Assault Characteristics Research Articles

Developing Trauma-Informed Research Methods: Using Proxy Respondents to Assess Sexual Assault Survivors' Experiences Seeking Medical Forensic Exams

In research on sexual assault victims' help-seeking, proxy data sources are often utilized because outreach to survivors immediately postassault may increase a study's risk-to-benefit ratio. Victim advocates and services providers are common proxy respondents, but empirical research comparing the accuracy of their information is needed. We collaborated with seven sexual assault nurse examiner (SANE) programs to collect de-identified, paired data from nurses and advocates regarding the help-seeking experiences of N = 744 adult victims. Using pairwise McNemar tests, we found statistically significant agreement on victim demographics, assault characteristics, and victims' decisions regarding medical forensic exams, sexual assault kit (SAK) collection, and release of SAKs for forensic DNA testing. Nurses and advocates had different information regarding victims' disclosure histories and their reasons for seeking SANE care.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers.

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors’ experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

Factors associated with experiencing reassault in Ontario, Canada: a population-based analysis

BackgroundIndividuals who experience a violence-related injury are at high risk for subsequent assault. The extent to which characteristics of initial assault are associated with the risk and intensity of reassaults...

Transfusion management of trauma from the 2019 El Paso mass shooting incident.

Mortality rates, transfusion ratios, trauma management logistics, and assault characteristics from the El Paso mass shooting incident (MSI) are evaluated in comparison to other MSIs. In 2019, El Paso, TX experienced the eighth-deadliest MSIs in modern US history. In this 21st mass killing in the United States of 2019, 19 people died immediately, and four of 27 injured, later died from ballistic injuries. We examined the victims' injuries, pre-hospital treatments, transfusions, rotational thromboelastometry (ROTEM) interpretation, tranexamic acid (TXA) use, and compared El Paso's outcomes with other MSIs. Fifteen casualties were treated for bullet injuries at University Medical Center (UMC). Three were in critical condition; one died during surgery. Of the remaining victims, two were guarded, and the remaining ten in stable condition. Anatomic trauma locations included chest, abdomen, hip, breast, thigh and arm. Haemostatic agents and TXA were administered to arriving patients. Seven casualties receiving blood products were administered 95 units at UMC (45 red blood cells [RBC], 38 fresh frozen plasma [FFP], 8 platelets and 4 cryoprecipitate). ROTEM guided mass transfusion decisions in three patients. Out of seven MSIs reviewed, El Paso had the highest mortality rate (50.0%) and lowest RBC:FFP:admission ratio (1.18 at UMC). We report the greatest proportion of transfusions per admission for an MSI and are first to discuss ROTEM roles to guide transfusion and manage coagulopathy during an MSI. This case highlights the severity and impact of MSIs on victims and requirements to follow established transfusion protocols with adjunct use of ROTEM, TXA and haemostatic agents.

Characteristics of Assaulting among Elderly Associated with Hospital Mortality in Southern Thailand

This study aimed to identify characteristics of assault and its association with mortality. A total of 342 elderly samples were assaulted. The data were derived from the Injury Surveillance Database from 5 General Hospitals in upper southern Thailand, during 2008-2013, the Office of Disease Prevention and Control, 11. The data were excluded as if unknown survival status. The data were analyzed using descriptive statistics. Logistic regression analysis was used to determine associations between characteristics assaulting and mortality using the R program. It revealed that 6.43% of the elderly die. Most of the deaths were males (59.09%), aged 60-69 years (77.28%), average age was 68.54 (SD = 7.76) years. Most of them were assaulted house-outside (90.91%), a period of assaulting was between 12.01-18.00 pm (36.35%). They were unknown career (36.35%), house-wife and having no income (27.28%), pensioner, state enterprise, trading company employees (27.28%). They had external trauma(45.46%) including; blunt, stab wound, sharp object, and use of force (54.54%). Factors significantly associated with mortality were as follows: pensioner, state enterprise, trading company employee, and the elderly group were murdered, assassinated by poisoning and gunshot. These factors need to be taken into consideration when promoting caregivers to prevent elderly assault.

Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study

PurposeTo describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users’ perceived needs and experiences.MethodLongitudinal, mixed methods cohort study of adolescents aged 13–17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13–15 months post-assault.Results75/141 participants were followed to study end (53% retention; 71 females) and 19 completed an in-depth qualitative interview. Despite many participants accessing support services, 54%, 59% and 72% remained at risk for depressive, anxiety and post-traumatic stress disorders 13–15 months post-assault. Physical symptoms were reported more frequently. Persistent (> 30 days) absence from school doubled between study entry and end, from 22 to 47%. Enduring mental ill-health and disengagement from education/employment were associated with psychosocial risk factors rather than assault characteristics. Qualitative data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault. Baseline levels of smoking, alcohol and ever drug use were high and increased during the study period (only significantly for alcohol use).ConclusionAdolescents presenting after sexual assault have high levels of vulnerability over a year post-assault. Many remain at risk for mental health disorders, highlighting the need for specialist intervention and ongoing support. A key concern for young people is disruption to their education. Multi-faceted support is needed to prevent social exclusion and further widening of health inequalities in this population, and to support young people in their immediate and long-term recovery.

Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study

ABSTRACT Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4–5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders – especially generalised anxiety disorder, panic disorder and major depressive disorders – as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.

Male Victims at a Dutch Sexual Assault Center: A Comparison to Female Victims inCharacteristics and Service Use.

Recently, there has been an increase in referrals of male victims of sexual assault to interdisciplinary sexual assault centers (SACs). Still, there is limited research on the characteristics of men who refer or are referred to SACs and the services they need. To facilitate the medical, forensic, and psychological treatment in SACs, a better understanding of male victims is indispensable.The first aim of the study was to analyze the victim and assault characteristics of male victims at a Dutch SAC, and to compare them to those of female victims. The second aim was to analyze and compare SAC service use between male and female victims.The victim characteristics, assault characteristics, and service use of 34 male victims and 633 female victims were collected in a Dutch SAC. T-tests and chi-square tests were used to analyze differences between male and female victims.No differences between males and females in victim or assault characteristics were found. Most victims received medical and psychological care, with no differences between male and female victims. Female victims were more likely to have contact with the police, but no differences in reporting or forensic medical examinations between males and females were found.These findings indicate that SACs can and do provide equal services to male and female victims, and that the current services are suitable for male victims as well. However, a focus on educating and advising male victims about police involvement is advisable.

Racial Disparities in Sexual Assault Characteristics and Mental Health Care After Sexual Assault Medical Forensic Exams

Background: Sexual assault (SA) is common, but Black individuals might be at higher risk of SA and negative health sequalae. Racial differences in SA characteristics and health care utilization after SA are largely unknown. Materials and Methods: We reviewed medical records of 690 individuals (23.9% Black; 93.6% women) who received a SA medical forensic exam (SAMFE) at a southeastern U.S. hospital. We examined bivariate racial differences in SA characteristics and used zero-inflated Poisson regressions to estimate racial differences in mental health outpatient visits at the SAMFE hospital. Results: Among survivors of SA, Black survivors were more likely than White survivors to have been victimized by an intimate partner (odds ratio [OR] = 1.77, confidence interval [95% CI] = 1.02-3.07) and they had more post-SA outpatient mental health visits at the SAMFE hospital (incidence rate ratio [IRR] = 2.05, 95% CI = 1.70-2.47). Black survivors were less likely to report alcohol or drug use before the SA (OR = 0.42, 95% CI = 0.28-0.62). In multivariable models, Black survivors trended toward more mental health visits than White survivors (IRR = 1.63, 95% CI = 0.82-2.44), but intimate partner violence (IPV) significantly moderated that association (IRR = 0.01, 95%CI = ≤0.001-0.03). Black survivors assaulted by an intimate partner were less likely to access mental health care than White IPV survivors. Conclusions: The hospital setting of a SAMFE could be a unique opportunity to serve Black survivors and reduce racial disparities in mental health sequelae, but additional support will be needed for Black survivors experiencing IPV. An intersectional, reproductive justice framework has the potential to address these challenges.

