An observational study to identify predictors of acute stress disorder and depressive symptoms in adult female victims of sexual assault

Abstract

Study objectives: The objective of this prospective study is to determine what psychosocial characteristics affect outcomes at 1 month in female victims of sexual assault. The main outcomes are the presence of acute stress disorder as measured by the Impact of Events Scale and the presence of depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Additional outcomes are the victim's satisfaction with care received in the emergency department (ED) as measured by the Satisfaction scale and patient follow-up. Our hypotheses are as follows. Patients with lower socioeconomic status, history of being a victim of a violent crime, and less social support will have more depressive symptoms and an increased incidence of acute stress disorder 1 month after a sexual assault. Greater satisfaction with ED services will result in increased compliance with follow-up and decreased symptoms of depression and inhibition. Centers that have a designated rape response team will have increased compliance with nationally recommended guidelines. Methods: Patients were recruited from 2 urban centers, 1 with a regional Sexual Assault Response Team with certified health care providers, advocates, and law enforcement, and 1 with 3 trained forensic examiners. Female victims who were 18 years or older and presenting to the ED for evaluation after a sexual assault were eligible for the study. Baseline demographic data, clinical data, and services received in the ED were documented. Social support was measured by administering the Duke Social Support and Stress Scale, and patient satisfaction was determined by the Satisfaction Scale. One month later, 2 instruments were administered to determine the presence of acute stress disorder, the Impact of Events Scale, a 15-item scale that measures symptoms of avoidance and inhibition, and the CES-D scale, a 20-item scale that measures the presence of depressive symptoms. Results: Fourteen patients from site 1 and 36 patients from site 2 were enrolled. The average age was 29 years. The racial distribution was 80% black, 13% white, and the remaining 7% Asian or Latino; 61% of the patients had at least 1 child, 78% were single mothers, and 55% of the patients were employed. Forty-eight percent of patients had scores of 16 or higher, consistent with presence of depressive symptoms. Patients with symptoms of depression had less social support. However, patients who were less-educated single mothers and had lower incomes were less likely to be depressed. For acute stress disorder, 10% of the patients scored greater than 26 on the inhibition subscale, and 14% of patients scored greater than 26 on the avoidance subscale. Our analysis found that the center with a sexual assault response team had higher compliance with guidelines (100% versus 63%) and increased patient satisfaction (87.4% versus 66%) and follow-up (75% versus 14%). Conclusion: The results of this study provide preliminary analysis that by identifying factors that predispose to acute stress disorder and depressive symptoms, an intervention can be developed to improve patient outcome. Health care providers should generate guidelines to provide a uniform service of care in the ED that results in increased patient satisfaction that can be replicated and implemented nationally.