosure”, “social support”, “post assault”, “reaction”, “clinician”, “provider”, “formal” etc.
Databases• OVID Medline• PubMed• PsycINFO• Embase
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Limited search to 1985-present; English
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Methods: Analysis
Title Screen
Abstract Screen
Full Article Review
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Records identified through database searching and reference lists of key articles (N=1166)
Duplicate records (N=383)
Title screen (N=779)
Titles excluded (N=601)
Abstracts assessed for eligibility (N=178)
Abstracts excluded (N=129)
Full-text articles assessed for eligibility (N= 49)
Studies included (N=24)
Full-text articles excluded (N=25)
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Methods: Exclusion Criteria
Titles Excluded (N=601)Sexual Assault or Related Terms Not in Title (N=369)Childhood or Male Sexual Assault (N=169)Acute Sexual Assault (N=6)Book Chapters, Dissertations etc. (N=100)Focused on Offender (N=9)Not English (N=7)
Abstracts Excluded (N=129)Childhood or Male Sexual Assault (N=12)Acute Sexual Assault (N=7)Book Chapters etc. (N= 9)No Response to Disclosure (N=98)Informal Support Provider Only (N=5)Screening (N=1)
Full Text Articles Excluded (N=25)Childhood Sexual Assault (N=4)No Healthcare Provider (N=15)Mental Health Setting (N=4)Fact Sheet, Commentary etc. (N=2)
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Results: Summary
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24 Studies
Country 20 USA2 Tanzania1 Australia1 N/A
Sample Size Range = 1 to 3026
Methods Questionnaire, Case Report, In-Depth Interview, Survey, Systematic Review
Health Care Providers Physicians, Nurses, Midwives, Physical Therapists.Medical Personnel, Medical Staff, Health Care System
Disclosure Rates to Health Care Providers
Range = 9 to 27.1%
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Results: Responses
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Unhelpful Responses
Blaming the SurvivorMinimizing, Dismissive or Distracting ResponsesDisplaying a Cold and/or Detached DemeanorTreating the Survivor Differently
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Results: Helpful Responses
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Helpful Responses DescriptionTangible aid (N=13) • Providing medical care
• Giving information about sexual assault and community resources
• Providing referrals to counsellors or mental health professionals
Providing emotional support (N=13)
• Showing concern• Being empathetic• Listening in an active and supportive manner• Telling the survivor that they are not to blame
Acknowledging or validating the disclosure (N=5)
• Using simple statements such as “I’m so sorry that this happened to you” or “I’m glad you told me about this”.
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Results: Unhelpful Responses
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Unhelpful Response Description
Blaming the survivor for the assault (N=7)
• Holding the survivor responsible for the assault
• Doubting the survivor’s account of the assault
• Accusing the survivor of not telling the truth
Minimizing, dismissive or distracting responses (N=6)
• Statements or attempts to make the assault seem less troubling than how the survivor perceived it
• Telling the survivor to stop talking or thinking about the assault
• Attempting to discourage survivor from further speaking about the assault.
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Results: Unhelpful Responses
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Unhelpful Response DescriptionHealth care provider displaying a cold and/or detached demeanor (N=6)
• Not making eye contact• Asking a question unrelated to the sexual
assault in an effort to change the subject• Ignoring the survivor• Not providing any assistance upon hearing
the disclosure• Having no reaction at all• Giving a prescription without asking further
questions
Treating the survivor differently after disclosure (N=5)
• Treating the survivor with contempt• Treating the survivor as if she is not able to
take care of herself• Avoiding the survivor
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Summary: “Best” Practices
Providing a safe and supportive environment
Being aware of the indicators of past
sexual assault
Direct questioning if patient presents
with indicators of a past sexual assault
Validating the disclosure
Providing emotional support
Providing appropriate
referrals
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Implications: Practice• Health care providers
require more training on recognizing indicators of past sexual assault and knowing how to respond to delayed disclosure in a helpful way.
• Implementing “best” practices is a first step in achieving this improved response.
After receiving a sympathetic reaction from her doctor, one survivor said: “It made me feel good, like I, wow, it’s not the end you know?” (Ahrens et al., 2009)
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Acknowledgements
Special thanks to:
Mona Frantzke, BSc, MLSc, Medical Librarian, Health Sciences Library, Women’s College Hospital
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ReferencesAhrens, C.E. (2006). Being silenced: The impact of negative social reactions on the disclosure of rape. American Journal of Community Psychology, 38, 263-274.
Ahrens, C.E., Cabral, G. & Abeling, S. (2009). Healing or hurtful: Sexual assault survivors’ interpretations of social reactions from support providers. Psychology of Women Quarterly, 33, 81-94.