Medications at the Emergency Department After Recent Rape.

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Typologies of Rape Victimization Experiences Among Women Attending College: A Latent Class Analysis

Past research has categorized the rape experiences of women attending college into types primarily based on perpetration tactics and/or survivor substance use. However, this practice may overlook key differences. Therefore, in the current study, we sought via latent class analysis (LCA) to identify types of rape using multiple assault characteristics, including survivor resistance and substance use by the survivor and perpetrator. Participants were 344 college women who experienced rape since age 14 who completed an online survey. A five-class rape typology model was the best-fit: (a) Combined force/substance-facilitated rape (16.0%), (b) Substance-facilitated rape, congruent drinking (18.0%), (c) Substance-facilitated rape, non-congruent drinking (14.0%), (d) Low force/resistance rape (25.0%), and (e) Forcible rape (27.0%). Classes differed in acknowledgment, perpetrator relationship, current psychological distress, and recent hazardous drinking. Findings showed that college women’s rape experiences fell into several distinct typologies on the basis of the presence of force/resistance as well as survivor and perpetrator substance use/substance-related impairment. Practitioners working with college rape survivors should be mindful of how multiple assault characteristics may affect survivors’ recovery trajectory. Future research should further investigate the implications of these rape typologies on adjustment, recovery, and re-victimization risk among survivors.

A Retrospective Descriptive Analysis of Sexual Assault Nurse Examiner Records From Sexual Assault Survivors at a Large University Emergency Department From 2003 to 2017.

This retrospective descriptive analysis of 837 patients seeking postassault care at an academic hospital in the United States describes characteristics of sexual assault survivors from a sociocultural context, with a specific focus on describing survivors presenting for sexual assault nurse examiner (SANE) exams and confirming existing literature on assault characteristics, such as disabilities and alcohol and/or drug use. Assaults resulting in SANE exams increased over time. Drug and/or alcohol use at the time of the assault was reported in 44.8% of cases and 20.8% of survivors reported having a disability. Understanding the demographic and sexual assault characteristics of survivors is fundamental to providing sensitive and responsive care.

What's in a Label? The Impact of Media and Sexual Assault Characteristics on Survivor Rape Acknowledgment.

Media coverage of sexual assault has increased since 2017 due to high-profile cases and social media campaigns designed to increase awareness of sexual assault. The purpose of this study was to examine whether media coverage of the Harvey Weinstein allegations and the onset of the 2017 viral #MeToo movement impacted the likelihood of college women acknowledging their own victimization as rape. Participants were 207 female rape survivors who completed an online survey that included assessments of survivor acknowledgment and characteristics of the sexual assault. Some participants completed the study prior to the Harvey Weinstein allegations and onset of the #MeToo movement, and some participants completed the study after these events. The likelihood of survivors labeling their experience as rape did not differ based on when participants completed the study, odds ratios (ORs) = 0.61-3.92, ps = .127-.604. Use of both nonforceful verbal resistance, OR = 2.63, p = .001, and assertive resistance, OR = 3.05, p < .001, were positively associated with the likelihood of survivor acknowledgment. The effects of both perpetrators' use of force and experiencing immobility on survivor acknowledgment were moderated by the timing of study completion, ORs = 4.22 and 0.11, respectively, ps = .023-.040. These findings suggest that media coverage may impact how certain sexual assault characteristics influence how survivors label their victimization experiences.

Reporting after sexual violence: The influence of victim, assault and perpetrator characteristics

Sexual violence is a worldwide public health concern. Care for victims has improved with the development of sexual assault centres, which have served to professionalise and tailor care and to get different services to improve collaboration. Nonetheless, reporting rates remain low, causing perpetrators to walk free without prosecution. We aimed to investigate, firstly, the influence of victim, perpetrator and assault characteristics on the reporting rate, and, secondly, the reasons why victims did not report to the police. Data of a Dutch sexual assault centre was used in this cross-sectional study. All victims who attended the centre between January 2016 and January 2019 were included. Logistic regression analysis was used to assess the relation of certain characteristics with reporting. Forty per cent of the victims reported to the police. Age and injuries were significantly related to reporting. Victims of 26 years or over were less likely to report than victims under 18 years old. Victims with objectified injuries reported to the police more often. Contrary to previous research, no relation between the perpetrator being well-known to the victim and a lower reporting rate was found. Victims mainly refrained from reporting as they experienced conflicting emotions, followed by their feeling discouraged by the police. Other reasons were fear of the perpetrator and defamation, wanting to move on with their life and wanting to spare the perpetrator. Our findings will serve to further optimise care for victims of sexual violence and increase reporting rates.

