History Of Sexual Trauma Research Articles

A Network Comparison of Sexual Dysfunction, Psychological Factors, and Body Dissociation between Individuals with and without Sexual Trauma Histories

ABSTRACT Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress.

Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma.

Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.

Quality of Life and Sexual Activity among a Group of Iranian Cervical Cancer Patients Undergoing Surgery or Radiotherapy

Background: This is a case-control study aimed at investigating the predictors of sexual function, depression levels, and quality of life in cervical cancer patients.
 Methods: The study enrolled women aged 18 years and older who were at least six months post cervical cancer diagnosis and treatment in a single institution and underwent surgery or radiotherapy. The control group was selected from women referred for routine gynecologic screening. The study excluded women who had a history of sexual trauma and mental disorders, any general health problems, and therapy potentially affecting sexual life, such as hormonal therapies other than contraception. Demographic and clinical data of all participants were gathered, and all participants were asked to respond to two questionnaires: the Female Sexual Function Index (FSFI) and the Medical Outcomes Study 12-item Short Form health survey (SF-12) in a face-to-face interview. The study analyzed the data using descriptive statistics and comparison of demographics, clinical data, tumor and surgical characteristics. Linear regression tests were used to predict numerical outcomes, and a p-value <0.05 was considered statistically significant.
 Results: The study concluded that there were no baseline characteristics identified to have statistically significant differences among study groups, and all three groups had similar distributions of socioeconomic and demographic variables.
 Conclusion: This study showed that cervical cancer and route of treatment may affect the patients’ quality of life and sexual health. Health care systems and health care providers may screen these patients and take early actions to prevent more morbidities.

(079) Evaluating Sexual Self-schema Scales for Use Among Women Who Experienced Sexual Trauma: A Systematic Review of Measurement Properties and Practice Implications

Abstract Introduction “Sexual self-schema" refers to a psychological construct describing the organization of cognitive, affective, and behavioral dimensions of our understanding of ourselves as sexual beings. Sexual self-schema have been shown to mediate a variety of women’s sexual wellbeing outcomes. It is unclear the extent to which existing measurements of sexual self-schema capture aspects relevant to a sexual trauma history, such as unique patterns of dysregulated sexual excitation and inhibition. Objective This systematic review describes existing validated sexual self-schema measurements, and critically discusses each instrument in the context of assessing women who experienced sexual trauma. Methods We conducted the review according to PRISMA guidelines. We searched Academic Search Premier, Web of Science, and PsycINFO for reports focused on development and validation of assessment tools for women’s sexual self-schema. The search used pre-specified keywords (“sexual self-schema,” “sexual self-concept,” “sexual self-perception,” or “sexual self-view”). To ensure literature saturation, authors conducted reference branching on studies identified from the search via Google Scholar. Authors then screened titles, abstracts, and methods of all potentially eligible studies. Results Searches identified 576 articles, of which 455 unique articles were considered. Of these, 287 and 63 were excluded based on information in the title and abstract, respectively. Of 43 full-text articles retrieved, 20 were removed upon methods inspection. Reference list branching identified 65 additional potential articles, of which two were included. Across methods, 21 total papers were included in the final review. This presentation will present data on each measurement tool, including scope of use, sample description, measurement validation properties, and application considerations. Qualitative synthesis across papers revealed that the Sexual Self Schema Scale for Women (Andersen & Cyranowski, 1994) is the most widely cited and is clearly the field standard, from which further emic versions have been developed across languages and nationalities. Further, available measures vary widely in content specificity/comprehensiveness, face validity, and response valence dimensionality. Only two papers explicitly considered elements of sexual trauma at the measurement development or validation phase. Conclusions Existing scales have limited utility in capturing unique social-relational patterns that are common among women who have experienced trauma. Further, few validated scales incorporate nuanced elements of co-occurring, conflicting approach-avoidance orientations toward sex, which suggests that measures may be limited in their ability to assess risk factors for sexual dysfunction among sexual trauma survivors. We list measurement development and validation details and relevant strengths and limitations of 21 unique, varied sexual self-schema measurement instruments for researchers and clinicians who seek to understand cognitive risk and resilience factors among women who have experienced sexual trauma. Disclosure No

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Dissociative Identity Disorder in an Inpatient Setting

