Study Highlights

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A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims

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Walsh, K., Badour, C. L., Zuromski, K. L., Gilmore, A. K., Kilpatrick, D. G., Acierno, R., & Resnick, H. S. (2021). A secondary analysis of a brief video intervention on suicidal ideation among recent rape victims. Psychological Services, 18(4), 703–708. For full text click here.

How does a brief video intervention before a medical forensic examination affect the stress levels of recent rape victims? An analysis was done to see how video intervention and cortisol levels impact suicidal ideation amongst different groups of women who presented at the emergency room after experiencing rape. These groups included those with and without prior rape experiences, white and minority groups, those with high or low cortisol levels at the ER, and marijuana users and non-users.

Methods

235 female rape survivors aged 15 and older participated in the study. They were randomly assigned to either watch the video intervention (the Prevention of Post-Rape Stress Video) and also receive a forensic examination or they were assigned to only the forensic examination. The cortisol levels and substance use was measured in both groups. A follow up was conducted at 6 weeks, 3 months, and 6 months using the Beck’s Depression Inventory-II to measure suicidal ideation.

Results

It was found that prior rape victims who did not receive video intervention had the highest probability of suicidal ideation, while prior rape victims who did receive video intervention had the lowest probability of suicidal ideation. Comparatively, cortisol had opposite effects on suicidal ideation. The likelihood of suicidal ideation for prior rape victims who did not watch the video was 0.6 when their cortisol levels were high compared to 0.48 when their cortisol levels were low. In contrast, for prior rape victims who received the video intervention, suicidal ideation was 0.17 for high cortisol and 0.29 for low cortisol. For those without a prior rape and no video intervention, cortisol was not significantly associated with suicidal ideation. And for those without a prior rape who watched the video, likelihood of suicidal ideation was 0.51 for high cortisol and 0.31 for low cortisol. It was found that the interaction between prior rape and watching the video on suicidal ideation was only significant at extreme values of cortisol. The intervention also benefitted women without a prior rape history who had heightened cortisol at the ER. Furthermore, women who used marijuana before the rape were more likely to report suicidal ideation.

Future Directions

These results open doors to questions about how neuroendocrine activity interacts with interventions to mediate PTSD of female survivors, and how women with prior rape histories require different kinds of treatment than those without. 

Prescription opioid misuse after a recent sexual assault: A randomized clinical trial of a video intervention

 

Oxycodone

Gilmore, A. K., Walsh, K., Frazier, P., Ledray, L., Acierno, R., Ruggiero, K., Kilpatrick, D.G., & Resnick, H. S. (2019). Prescription opioid misuse after a recent sexual assault: A randomized clinical trial of a video intervention. The American Journal on Addictions, 28(5), 376-381. For full text click here

Prescription opioid (PO) misuse is commonly associated with overdose and is on the rise. Individuals who recently experienced a sexual assault risk heightened substance abuse, but few interventions focus on PO misuse following sexual assault. Prior studies show a fairly strong association between sexual assault history and PO misuse among adolescent girls (Young, 2011). Individuals who experienced a recent sexual assault who report to the ED (Emergency Department) for a sexual assault medical forensic examination (SAMFE) may be feeling significant stress, but there is limited information about PO misuse during this very stressful time after a recent sexual assault. Only one intervention, the Prevention of Post-Rape Stress (PPRS) video has been utilized to target post-sexual assault substance use and mental health symptoms during a SAMFE amongst girls and women after a recent sexual assault, which includes information such as self-directed exposure methods (Resnick, 2007).

Methods 

The current study recruited 154 adolescent girls and women in the context of a SAMFE in the ED. Researchers compared effects of a PPRS video and a pleasant imagery and relaxation instruction (PIRI) video with a treatment as usual (TAU) video. At a 1.5 month follow up, participants reported if they had used POs for non-medical purposes since the sexual assault. Researchers hypothesized that relative to TAU, both the PPRS and PIRI conditions would be associated with lower PO misuse 1.5 months after sexual assault. Researchers also hypothesized that after 1.5 months after the assault, the PPRS and PIRI conditions would be associated with reductions in PO misuse compared to TAU among those with a prior sexual assault (SA).

