Perceived Barriers and Facilitators to Treatment for Alcohol Misuse Among Survivors and Victim Service Professionals Following Sexual Assault and Intimate Partner Violence.

Survivors of sexual assault (SA) and intimate partner violence (IPV) report high rates of alcohol misuse and often receive services from community agencies. We conducted a qualitative study to examine barriers and facilitators to treatment for alcohol misuse after experiences of SA/IPV among survivors (N = 13) and victim service professionals (VSPs; N = 22) at community-based agencies using semi-structured interviews and focus groups. Survivors discussed seeking treatment for alcohol misuse when alcohol is being used to cope with SA/IPV-related distress and when alcohol use becomes problematic. Survivors identified that stigma and acknowledgment of alcohol misuse are individual-level barriers and facilitators to treatment. System-level factors were also described including having access to treatment and sensitive providers. VSPs also discussed individual (e.g., stigma) and system (e.g., availability and quality of services) level barriers and facilitators to treatment for alcohol misuse. Results indicated several unique barriers and facilitators to treatment for alcohol misuse following SA/IPV.

Women's Behavioral Coping Responses During Sexual Assault: Association With Posttraumatic Stress Disorder Symptoms and the Moderating Role of Alexithymia.

We examined the associations between women's behavioral coping responses during sexual assault and posttraumatic stress disorder (PTSD) symptoms, and the moderating role of alexithymia in college women (N = 152). Immobilized responses (b = 0.52, p < .001), childhood SA (b = 0.18, p = .01), and alexithymia (b = 0.34, p < .001) significantly predicted PTSD. The interaction between immobilized responses and alexithymia was significant (b = 0.39, p = .002), indicating a stronger association for those higher in alexithymia. Immobilized responses are associated with PTSD, particularly for those with difficulty identifying and labeling emotions.

Early intervention using written exposure therapy for PTSD and AUD symptoms following sexual assault: Description of design and methodology.

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is common following sexual assault and associated with more severe symptomology and increased likelihood of sexual revictimization. Integrated interventions aimed at reducing PTSD and AUD symptoms following recent sexual assault are needed and should address barriers to care and early treatment termination. The proposed study will test a novel, brief (5 to 7 sessions) intervention that integrates Written Exposure Therapy for PTSD and Cognitive Behavioral Therapy for AUD, and is initiated within the first six weeks post-assault. In Phase 1, qualitative analysis of content gathered during focus groups with treatment providers will be conducted to inform intervention development. In Phase 2, a proof-of-concept pilot study (n = 10) of the intervention, Substance Use Skills Training and Exposure Post-Sexual Assault (STEPS), will be conducted. In Phase 3, a pilot randomized controlled trial (RCT) among 54 recent sexual assault survivors will be implemented using the updated manualized STEPS intervention to evaluate feasibility and preliminary efficacy in reducing PTSD and AUD symptoms. Ecological momentary assessments will be used to assess daily alcohol use, craving, affect, intrusions and avoidance. The effects of STEPS on commonly associated symptoms (e.g., depression, substance use) will be examined. The proposed study has the potential to make a significant public health impact by advancing knowledge on the link between sexual assault and co-occurring PTSD and AUD and informing early intervention efforts for this high-risk population.

Sexual Harassment and Assault During Deployment: Associations with Treatment Outcomes Among Veterans with Co-occurring PTSD and SUD.

Sexual trauma is common and increases risk for posttraumatic stress disorder (PTSD), substance use disorders (SUD), and depression among veterans. Limited research has examined the impact of sexual harassment and assault during deployment on treatment outcomes among veterans with co-occurring PTSD and SUD. The current study examined frequency of exposure to sexual harassment and assault during deployment as a predictor of treatment outcomes among a primarily male sample of U.S military veterans diagnosed with current PTSD and SUD. A secondary analysis was performed using data from a randomized clinical trial examining the efficacy of Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) compared to Relapse Prevention (RP). Data from 69 veterans (91.3% male) who were deployed while in the service were analyzed using mixed models to determine whether frequency of exposure to sexual harassment and assault during deployment impacted changes in PTSD symptom severity, percent days using substances, and depressive symptoms during treatment. Over one-third of the sample (36.2%) reported exposure to sexual harassment and/or assault during deployment. Frequency of exposure to sexual harassment and assault during deployment was not a predictor of treatment outcome in any of the models, suggesting a similar response to treatment among those with varying frequency of exposure to sexual harassment and assault during deployment. Veterans with co-occurring PTSD and SUD who have been exposed to sexual harassment and assault during deployment may benefit from integrated trauma-focused treatments and treatments focused on decreasing SUD symptoms.