New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging.

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants (N = 882) ranged in age from 18 to 81 (M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

Multiple perpetrator sexual assault: correlates of PTSD and depressive symptoms in a sample of adult women

ABSTRACT While most sexual assaults are committed by a sole perpetrator, multiple-perpetrator assaults (MPSAs) still occur. However, less is known about their post-assault impacts. This study examined demographic, assault, and post-assault characteristics as correlates of post-traumatic stress disorder (PTSD) and depressive symptoms in a community sample of adult sexual assault survivors who experienced MPSA (N = 350) in the Chicago area. This study also included demographic and assault characteristics of perpetrators as reported by survivors. Backward regression analysis showed that stressful life events, more violent assaults, post-assault maladaptive coping and characterological self-blame, and receiving acknowledgement without support (e.g. acknowledging the assault happened, but giving inadequate support) reactions were related to greater PTSD symptoms. Older age and greater perceived control over recovery were associated with fewer PTSD symptoms. Greater violence, maladaptive coping, and characterological self-blame were related to greater depressive symptoms, whereas more education and greater perceived control over recovery correlated with fewer depressive symptoms. This study adds to research on MPSA and findings have implications for clinical treatment, intervention, and prevention with survivors.

Karakteristik Kasus Kekerasan Seksual di Rumah Sakit Tipe A di Jawa Barat dan Sumatera Barat

Introduction: Sexual assault in women and children are very prominent among other abuse. Knowledge related to the characteristics of sexual assault is vital for optimal handling of sexual assault cases. Aims: This research aimed to evaluate the characteristics of sexual assault cases in referral hospital (type A hospital) in West Java and West Sumatera provinces. Method: This research is a retrospective descriptive research. The samples were patients suspected of being victims of sexual assault, examined from 1 January 2014 to 31 December 2018. Results: The alleged sexual assault victims are dominated by women, unmarried, with the most age groups of 10-19 years. Most victims come to the hospital within a week after the case. The primary type of sexual assault experienced by the victims is vaginal penetration. Most perpetrators were someone who was well known by the victims. The perpetrators prefer to act at noon in a private place. Medical records revealed that in most cases only signs of violence on the anogenital region, and no trace on other body parts. Conclusion: The characteristic of sexual assault from both provinces are almost similar. The difference that stands out lies in the level of education of victims. Knowledge about the aspects of sexual assault cases is essential for health service to provide optimal health service to sexual violence victims as well as the prevention efforts.

L’influence de l’abus sexuel dans l’enfance sur le sentiment de compétence parentale des mères : analyse qualitative et quantitative

The aim of this paper was to study the self-perception of parenting skills in mothers who were sexually abused during their childhood (between 0 and 16 years old) and to highlight the factors that affect this perception among these mothers. In order to take into account the complexity of the phenomenon, we examined various characteristics of sexual assault (duration, age at first occurrence, strength and threat, intensity of trauma, whether or not one has received therapy, various disorders still present today). In addition, we considered the presence of other child abuse that occurred during childhood and/or adolescence. The tools used for data collection were the Parental Competency Self-Assessment Questionnaire (QAECP), the Trauma Q and a semi-structured interview constructed following a literature review. Eleven assaulted mothers were interviewed and 11 non-victim mothers (control group) were matched. Qualitative and quantitative analyses showed that mothers who have been sexually assaulted have a lower feeling of parental competency and that the more severe the psychological trauma, the lower the scores of self-perception of parenting. It is also noted that these sexually assaulted mothers perceived their own parents as less competent than control mothers. The association with other types of child abuse and sexual abuse occurring within a family were associated with a particularly poor prognosis. It would therefore not be sexual assault as such that would affect the self-perception of parenting skills, but the characteristics of this assault, namely the presence of other forms of abuse and the fact that it is within the family. Our results show the influence of other characteristics on the self-perception of parenting skills, such as age at the beginning of the event, aggressor status, depressive disorders and sleep disorders. All these factors and their consequences illustrate the individual and intergenerational complexity of this issue.