Results

The researchers found that based on a logistic regression analysis, 1.5 months after the sexual assault, participants with a prior sexual assault were less likely to misuse prescription opioids in the PIRI condition compared with TAU. There were no main effects for the video condition and no interactions for the PPRS condition on PO misuse.

These results indicate that teaching types of mindfulness or relaxation exercises, such as providing the PIRI video, may function as a secondary prevention for individuals during the SAMFE for individuals with sexual assault history. Compared with the PPRS, the PIRI video may have been associated with less PO misuse among those with prior sexual assault because it used evidence-based techniques to reduce pain including mindfulness and relaxation. It is likely that PO misuse is directly linked to the experience of pain, and the PIRI may have reduced pain.

Future Directions

Future research should examine if the ED’s use of relaxation techniques are indirectly associated with reductions in PO misuse through reduction in pain. Future research should also examine why these technology-based interventions are not as effective for individuals who have not experienced prior sexual assault. 

A randomized clinical trial examining the effect of video-based prevention of alcohol and marijuana use among recent sexual assault victims

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Walsh, K., Gilmore, A. K., Frazier, P. A., Ledray, L., Acierno, R., Ruggiero, K. J., Kilpatrick, D. G., & Resnick, H. S. (2017). A randomized clinical trial examining the effect of video-based prevention of alcohol and marijuana use among recent sexual assault victims. Alcoholism: Clinical and Experimental Research, 41(12), 2163–2172. For full text click here.

​​Sexual assault (SA) is known to have long-term health consequences such as misuse of alcohol and/or marijuana and post-traumatic stress disorder. Researchers have implemented secondary prevention interventions to negate the negative consequences of SA, but only one targeted drug and alcohol use after peritraumatic distress. Researchers used the theoretical framework of Resnick and colleagues’ program, the Prevention of Post-Rape Stress (PPRS) which targeted drug and alcohol use, to further the research of secondary prevention interventions.

Methods

The current study focused on changes in drug and alcohol use from pre-SA (assessed at baseline) to follow-up periods at 6 weeks (T1), 3 months (T2), and 6 months (T3). They hypothesized that individuals in the PPRS condition would have less alcohol and drug use than the other conditions. They also hypothesized that people reporting previous SA encounters and previous substance use would benefit the most in the PPRS condition. 

After receiving medical care post-assault, participants were randomly assigned to three intervention conditions: PPRS, Pleasant Imagery and Relaxation Information video (PIRI), and Treatment as usual (TAU). Participants completed measures that included demographics, prior sexual assault, negative affect, alcohol use and problems, and marijuana use and problems. They were then randomly assigned a treatment intervention and received telephone follow-up interviews at 6 weeks, 3 months, and 6 months post-SA. 

Results

Findings concluded that PPRS may be the optimal intervention for assessing drug and alcohol use post-SA. Specifically, the PPRS was effective at reducing substance use at 6 months, but this holds for some groups of women. PPRS resulted in less substance use than the other conditions for women who reported binge drinking in the past year. Subsequently, the PPRS appeared to lessen the usage of alcohol for minority women. Although results with marijuana use appear to differ, the PPRS resulted in a decrease in marijuana use compared to TAU, but this was upheld only for women who had no previous marijuana use and no previous sexual assaults. For women who did report a previous SA, the PPRS was effective in reducing marijuana use at 6 months. 

Although research on secondary prevention interventions is needed to combat the negative consequences that come with SA, there are some implications within this study. One implication includes the intervention videos the participants watched. Some participants watched a brief version of the video after the forensic examination, but some did not. It is important to note that not all participants went through the same procedure. Furthermore, the sample size was relatively small in all conditions.

Future Directions

Research should follow up with a larger sample size to detect possible interactions between conditions and participants. Another implication involves the demographics of the women participants. Most of the women were low-income, unemployed, single, and had a previous SA. Researchers should be hesitant in relaying these findings as it is unsure if the results would translate to those with different demographics. Lastly, the analyses did not bear in mind other mental health symptoms that could impede these results. Further research should address these implications for the purpose of generalizing the results.