History of rape moderates the pathways from emotion dysregulation to alcohol and risky sex outcomes among college women.

OBJECTIVE: Affective and emotional dysregulation are consistently linked to greater alcohol use and related consequences, including risky sexual behavior. Moreover, these associations are even stronger among women with experiences of sexual assault. The current study tested affect, alexithymia, positive urgency, and negative urgency as predictors of alcohol use, alcohol-related consequences, and risky sexual behavior and the moderating impact of rape history on these associations among a sample of college women. METHOD: Participants were 1,005 college women between the ages of 18 and 25. Approximately 20% of the sample (n = 204) reported a history of rape since age 14. RESULTS: Positive and negative urgency statistically mediated the associations between negative affect and alexithymia and the alcohol and risky sex outcomes. Positive urgency was directly associated with alcohol use, while negative urgency was directly associated with alcohol-related consequences. Moreover, rape history moderated these associations, indicating that positive affect may be an important protective factor among women who have experienced rape. CONCLUSIONS: The current study identified important unique risk and protective pathways that may increase or reduce women's risk for alcohol-related consequences and risky sexual behavior. Importantly, these pathways are comprised of constructs that are malleable and modifiable and can be targeted and changed through intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of Emotion Dysregulation on Post-treatment Post-traumatic Stress Disorder and Depressive Symptoms Among Women Veterans With Military Sexual Trauma.

Military sexual trauma (MST), defined as sexual assault or repeated, threatening sexual harassment while in the military, is associated with increased risk of long-term mental and physical health problems, with the most common being symptoms of post-traumatic stress disorder (PTSD) and depression. In addition to PTSD and depression, MST is linked to difficulties in emotion regulation as well as poor treatment engagement. Thus, it is important to examine these correlates, and how they affect postintervention symptom reduction in this vulnerable population. The current study presents secondary data analyses from a randomized clinical trial comparing the efficacy of in-person versus telemedicine delivery of prolonged exposure therapy for female veterans with MST-related PTSD (n = 151). Results of the study found that changes in difficulties with emotion regulation predicted postintervention depressive symptoms but not postintervention PTSD symptoms. Neither postintervention depressive nor PTSD symptoms were affected by treatment dosing (i.e., number of sessions attended) nor treatment condition (i.e., in-person vs. telemedicine). Findings from the current study provide preliminary evidence that decreases in difficulties with emotion regulation during PTSD treatment are associated with decreases in depressive symptom severity.

Intimate Partner Violence and Completion of Post-Sexual Assault Medical Forensic Examination Follow-Up Screening.

Sexual assault is a major public health concern associated with significant mental health and medical symptoms. Follow-up screening post-sexual assault medical forensic examination (SAMFE) can be one method of determining needs and providing targeted prevention of mental health and medical symptoms among individuals who experienced a recent sexual assault. However, the factors associated with engagement in post-SAMFE follow-up screening have not been identified. The current study examined the association between intimate partner violence victimization and sexual assault-related characteristics and engagement in post-SAMFE follow-up screening. Participants were 193 individuals who received a SAMFE and indicated at the time of SAMFE that they were interested in follow-up by the hospital. It was found that individuals were less likely to engage in follow-up screening if the assault was perpetrated by an intimate partner. These findings suggest that other resources are needed to reach individuals who experience sexual assault perpetrated by an intimate partner due to the unique needs of that population.

Barriers to Accessing Mental Health Care After a Sexual Assault Medical Forensic Examination.

BACKGROUND: Research indicates low rates of accessing mental health care following sexual assault; however, barriers associated with accessing care are not well understood. DESIGN: Participants (N = 37) were recruited from a local hospital following a sexual assault medical forensic examination (SAMFE). Hierarchical linear regressions models examined the effects of age, racial identity, student status, insurance status, relationship to perpetrator, time since assault, problematic drinking, and posttraumatic stress symptoms on (a) barriers to accessing care and (b) the likelihood of seeking mental health treatment at no charge. RESULTS: Lack of insurance was associated with more barriers to accessing mental health care and a higher likelihood of seeking post-SAMFE care at no charge. Posttraumatic stress symptoms were associated with more barriers to accessing care (p = 0.038). Identifying as a student (p = 0.026) and engaging in problematic drinking (p = 0.047) were associated with a lower likelihood of seeking post-SAMFE care, whereas increased symptoms of posttraumatic stress were associated with a greater likelihood of seeking post-SAMFE care (p = 0.007). CONCLUSIONS: Providing post-SAMFE care, irrespective of insurance, may be a needed first step in addressing the mental health needs of individuals with recent sexual assault. Secondary prevention programs targeted toward alcohol misuse may also be warranted.

