Prise en charge médico-psychologique immédiate aux urgences des personnes adultes victimes d’agression sexuelle : revue systématique de la littérature

Abstract

IntroductionIt seems that sexual violence has a greater impact on mental health (consequences like post-traumatic stress disorder, major depressive disorder, alcohol use disorder, suicidal thoughts, suicide attempts) than any other form of traumatic event. One of the challenges public health instances have to face is how to provide medico-psychological care from an early stage. When it comes to dealing with traumatic collective events, immediate medico-psychological care protocols have been widely formalized. The purpose of our study is to determine whether this first care is usually applied to adults who are victims of sexual assault. MethodA systematic review was conducted using the Pubmed, PsycINFO and SUDOC databases. ResultsOut of 2173 articles, 24 were selected. There seems to be a consensus on a few points regarding how to take psychological care of sexual assault victims as soon as they are admitted in the ER. For the victims’ reception, all professionals dealing with victims of sexual assault should be specifically trained to do so. Multi-professional care should be coordinated and those interventions should be centralized, in one single place. Initially, It's essential to collect the risk factors that could trigger post-traumatic stress disorder, assess the signs of acute distress and assess the risk of suicide. Psychological interventions for victims of collective traumatic events (interventions as Psychological First Aid or the interventions of the Cellules d’Urgence Médico-Psychologique in France) should be applied to sexual assault victims. These acts consist in having an empathetic and non-judgmental attitude, while at the same time aiming to restore an immediate sense of security and control. These also include assessing and ensuring the future security of the patient, assessing and promoting social support and finally assessing and addressing his potential needs. Moreover, it's necessary to inform the patient about the symptoms associated to stress, their possible evolution and the available care ressources. However, regarding specific care, there is no agreement on the systematic intervention of a professional specialist in mental health and no agreement on the drug treatments to be employed. The technique of Defusing is only mentioned in one publication. As for systematically referring patients after emergencies to mental health services, opinions are divided. ConclusionMany aspects of the immediate medico-psychological care usually offered to victims of collective traumatic events is recommended for victims of sexual assault provided that the medical staff or team of caregivers receive appropriate training. The ER would also highly benefit from an organization in which gynecologists, legal doctors, psychiatrists, social and judicial actors would collaborate towards a comprehensive support of patients. It seems important to be able to offer comprehensive patient support, like a Case Management, in the short and medium term (support on the medical, social and legal aspects which would take into account the evolution particular to each case) and to assess the effectiveness of these devices. It also seems important to continue evaluating the impact of interventions and drug treatments used in practice on the prevention of post-traumatic stress disorder.