Differences in Women's Substance-Related Sexual Assaults: Force, Impairment, and Combined Assault Types.

This study furthers previous research on sexual assaults (SAs) involving substances and/or force by examining effects of perpetrator behaviors of alcohol and/or drug impairment level (none, impaired, incapacitated) and/or force during SA in relationship to various assault and recovery outcomes. A diverse sample of 632 women from a large Midwestern city participated in a study on women's experiences with SA. Of this sample of substance-involved SAs, 37.3% (n = 236) reported a forcible-only unimpaired assault, 50.6% (n = 320) reported a combined impairment/incapacitation and force assault, and 12% (n = 76) reported an impaired/incapacitated-only assault. Multivariate analyses of covariance (MANCOVAs) and chi-square analyses compared assault types as defined by combined alcohol and/or drug impairment level and/or force to determine how these assaults differed in demographics, other assault characteristics, and post-assault experiences. Assault types differed on several demographic, assault, and post-assault factors with most differences showing that the combined assault type was related to worse outcomes than forcible-type assaults, including greater reexperiencing, avoidance, and numbing post-traumatic stress disorder (PTSD) symptoms. Implications for clinical intervention include recognizing that assaults involving substance use and force are traumatic and warrant individualized treatment.

MP45: What to do with #MeToo: pre and post presenting patterns of intimate partner violence

Introduction: The #MeToo social media movement gained international status in October 2017 as millions disclosed experiences of sexual and intimate partner violence. People who experience violence from a former/current intimate partner may not present for care for many reasons, among them not knowing where to go for care, or not realizing they were experiencing abuse since the behavior was portrayed as ‘normal’. Empirical research identified increased police reporting, internet searches, and new workplace regulations on sexual assault/harassment after #MeToo. Less is known about how #MeToo has influenced hospital-based care, particularly among IPV cases. We aimed to investigate if the #MeToo social movement influenced patterns of IPV cases presenting for emergency care. Methods: This study took place at the Sexual Assault and Partner Abuse Care Program (SAPACP), within the Emergency Department of The Ottawa Hospital. Patients seen from November 1st, 2016 through to September 30th, 2017 was considered Pre-#MeToo and those seen November 1st, 2017 to September 30th, 2018 was considered Post-#MeToo. All patients seen in October 2017 were excluded. Analyses compare the proportion and characteristics of IPV cases seen Pre- and Post-#MeToo. Log-binomial regression models were used to calculate relative risk and 95% CI. Results: 890 cases were seen by the SAPACP during the total study period, of which 564 (63%) were IPV cases. 258 IPV cases were seen Pre-#MeToo and 306 IPV Post-#MeToo. The clinical presentation for IPV cases was similar between both periods where approximately 42% of IPV cases presented for sexual assault, 50% presented for physical assault. An increase in frequency and proportion of IPV cases was observed post-#MeToo. Post-#MeToo there were 48 additional cases of IPV, corresponding to almost a 20% increase in risk compared to the Pre-#MeToo period. (RR: 1.19, 95% CI: 1.07-1.31) Post-#MeToo, there were more presenting cases of IPV among male/trans cases (9 vs 26) and youth cases (82 vs 116). Conclusion: #MeToo is a powerful social movement that corresponded with a significant increase in IPV cases presenting for emergency care. While the assault characteristics among IPV cases remained similar, an important contribution of this research is the increase in youth, male/transgender patients who presented for care post-#MeToo. Continued investigations into pre- post-#MeToo trends is needed to understand more about the changing clinical population and to inform resource and service allocation.