Women's Perceived Likelihood to Engage in Sexual Risk Taking: Posttraumatic Stress Symptoms and Poor Behavioral Regulation.

Sexual abuse prior to age 18 may put some women at risk for engaging in sexual risk taking. This association could exist, in part, as a result of the impact of posttraumatic stress symptoms on behavioral regulation. The current study utilized a path analysis to investigate the association between severity of sexual abuse before age 18, posttraumatic stress symptoms, poor behavioral regulation, and expected engagement in sexual risk taking among college women. The sample consisted of 88 college women with experiences of sexual abuse prior to the age of 18. Severity of sexual abuse predicted posttraumatic stress symptoms. In addition, posttraumatic stress symptoms predicted poor behavioral regulation, which in turn predicted expected engagement in sexual risk taking. These findings indicate functional mechanisms involved in sexual decision making of women who have had past sexual abuse and experience posttraumatic stress symptoms.

A Latent Class Analysis of Mental Health Beliefs Related to Military Sexual Trauma.

Military veterans with histories of military sexual trauma (MST) are at risk for several negative mental health outcomes and report perceived barriers to treatment engagement. To inform interventions to promote gender-sensitive access to MST-related care, we conducted an exploratory, multiple-group latent class analysis of negative beliefs about MST-related care. Participants were U.S. veterans (N = 1,185) who screened positive for MST within the last 2 months and reported a perceived need for MST-related treatment. Associations between class membership, mental health screenings, logistical barriers, difficulty accessing care, and unmet need for MST-related care were also examined. Results indicated a four-class solution, with classes categorized as (a) low barrier, with few negative beliefs; (b) high barrier, with pervasive negative beliefs; (c) stigma-related beliefs; and (d) negative perceptions of care (NPC). Men were significantly less likely than women to fall into the low barrier class (27.9% vs. 34.5%). Relative to participants in the low barrier class, individuals in all other classes reported more scheduling, ps < .001; transportation, p < .001 to p = .014; and work-related barriers, p < .001 to p = .031. Participants in the NPC class reported the most difficulty with access, p < .001, and those in the NPC and high barrier classes were more likely to report unmet needs compared to other classes, ps < .001. Brief cognitive and behavioral interventions, delivered in primary care settings and via telehealth, tailored to address veterans' negative mental health beliefs may increase the utilization of mental health treatment related to MST.

Predictors of College Students' Likelihood to Report Hypothetical Rape: Rape Myth Acceptance, Perceived Barriers to Reporting, and Self-Efficacy.

Rape myth acceptance (RMA), perceived barriers, and self-efficacy were examined as predictors of likelihood to report different types of rape to law enforcement among 409 undergraduates. Participants had lower likelihood to report incapacitated compared to physically forced rape. Men had lower reporting likelihood than women for rape perpetrated by the same and opposite sex, and were more likely to perceive several barriers. RMA and perceived barriers predicted a lower likelihood to report several types of rape. Among men, higher self-efficacy predicted increased reporting likelihood. Targeting RMA and decreasing perceived barriers is imperative to increase college students' likelihood to report rape to local and campus law enforcement.

Tailoring Cognitive Behavioral Therapy for Trauma-Exposed Persons Living With HIV.

This Treatment Development Report describes the need for evidence-based psychosocial trauma-focused treatment for people living with comorbid posttraumatic stress disorder (PTSD) and HIV. Individuals with HIV have higher rates of exposure to traumatic events and PTSD than the general public, and they also experience additional consequences of PTSD on the management of their chronic disease (e.g., established link between PTSD symptoms and lack of adherence to antiretroviral therapy [ART]). We used the empirically-supported ADAPT-ITT approach to consider the initial steps in adapting evidence-based Cognitive Processing Therapy (CPT) for individuals with PTSD and HIV. This paper reviews a case example that involved various clinical issues that may arise when providing trauma-focused treatment for people living with HIV including HIV-stigma, disease management, and the need for making multicultural adaptations to psychotherapy. This case example illustrates how trauma-focused treatment may benefit from enhancement to address additional barriers that may arise over the course of PTSD treatment in this population. Feasibility of engaging and delivering a "full dose" of evidence-based PTSD treatment among individuals living with HIV is discussed. While evidence-based treatments can reduce PTSD symptom severity, issues related to chronic disease coping and HIV-related stigma management could be integrated to augment the efficacy of treatment for individuals with HIV. Adaptive intervention research targeting PTSD in persons living with HIV warrants further attention, especially given the association between PTSD and adherence to ART.

