Psychological care for victims of recent rape: an exploration of early intervention for reducing the risk of PTSD

Abstract

As of 2018, sixteen sexual assault centres (SACs) exist in the Netherlands. Chapter 2 describes the formation of these centres and how their services are provided. Between 2016 and 2020, over 7,000 victims were served by the SACs within 7 days after the assault. The main strengths of the SACs were determined to be the 24/7 accessibility and the close collaboration with the police. However, the outreach towards non-female victims and other minority groups is in need of evaluation. Moreover, lack of funding threatens the consistency in quality of care across centres. In Chapter 3, we analysed the data of 34 male victims who were referred to the SAC within seven days post-assault, and compared their characteristics and service use to those of female victims. We found no differences between genders in age, use of mental health services, or in any assault characteristics. However, we found that male victims were less likely to get in contact with the police relative to female victims. Yet, for victims who were in contact with the police, we found no gender differences in police reporting or the prevalence of forensic medical examinations. Initiating psychological interventions within the first months after sexual assault may help to prevent the development of PTSD. In Chapter 4, a meta-analysis was performed to determine the efficacy of early interventions for post-traumatic stress. No differences were found in post-traumatic stress symptoms between those who received early intervention and those who received standard care at the first assessment after treatment. However, the early interventions were more efficacious than standard care at the last assessments. Chapter 5 described the study protocol of the Early EMDR study that aimed to examine the efficacy of early intervention using EMDR therapy for reducing post-traumatic stress symptoms in victims of rape. Participants were randomly allocated to receive either two sessions of EMDR therapy or standard care in the first month after rape. Standard care entailed psychological services of the SAC. Chapter 6 describes the results of this RCT. Although post-traumatic stress symptoms decreased significantly over time, there was no difference between conditions. Symptoms of anxiety and dissociation were significantly lower for those in the EMDR condition than those in the standard care condition at post-treatment and 8-weeks assessments, but this effect disappeared at the 12-week follow-up. Moreover, symptoms of general psychopathology, depression, pelvic floor overactivity (PFO), sexual dysfunction, guilt and shame did not differ between conditions at any assessment. Chapter 7 assessed potential predictors of the development of post-traumatic stress symptoms after rape. Several pre-existing, peritraumatic, and post-traumatic factors were assessed. Early symptoms of post-traumatic stress and persistent dissociation predicted post-traumatic stress severity across 12 weeks. Chapter 8 analysed the relationship between early symptoms of post-traumatic stress, sexual dysfunction, and PFO. At two weeks after rape, higher post-traumatic stress severity was related to more symptoms of sexual dysfunction and PFO. Lower post-traumatic stress severity after 12 weeks was related to more recovery in sexual dysfunction. In contrast, PFO reduced regardless of post-traumatic stress severity.