AbstractDespite recognition in current and past versions of DSM, dissociative identity disorder (DID) remains a controversial psychiatric disorder which hampers its diagnosis and treatment. Factors that lead misdiagnosing of DID are the unfamiliarity with spectrum of dissociative disorders, the existence of feigned DID, the reluctance of individuals with DID to present their dissociative symptoms, and lack of knowledge and appreciation of its epidemiology which is shown to have 1.5% lifetime prevalence. An accurate diagnosis allows the appropriate interventions leading to fewer hospitalizations.KC is 28 y.o. female with a psychiatric history significant for polysubstance use, PTSD, and GAD, who presented to the ED due concern for DID per mother. Prior to presentation, she had thrashed her mother’s home of which she denies recollection. She has a history of early sexual trauma by her own family. She screened 44 on the Dissociative Experiences Scale (DES). Throughout her hospitalization, she exhibited questionable lapses of disassociation, although there were no noted changes of posture, dress, speech, or acknowledgement of alters. She was discharged on Remeron 15 mg, Risperdal 2 mg, and Prazosin 2 mg with outpatient resources for trauma-based therapy.DID is characterized by two or more distinct identities or personality that coincide with fluctuating states of consciousness and changing access to autobiographical memory. The neurological similarities between personality states in DID and PTSD subtypes support a trauma-related etiology of DID. Although there are many interviewing tools, the DES has been the most widely used clinically. Although collateral information, detailed history, and DES were concerning for DID, observation did not show distinct dissociative episodes as discussed by collateral (alter described as destructive and cold towards her own infant) although the hospital environment may not have provided enough stress for patient to transition from one personality to another.The International Society for the Study of Trauma and Dissociation proposes a phase-oriented treatment approach: 1) establishing safety, stabilization, and symptom reduction; 2) confronting, working through and integrating traumatic memories; 3) identity integration and rehabilitation. From inpatient standpoint, phase 1 and 2 may be promptly addressed. Besides initiation of Remeron and Risperdal (consistent with treatment of DID in two prior case reports), implement grounding techniques and coping mechanisms against triggers for dissociative episodes. Inpatient screening can facilitate earlier accurate diagnosis, faster and more targeted interventions, prevent unnecessary direct and indirect societal costs, and, most importantly, improve quality of life for those with the disorder.FundingNo Funding

Treatment Utilization for Posttraumatic Stress Disorder in a National Sample of Veterans and Nonveterans.

The current study sought to compare rates of posttraumatic stress disorder (PTSD) treatment utilization (medication and psychotherapy) among veterans and nonveterans-and to investigate which factors are associated with treatment utilization among veterans versus nonveterans. Participants were 2775 individuals (veteran, n=2508; nonveteran, n=267) meeting criteria for probable PTSD (determined by the PTSD Checklist) drawn from a nationwide, population-based survey. Participants reported demographic information, trauma history, mental health symptoms, insurance coverage, and treatment history. Analyses revealed that the majority of veterans and nonveterans with probable PTSD had not received any PTSD treatment (56% of veterans and 86% of nonveterans). Population-weighted logistic regression models demonstrated that veterans with probable PTSD were substantially more likely to receive medication and psychotherapy for PTSD than nonveterans with probable PTSD. Logistic regression models demonstrated that, among veterans, having Veterans Affairs health care coverage was most strongly associated with receiving PTSD medication and psychotherapy. Black (vs. White) veterans were less likely to have received PTSD medication and psychotherapy. In contrast, among nonveterans, being married or divorced (vs. never married) was most strongly associated with receiving PTSD medication, and reporting a history of sexual trauma was most strongly associated with receiving PTSD psychotherapy. Given that most individuals do not receive PTSD treatment, additional understanding of treatment barriers and facilitators for both veterans and nonveterans is needed to improve intervention reach.