Managing post-sexual assault suicide risk.

Suicidal ideation and suicidal behavior are common after experiencing a sexual assault. Therefore, it is imperative to assess for and manage suicidal ideation using evidence-based techniques after a sexual assault medical forensic examination (SAMFE). We assessed factors associated with higher suicidal ideation identified in a post-SAMFE mental health screening conducted over the phone and strategies to manage suicide risk. We also discuss three case examples and unique considerations when assessing post-SAMFE suicide risk. It was found that among individuals who completed a post-SAMFE screen, individuals who have been previously hospitalized for a mental health problem, who had higher acute stress symptoms, and who were homeless reported more suicidal ideation than those without those histories or symptom presentations. No matter the risk factors for suicidal ideation post-SAMFE, it is essential to screen all individuals post-SAMFE due to their high risk for suicidal ideation and death by suicide.

The Association Between Type of Sexual Assault and Post-Assault Alcohol Misuse Is Moderated by Avoidance Among Recipients of a Sexual Assault Medical Forensic Examination.

OBJECTIVE: The purpose of this study was to examine the association between the type of sexual assault (intoxicated vs. non-intoxicated) and post-assault avoidance on post-assault alcohol misuse among people who experienced a recent sexual assault. METHOD: The sample included 72 adults aged 18-58 who completed a follow-up phone screen within 30 days of completing a sexual assault medical forensic examination. Participants reported demographics, prior sexual assault, if they were intoxicated from alcohol or other drugs during the sexual assault that preceded receipt of a sexual assault medical forensic examination, post-assault avoidance symptoms, and post-assault alcohol misuse. RESULTS: Post-assault alcohol misuse was higher among participants with intoxicated (vs. non-intoxicated) sexual assault, prior sexual assault (vs. none), and who identified as White. There was a significant interaction between the type of sexual assault and avoidance symptoms on post-assault alcohol misuse. There was a significant association between avoidance symptoms and alcohol misuse (b = 0.82, p = .003) among participants who experienced a non-intoxicated sexual assault, but not among those who reported intoxication during the recent sexual assault (b = -0.33, p = .468). CONCLUSIONS: Intoxicated sexual assault and post-assault avoidance may be influential factors contributing to post-assault alcohol misuse among people who are recently sexually assaulted. Interventions targeting post-sexual assault alcohol misuse should be tailored based on the type of recent assault and post-assault avoidance.

Usability Testing of a Mobile Health Intervention to Address Acute Care Needs after Sexual Assault.

Sexual assault is associated with a range of poor mental health outcomes. To enhance access to care by this population, technology-based mental health interventions have been implemented in the emergency room; however, more accessible and easily disseminated interventions are needed. The aim of the present study was to test the usability of a mobile health intervention targeting alcohol and drug misuse, suicide prevention, posttraumatic stress symptoms, coping skills, and referral to formal assistance for individuals who have experienced sexual assault. Feedback on the usability of the intervention was collected from individuals who received a sexual assault medical forensic examination (n = 13), and feedback on the usability and likelihood of recommending the application was collected from community providers (n = 25). Thematic analysis was used to describe qualitative data. Content themes related to aesthetics, usability, barriers to resources, and likes/dislikes about the intervention arose from interviews following the intervention. Participants found the intervention to be user friendly and endorsed more likes than dislikes. Providers rated the intervention as being helpful and would recommend it to survivors of sexual assault. Findings suggest that the intervention is usable and fit for future effectiveness testing, filling an important gap in treatment for individuals who experience sexual assault.

Gender differences in subjective stress and neuroendocrine response to a stress task among individuals with opioid dependence: A pilot study.