 

 

A systematic review of campus characteristics associated with sexual violence and other forms of victimization

Tashkandi, Y., Hirsch, J. S., Kraus, E., Schwartz, R., & Walsh, K. (2023). A systematic review of campus characteristics associated with sexual violence and other forms of victimization. Trauma, Violence, & Abuse, 24(3), 1777-1796. For full text click here.

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The research investigates the associations between institutional characteristics and various forms of victimization, focusing on sexual assault, intimate partner violence (IPV), stalking, bullying, and crimes in educational settings. The intersectionality of various identities and the potential impact on victimization experiences are acknowledged, framing the investigation within the broader context of campus safety and well-being. 

Methods

A thorough search strategy was done across three databases, focusing on victimization across multiple campuses. Inclusion criteria considered studies published/translated into English by September 2020, emphasizing empirical research on victimization types across campuses. Exclusion criteria ruled out non-empirical papers and those not meeting specific criteria. Additional papers were identified through reference list examination. After initial screening of 1124 records, 43 studies met the inclusion criteria. Data extraction involved gathering information on various study aspects, and a second review was conducted to create a table of characteristics associated with victimization. The process followed PRISMA guidelines, ensuring a comprehensive and systematic approach to study selection and data extraction

Results

Intricate associations between institutional characteristics and victimization experiences was highlighted. Higher rates of traditional bullying experiences were found at urban schools compared to rural schools. Sexual assault victimization rates were found to be higher at private institutions, whereas IPV rates showed an opposite trend, being higher at public institutions. Other forms of violent victimization often co-occur with sexual assault victimization among college students. Campus demographics and behaviors, such as alcohol environment and the percentage of students living on campus, exhibited differential associations with various types of victimization. Regarding the relationship between crime victimization and campus characteristics, findings were overall mixed or contradictory. Intervention strategies must consider the diverse landscape of campus characteristics. 

Future Directions

Future research should use an intersectional approach and focus on establishing a multi-campus dataset while preserving anonymity, and should address reporting biases and variations in reporting victimization. The scope of research should be broadened beyond English-language studies, and qualitative and ethnographic research is needed to understand the pathways through which institutional characteristics influence rates of sexual violence. Additionally, exploring perpetration research and ecological approaches could provide insights for impactful prevention policies in educational settings and beyond. 

Prevalence and correlates of sexual assault perpetration and ambiguous consent in a representative sample of college students

Walsh, K., Sarvet, A. L., Wall, M., Gilbert, L., Santelli, J., Khan, S., Thompson, M. P., Reardon, L., Hirsch, J. S., & Mellins, C. A. (2019). Prevalence and correlates of sexual assault perpetration and ambiguous consent in a representative sample of college students. Journal of Interpersonal Violence, 36(13–14). For full text click here.

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The researchers set out to better understand the prevalence of sexual assault (SA) occurrences and sexual events following ambiguous consent, which occurs when individuals do not know whether their partner consented or not, by male, female, and gender nonconforming (GNC) college students. In addition, they hoped to gain insights into possible correlates of sexual assault and ambiguous consent perpetrations. Sexual assault being major problems among college students and limited data being available on female and GNC perpetrators as well as correlates of perpetration drove the researchers to pursue these research topics. An ambiguous consent question was included in the study to combat the possibility participants may be reluctant to report SA perpetration due to social desirability considerations.

Methods

Students invited to participate in the study were randomly sampled from two interconnected universities. The students enrolled in the study represented 67% of those emailed invitations to the study. Information was obtained via self-reported online surveys which had questions on sexual assault perpetration and strategies used to accomplish (if applicable), ambiguous consent experiences, demographic correlates, victimization and perpetration history, pornography viewing frequency, binge drinking and frequency of substance use prior to sex, psychological symptoms, beliefs and attitudes, sexual relationship history, verbal consent habits, participation in fraternity, sorority, and/or athletic teams, and perceived support from friends and family. Statistical analyses were done separately for men, women, and GNC student groups, prevalence of SA perpetration, prevalence of ambiguous consent, and all possible correlates.