Editor’s Note

Editor’s Note Benjamin Schaefer At the height of the COVID shutdown in the United States, I was asked to speak at an informal recovery meeting by a friend I had met ten years earlier in a twelve-step fellowship in Boston, Massachusetts. I got sober relatively young, at the age of twenty-four, and have remained sober and active in twelve-step recovery since October 26, 2008. Sobriety has been the singular blessing of my life, and in my time in recovery I’ve witnessed miraculous things occur in my life and the lives of other recovering people. And yet, to this day, one of the most impressive remains watching how quickly and efficiently the recovery community moved online in the early days of the shutdown. Within a week I could go to meetings all over the country, all over the world, with other people who were making it their business to stay sober a day at a time amidst the most cataclysmic event of our lifetimes. Never before had recovery felt so democratic. But when my friend asked me to speak, I was reluctant. I was just then coming off a period of intensely painful emotional and spiritual growth—what we might call in recovery a spiritual awakening, but which had felt at the time more like a crisis of confidence. In the slow and quiet days of that summer’s isolation, I had realized that at some point in my early sobriety I had developed certain ways of operating in the world to keep myself safe—particularly in my intimate relationships with men—but which had ultimately left me unseen. And I had wanted so badly to be seen. At twelve years sober, this was a difficult truth to reckon with, and in the aftermath of its revelation, I felt like cellophane: thin and transparent. But I agreed to speak at the meeting, because he was my friend and he had asked. Logging onto the meeting, I was nervous. By that point in my recovery, I had shared at more meetings than I could possibly count, but I was still adjusting to sharing online where I couldn’t gauge the feel of a room in quite the same way I could in person. I watched, slightly horrified, as more and more people signed into the meeting—people from Madison, Wisconsin, [End Page 15] and Fort Lauderdale, Florida, and Southern California and New York City. Soon the number of participants reached more than eighty. The meeting began and my friend introduced me. I read from a piece of recovery literature and then spoke for fifteen or twenty minutes about my experience in sobriety, after which the meeting opened for other people to share. It wasn’t long before I realized that a large contingent of the meeting was made up of gay men. This was something of a revelation. Though there is a robust recovery community in my hometown, with more than three hundred meetings each week, only two are designated as queer meetings, and I had largely avoided those meetings throughout my sobriety for reasons that weren’t entirely clear to me at the time, but which undoubtedly had to do with my own history of sexual trauma and my general distrust of men. But listening to those men share at that online meeting, I felt a familiar mixture of discomfort and curiosity. It was the peculiar emotional cocktail I’ve come to recognize as an invitation for further spiritual growth. The Universe was trying to tell me I had something more to learn. And so I began attending that meeting, which met every night during the pandemic, regularly. It was at that meeting that I met a gay actor who was weathering the shutdown in Stamford, Connecticut, and who had been sober for almost three years. We embarked on a deep and abiding friendship. Every night after the meeting, we’d talk on the phone, sometimes for hours. During one of these phone calls, this man told me he had once heard someone describe recovery as a journey towards becoming whole, but that something about that framing didn’t feel right to him. It was a...

Gynaecological care of women with chronic pelvic pain: Patient perspectives and care preferences.

To explore the experiences and care preferences of women with chronic pelvic pain, with or without a history of sexual trauma, seeking gynaecological care. Qualitative study. Ambulatory endometriosis centre. Women aged 18-55 years with chronic pelvic pain. Baseline demographics and sexual trauma history were obtained, and participants were assigned to focus groups according to a positive (four groups, 13 participants) or negative (two groups, nine participants) screen for a history of sexual trauma. The focus groups were led by a clinical psychologist and a gynaecological surgeon and consisted of semi-structured interviews. The interviews were audio-recorded and transcribed, and the transcripts were coded in NVivo 12. Content analysis was used to derive themes according to the participants' own words. Participants with chronic pelvic pain, with or without a history of sexual trauma, experienced delay in diagnosis and repetitive dismissals by clinicians. Participants' experiences of dismissals included: clinicians not listening, insufficient allocation of time to appointments and perceived redundant medical testing (i.e. sexually transmitted infection testing, urine cultures, ultrasounds). Participants identified clinician interactions as pivotal in coping with both pelvic pain and sexual abuse. Participants also provided feedback regarding trauma-informed practices and care delivery specific to patients with chronic pelvic pain. Patients with chronic pelvic pain, with or without a history of sexual trauma, report negative experiences when interacting with the healthcare system. They have clear needs and preferences regarding gynaecological care and provide feasible suggestions for improving care delivery.

Characteristics associated with non-suicidal self-injury among veterans seeking military sexual trauma-related mental healthcare

Military sexual trauma (MST) is a serious issue among Veterans; it is associated with increased rates of posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), both of which are correlated with poorer mental health outcomes, including increased suicide risk. Additional insight into the characteristics associated with NSSI among Veterans with MST can help identify individuals at increased risk for suicide and other negative outcomes and improve care for Veterans with a history of MST. The current study was comprised of 327 Veterans referred for MST-related mental health services at a VHA hospital. Participants completed a semi-structured interview for clinical symptoms, including NSSI behaviors. Results of a retrospective chart review revealed a high endorsement of lifetime NSSI (26.9%) with cutting behaviors identified as the most frequently endorsed method. Logistic regression showed personality features, history of cumulative sexual trauma, and younger age were uniquely related to lifetime NSSI. These results corroborate previous findings that show elevated rates of NSSI among Veterans with exposure to trauma. This study expands upon previous findings by examining risk factors specific to treatment-seeking Veterans with a history of MST, which can aid clinical care and risk management procedures in Veteran healthcare.