BACKGROUND: Opioid dependence is a significant public health problem in the United States and the number of opioid overdose deaths among women has increased dramatically in comparison to men in the last few years. In this context, understanding the biological mechanisms underlying gender differences in vulnerability to opioid dependence is essential. METHODS: The current pilot study examined gender differences in subjective stress, heart rate (HR), and cortisol/dephydroepiandrosterone (DHEA) response to a laboratory stressor (Trier Social Stress Test; TSST) or a no-stress condition, and drug cue paradigm among men (n = 21) and women (n = 18) with opioid dependence. RESULTS: Significant group (TSST vs. no stress) differences emerged in self-reported stress [F(1,35) = 23.8, p < .001], HR [F(1,31) = 12.3; p = .001] and cortisol (F1,34 = 5.0; p = .032) response, such that the TSST group was more reactive than the no-stress group. Women reported greater subjective stress [F(1,35) = 6.5, p <= .015] in response to the TSST compared to men. However, men evidenced marginally greater cortisol and DHEA responses to the TSST compared to women [F(1,34) = 2.7; p = .113 and F(1,31) = 3.4; p = .073, respectively]. CONCLUSIONS: Although women with opioid dependence reported greater subjective stress when exposed to a laboratory stress paradigm as compared to men, the neuroendocrine response was more robust in men. This pattern was similar to gender findings in men and women with cocaine and tobacco use disorders. The blunted cortisol combined with an increased subjective response among women may be a sign of HPA axis dysregulation which could increase vulnerability to relapse in women.

Acute Stress Symptoms After Forcible and Substance-Involved Rapes.

In the early aftermath of a sexual assault, survivors often experience symptoms of distress including reexperiencing, avoidance, and hyperarousal symptoms. However, less is known about associations between rape characteristics and the nature of early reactions. We designed the current study to examine the unique and combined associations between force and substances during rape on acute stress symptoms. Participants were 56 women (ages 18 to 58) who completed a sexual assault medical forensic exam in the emergency department within 120 hours of the rape and then completed a follow-up clinical phone screening within 30 days of the forensic exam. Follow-up assessments included characteristics of the recent rape (force, substances), history of prior sexual assault, demographics, and symptoms of acute stress. Multivariate regression analyses revealed that, after controlling for prior sexual assault, sexual orientation, and race/ethnicity, there were no significant differences on any symptom cluster by rape type. However, this study involved a small, difficult-to-reach sample and, therefore, was only powered to detect large effect sizes. We encourage more research examining potentially unique, early symptom presentations for substance-involved rapes.

Perinatal Intimate Partner Violence.

This article reviews the prevalence and outcomes of perinatal intimate partner violence (IPV). Reported rates of perinatal IPV range from 3.7% to 9.0%. Perinatal IPV is associated with a multitude of mental and obstetric health outcomes that affect the mother and child. Perinatal medical providers have an opportunity to detect victims of IPV and facilitate services for this population. Screening, safety planning, and referral procedures are essential for addressing this public health problem.

Gender moderates the association between distress tolerance and alcohol use among individuals with opioid use disorder.

BACKGROUND: Alcohol use among individuals with opioid use disorder (OUD) can be dangerous, and understanding factors contributing to alcohol use in this population is important. The current study examined alcohol use among individuals with prescription OUD based on distress tolerance. It was hypothesized that individuals with greater distress tolerance abilities would have a lower frequency and quantity of alcohol use compared to individuals with less distress tolerance. It was also hypothesized that this association would differ based on gender. METHODS: A total of 122 individuals with prescription OUD participated in the current study. Participants completed questionnaires regarding demographics, distress tolerance, mental health symptoms, and frequency and quantity of alcohol in the past 30 days. A regression model was conducted using the alcohol-related variables as outcomes. RESULTS: There was a significant interaction between gender and distress tolerance on alcohol use frequency. Greater distress tolerance was associated with fewer alcohol use days in women, but there was no association between distress tolerance and alcohol use days in men. CONCLUSIONS: The findings suggest that distress tolerance skills may be key to reducing alcohol use in women with prescription OUD.

Suicidal ideation among adults with a recent sexual assault: Prescription opioid use and prior sexual assault.

INTRODUCTION: Sexual assault (SA) is common, and recent sexual assault is associated with suicidal ideation and prescription opioid (PO) use. PO use is also associated with increased risk of suicidal ideation. The current study examined suicidal ideation among adults seeking medical and psychological follow-up care after a SA medical forensic examination based on PO use and prior SA. METHODS: Adults (n = 60) who received a SA medical forensic exam at the emergency room within 120 h of a SA were invited to receive medical and psychological follow-up care, which included a questionnaire about current mental health symptoms. RESULTS: Results from a linear regression model revealed that more acute stress symptoms were associated with higher suicidal ideation. Further, there was a significant association between PO use and suicidal ideation among those with a prior SA such that those with a prior SA and who used POs reported more severe suicidal ideation than those with a prior SA who did not use POs. CONCLUSIONS: Routine screening at the emergency department for PO use and prior SA may help prevention efforts for suicide among adults who recently experienced SA.