Ahrens, C.E., Campbell, R., Ternier-Thames, N.K., Wasco, S. & Sefl, T. (2007). Deciding whom to tell: Expectations and outcomes of rape survivors’ first disclosures. Psychology of Women Quarterly, 31, 38-49.
Ahrens, C.E., Stansell, J. & Jennings, A. (2010). To tell or not to tell: The impact of disclosure on sexual assault survivors’ recovery. Violence and Victims, 25, 631-648.
Diaz, A., Edwards, S., Neal, W.P., Ludmer, P., Sondike, S.B., Kessler, C., Medeiros, D. & Nucci, A.T. (2004). Obtaining a history of sexual victimization from adolescent females seeking routine health care. The Mount Sinai Journal of Medicine, 71(3), 170-173.
Dunleavy, K. & Slowick, A.K. (2012). Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: Patient-centered and trauma-cognizant management by physical therapists. Physical Therapy Journal, 92(2), 339-351.
Esposito, N. (2006). Women with a history of sexual assault: Healthcare visits can be reminders of a sexual assault. American Journal of Nursing, 106(3), 69-73.
Filipas, H.H. & Ullman, S.E. (2001). Social reactions to sexual assault victims from various support sources. Violence and Victims, 16(6), 673-692.
Ullman, 1996aUllman, 1996bUllman & Filipas, 2001Ullman & Najdowski, 2009Ulllman & Siegel, 1995
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ReferencesGolding, J.M., Siegel, J.M., Sorenson, S.B., Burnam, M.A. & Stein, J.A. (1989). Social support sources following sexual assault. Journal of Community Psychology, 17, 92-107.
Lessing, J.E. (2005). Primary care provider interventions for the delayed disclosure of adolescent sexual assault. Journal of Pediatric Health Care, 19, 17-24.
Littleon, H.L. (2010). The impact of social support and negative disclosure reactions on sexual assault victims: A cross-sectional and longitudinal investigation. Journal of Trauma & Disassociation, 11, 210-227.
Long, S.M., Ullman, S.E., Long, L.M., Mason, G.E. & Starzynski, L.L. (2007). Women’s experiences of male-perpetrated sexual assault by sexual orientation. Violence and Victims, 22, 684-701.
Mazza, D., Dennerstein, L., & Ryan, V. (1996). Physical, sexual and emotional violence against women: A general practice-based prevalence study. The Medical Journal of Australia, 164, 14-17).
Muganyizi, P.S., Hogan, N., Emmelin, M, Lindmark, G., Massawe, S., Nystrom, L., & Axemo, P. (2009). Social reactions to rape: Experiences and perceptions of women rape survivors and their potential support providers in Dar es Salaam, Tanzania. Violence and Victims, 24(5), 607-626.
Muganyizi, P.S., Nystrom, L., Axemo, P. & Emmelin, M. (2011). Managing in the contemporary world: Rape victims and supporters experiences of barriers within the police and the health care system in Tanzania. Journal of Interpersonal Violence, 26(16), 3187-3209.
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ReferencesPlumbo, M.A. (1995). Delayed reporting of sexual assault: Implications for counseling. Journal of Nurse-Midwifery, 40(5), 424- 427.
Popiel, D.A. & Susskind, E.C. (1985). The impact of rape: Social support as a moderator of stress. American Journal of Community Psychology, 13(6), 645-676.
Starzynski, LL., Ullman, S.E., Filipas, H.H., Townsend, S.M. (2005). Correlates of women’s sexual assault disclosure to informal and formal support sources. Violence and Victims, 20(4), 417-432.
Sturza, M.L. & Campbell, R. (2005). An exploratory study of rape survivors’ prescription drug use as a means of coping with sexual assault. Psychology of Women Quarterly, 29, 353-363.
Ullman, S.E. (1996a). Correlates and consequences of adult sexual assault disclosure. Journal of Interpersonal Violence, 11(4), 554-571.
Ullman, S. E. (1996b). Do social reactions to sexual assault victims vary by support provider? Violence and Victims, 11(2), 143-157.
Ullman, S.E. & Filipas, H.H. (2001). Correlates of formal and informal support seeking in sexual assault victims. Journal of Interpersonal Violence, 16(10), 1028-1047.
Ullman, S.E. & Najdowski, C.J. (2009). Correlates of serious suicidal ideation and attempts in female adult sexual assault survivors. Suicide and Life-Threatening Behavior, 39(1), 47-57.
Ullman, S.E. & Siegel, J.M. (1995). Sexual assault, social reactions and physical health. Women’s Health: Research on Gender, Behavior, and Policy, 1(4), 289-308.
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Questions?
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