Obsessive-compulsive symptoms and daily experiences of posttraumatic stress and mental contamination following sexual trauma

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

Daily Associations Between Trauma-Related Mental Contamination and Use of Specific Coping Strategies: Results of a Daily Monitoring Study.

Mental contamination (MC)-a sense of dirtiness experienced without contacting an identifiable pollutant-is a distressing and enduring experience among many survivors of sexual trauma. MC has been linked to more frequent use of avoidant coping behaviors (e.g., washing behavior, substance use, binge eating) and approach coping. However, it is unclear if specific approach and avoidant coping strategies are more consistently related to perseverative experiences of trauma-related MC, if the use of certain strategies predicts changes in MC, and if fluctuations in MC predict the use of certain strategies. The present study evaluated contemporaneous and prospective relationships between sexual trauma-related MC and use of 11 specific coping strategies among 41 women with a history of sexual trauma using an experience sampling design. Women completed twice-daily assessments of coping strategy use and MC for 14 days. Between-persons, women reporting more intense MC on average reported more frequent use of distraction, denial, giving up, self-blame, thought suppression, washing behavior, emotional processing, and emotional expression than those experiencing less intense MC. Within-person increases in MC were associated with more frequent concurrent use of all coping strategies except seeking support. Lastly, within-person increases in MC predicted more frequent use of giving up, substance use, and seeking support at the next assessment and within-person increases in substance use predicted less severe MC at the next assessment. Future work should aim to identify factors influencing the selection and/or quality of use of these specific coping strategies among individuals experiencing MC.

Differences in mental health care service utilization in older veterans with a history of military sexual trauma.

Differences in mental health care service utilization in older veterans with a history of military sexual trauma.

Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

BackgroundSexual dysfunction (SD), including erectile (ED) and ejaculatory dysfunction, is associated with diminished quality of life (QoL) in men with UCPPS (chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and/or interstitial cystitis/bladder pain syndrome (IC/BPS)). AimWe sought to compare SD among male patients with UCPPS, other chronic pain conditions (positive controls, PC), and healthy controls (HC) without chronic pain, and to evaluate the association of comorbidities, psychosocial factors, and urologic factors of SD in all 3 groups. MethodsBaseline data from male UCPPS participants, PC (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and HC enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping Study were included in the analysis. Sexual function was assessed using the International Index of Erectile Function-Erectile Function Domain (IIEFEF) and Ejaculatory Function Scale (EFS). Male ED was defined as a composite IIEF-EF score <21. Higher EFS score indicated worse sexual dysfunction; no threshold to define SD was identified for the EFS. Multivariable logistic and linear regression was used to investigate associations of comorbidities, psychosocial factors, and urologic factors with ED and ejaculatory, respectively. OutcomesComorbidities, genital pain, and psychosocial factors are associated with SD across the study population and male patients with UCPPS had a high prevalence of ED and greater ejaculatory dysfunction. ResultsThere were 191 males with UCPPS; 44 PC; and 182 HC. Males with UCPPS had worse SD compared to PC and HC including lower mean IIEF-EF scores, greater degree of ejaculatory dysfunction, and lower quality of sexual relationships. Among all 3 cohorts, depression, stress, and pain were associated with ED in univariable and multivariable analysis, as was diabetes mellitus. Pain in the genitalia, severity of urinary symptoms, depression, stress, and history of childhood sexual trauma were associated with ejaculatory dysfunction in univariable and multivariable analysis. Clinical ImplicationsA multidisciplinary approach that addresses the identified risk factors for SD may improve overall QoL in males with UCPPS. Strengths and LimitationsOur study is strengthened by its use of validated, patient-reported questionnaires and inclusion of healthy and positive controls. Our understanding of the role of IC in this study is limited because only 1 patient in the study had IC/BPS as a sole diagnosis. ConclusionsWhen compared to healthy controls and patients with other chronic pain conditions, males with UCPPS experience higher degrees of SD, including erectile and ejaculatory dysfunction.Loh-Doyle JC, Stephens-Shields AJ, Rolston R, et al. Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. J Sex Med 2022;19:1804–1812.