Results

For the 34 students who reported SA perpetration (2.1% of students enrolled), most SA events occurred when the student was a freshman, involved sexual touching only, involved the perpetrator taking advantage of the victim being incapacitated, occurred on campus, and involved substance use by the perpetrator. Most SA perpetrators described the victim as being a friend who they met at college. Correlates of SA perpetration which were statistically significant were sexual victimization in the past year, SA perpetration event(s) prior to college, a monthly binge drinking habit, elevated depression levels, higher traditional masculinity beliefs, and higher belief in nonverbal consent tactics.

For the 144 students who reported they experienced ambiguous consent with a sexual partner (9% of students enrolled), the correlates which were statistically significant were older age, higher year in college, identifying as Hispanic, having selected difficulty paying for basic necessities “rarely/sometimes” or “often/always,” identifying as being homosexual or other sexual orientation, childhood sexual victimization, sexual victimization at any point before college, any perpetration prior to attending college, monthly habit of binge drinking, higher frequency of substance use before sex, higher depression and anxiety scores, lower self-esteem score, increased rape myth acceptance, higher belief in nonverbal consent behaviors, involvement in hookups, and fraternity/sorority association.

The researchers noticed perpetration rates in this study are lower than other comparable studies. They propose this is likely due to the widely increased discussion and interventions around sexual perpetration in recent years, leading to social desirability bias in the current study. The authors offered the ambiguous consent question in the current study may have captured students who were not aware their consent practices did not meet the standards but did not actually have sex which was undesired by their partner.

Future Directions

Future directions may include interventions for students who are both victims and perpetrators, interventions for students to successfully navigate sexual relationships, interventions for improving family support systems, studying GNC student perpetration more specifically, performing studies which are more longitudinal, and replicating the study at other universities in different regions. 

Post-sexual assault cigarette smoking: Findings from a randomized clinical trial of a video-based intervention

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Walsh, K., Gilmore, A. K., Schumacher, J. A., Coffey, S. F., Frazier, P. A., Ledray, L., Acierno, R., Ruggiero, K. J., Kilpatrick, D. G., & Resnick, H. S. (2020). Post-sexual assault cigarette smoking: Findings from a randomized clinical trial of a video-based intervention. Addictive Behaviors, 100. For full text click here.

The authors were motivated by a desire to understand trends in smoking behavior among sexual assault victims following a sexual assault, as well as to explore the effects of various factors on this behavior and in particular whether they could benefit from a video intervention to reduce smoking behavior.

Methods

Using a randomized controlled trial approach, they examined the effects of three different intervention conditions on post-sexual assault smoking behavior. These conditions included the Prevention of Post-Rape Stress video, the Pleasant Imagery and Relaxation Information (PIRI) video, and Treatment as Usual (TAU). They assessed the effect of each factor on smoking behavior by collecting a variety of data, including information on smoking behavior, subjective pain units, age, education level, and income.

Results

The results showed a downward trend in smoking behavior during the follow-up period after sexual assault. Specific data showed that smokers in the PPRS group smoked fewer cigarettes per day, on average, at the first follow-up time point (T1, approximately 2 months later). The frequency of smoking increased as time progressed in participants receiving TAU.

Interpreting the results, the authors noted that pre-sexual assault subjective pain units, education level, income, and intervention condition (TAU vs. PPRS) were key factors influencing smoking behavior. They emphasized the importance of psychological distress, socioeconomic factors, and interventions in smoking behavior after sexual assault. The study analyzed trends in smoking behavior through potential growth curve modeling and found a downward trend in smoking behavior during the follow-up period after a sexual assault incident. In addition, the authors identified key factors influencing smoking behavior, including level of psychological distress (ED SUDS), level of education, and income, as well as the effect of different intervention conditions (TAU vs. PPRS) on smoking trends.

Future Directions

For the next steps, the authors may suggest an in-depth exploration of the effectiveness of interventions and how they can better help sexual assault victims reduce smoking behavior. In addition, they may suggest areas for further research to improve support and treatment for this population.