Factors Associated With Follow-Up Attendance Among Rape Victims Seen in Acute Medical Care

Abstract

Objective: Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Method: Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Results: Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21–0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13–0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28–0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86–4.91), a completed Sexual Assault Nurse Examiner’s (SANE) examination (OR = 2.97, 95% CI = 1.84–4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76–7.11) were associated with an increased odds of attending the follow-up. Conclusions: Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.