Anxiolytic Herbs and Naturopathic Treatment of Anxiety-Induced Female Sexual Dysfunction: A Case Report

We report on successful treatment of female sexual dysfunction in a young (23-year-old) woman (she/her) with a combination of anxiolytic and stress-relieving natural health products (NHPs) together with patient education and lifestyle counselling. Presenting symptoms included decreased sexual desire and arousal, anorgasmia, dyspareunia, and vaginismus that had improved with pelvic physiotherapy prior to the onset of naturopathic treatment. Contributing factors in this case included a personal history of abuse and sexual trauma. Alongside counseling and patient education, NHPs initially included L-theanine, Rhodiola rosea, Panax ginseng, and vitamin D. Over approximately 4 months of treatment, the patient reported significant improvements in sexual desire, both physical and psychological arousal, and was able to achieve orgasm. This case report identifies the important role of mental health and stress in female sexual dysfunction and supports the use of natural anxiolytics to support sexual function, in particular in patients with a history of trauma.

Specific Associations Between Type of Childhood Abuse and Elevated C-Reactive Protein in Young Adult Psychiatric Rehabilitation Participants.

Early-life adversity such as childhood emotional, physical, and sexual trauma is associated with later-life psychiatric and chronic medical conditions, including elevated inflammatory markers. Although previous research suggests a role for chronic inflammatory dysfunctions in several disease etiologies, specific associations between childhood trauma types and later-life inflammation and health status are poorly understood. We studied patients (n = 280) admitted to a psychiatric rehabilitation center. Self-reported histories of childhood emotional, physical, and sexual trauma were collected with a standard instrument. At the time of admission, we also assessed individuals' body mass index and collected blood samples used to examine inflammatory marker C-reactive protein (CRP) levels. The prevalence of all 3 types of abuse was relatively high at 21% or more. Fifty percent of the sample had elevations in CRP, with clinically significant elevations in 26%. We found that compared with a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP. This result held up when using linear regressions to examine the contribution of body mass index. Our sample was relatively young, with an average age of 27.2 years and minimal representation of ethnic and racial minority participants. Relative to childhood emotional and physical trauma, childhood sexual trauma may lead to elevated inflammatory responses, as confirmed in our finding of an association between CRP and sexual abuse. Future studies need to assess the causal link between childhood sexual trauma and poorer health outcomes later in life.

Perinatal Care for Individuals With a History of Sexual Trauma

Many women and individuals assigned female at birth experience sexual assault or abuse in their lives leading to sexual trauma. In this article, we review the effects of sexual trauma and resulting chronic stress on the body and during the perinatal period. Maternal, fetal, and neonatal health implications are discussed. Routine screening for sexual assault and violence can assist with early identification and intervention. A variety of modalities and methods for managing the effects of sexual trauma have been identified, including pharmacologic treatment, psychotherapy, complementary and alternative medicine, and shared decision-making. Further research regarding different treatments is essential to find additional tools to aid clinicians providing care to this vulnerable population. When nurses care for individuals with a history of sexual trauma, incorporating trauma-informed care can help prevent retraumatization and promote a healthy perinatal experience.

Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

BackgroundUnited States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.ObjectiveTo examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019.DesignWe performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019.ParticipantsWomen Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year.Key ResultsAmong women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.)ConclusionsGonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.

Mental health services use among Canadian Armed Forces members and Veterans: Data from the 2018 Canadian Armed Forces members and Veterans mental health follow-up survey (CAFMVHS).

Differences in healthcare delivery systems and pathways to mental healthcare for Canadian Armed Forces (CAF) members and Veterans may contribute to variations in mental health services use (MHSU) and the factors associated with it. We: (1) estimated the prevalence of past 12-month MHSU (≥1 visit with a medical or mental health professional); and (2) identified sociodemographic, military-, trauma-, and health-related variables associated with MHSU among CAF members and Veterans. The current study used data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Model variables were selected a priori, and their respective associations with MHSU were estimated among (1) CAF members and (2) Veterans using separate multivariable logistic regression models. Similar proportions of CAF members and Veterans reported past 12-month MHSU (26.9 vs. 27.5%, respectively). For both CAF members and Veterans, meeting criteria for at least one past 12-month MH disorder was associated with past 12-month MHSU [adjusted odds ratio (AOR) = 7.80, 95% confidence interval (CI) = 7.18-8.46; and AOR = 11.82, 95% CI: 11.07-12.61, respectively). Past-year suicide ideation, a history of sexual trauma, and endorsement of adverse childhood experiences were also significantly associated with MHSU among CAF members and Veterans. Similar to previous research, meeting screening criteria for a past 12-month MH disorder was strongly associated with MHSU among both samples. This study extends our existing knowledge about factors associated with MHSU among CAF members and Veterans, and offers direction for future research to increase MHSU.

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial

BackgroundAddressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting.MethodsThis study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR).DiscussionThis trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa.Trial registrationClinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.