Treatment of multiple traumatized adolescents by enhancing regulation skills and reducing trauma related symptoms: rationale, study design, and methods of randomized controlled trial (the Mars-study).

BACKGROUND: There is ongoing debate regarding the treatment of severe and multiple traumatized children and adolescents with post-traumatic stress disorder (PTSD). Many clinicians favor a phase-based treatment approach (i.e., a stabilization phase prior to trauma-focused therapy) over immediate trauma-focused psychological treatment, despite the lack of scientific evidence. Research on the effects of different treatment approaches is needed for children and adolescents with (symptoms of complex) PTSD resulting from repeated sexual and/or physical abuse during childhood. OBJECTIVE: This paper describes the rationale, study design, and methods of the MARS-study, a two-arm randomized controlled trial (RCT) that aims to compare the results of phase-based treatment with those of immediate trauma-focused treatment and determine whether immediate trauma-focused treatment is not worse than phase-based treatment in reducing PTSD symptoms. METHODS: Participants are individuals between 12 and 18 years who meet the diagnostic criteria for PTSD due to repeated sexual abuse, physical abuse, or domestic violence during childhood. Participants will be blindly allocated to either the phase-based or immediate trauma-focused treatment condition. In the phase-based treatment condition, participants receive 12 sessions of the Dutch version of Skill Training in Affective and Interpersonal Regulation (STAIR-A), followed by 12 sessions of EMDR therapy. In the immediate trauma-focused condition, the participants receive 12 sessions of EMDR therapy. The two groups are compared for several outcome variables before treatment, mid-treatment (only in the phase-based treatment condition), after 12 trauma-focused treatment sessions (post-treatment), and six months post-treatment (follow-up). The main parameter is the presence and severity of PTSD symptoms (Clinician-Administered PTSD Scale for Children and Adolescents, CAPS-CA). The secondary outcome variables are the severity of complex PTSD symptoms (Interpersonal Problems as measured by the Experiences in Close Relationship-Revised, ECR-RC; Emotion Regulation as measured by the Difficulties in Emotion Regulation Scale, DERS; Self Esteem as measured by the Rosenberg Self Esteem Scale, RSES), changes in anxiety and mood symptoms (Revised Anxiety and Depression Scale; RCADS), changes in posttraumatic cognitions (Child Posttraumatic Cognitions Inventory, CPTCI), changes in general psychopathology symptoms (Child Behavior Checklist, CBCL), and Quality of Life (Youth Outcome Questionnaire, Y-OQ-30). Furthermore, parental stress (Opvoedingsvragenlijst, OBVL) and patient-therapist relationship (Feedback Informed Treatment, FIT) will be measured, whereas PTSD symptoms will be monitored in each session during both treatment conditions (Children's Revised Impact of Event Scale, CRIES-13). DISCUSSION: Treating (symptoms of complex) PTSD in children and adolescents with a history of repeated sexual and/or physical abuse during childhood is of great importance. However, there is a lack of consensus among trauma experts regarding the optimal treatment approach. The results of the current study may have important implications for selecting effective treatment options for clinicians working with children and adolescents who experience the effects of exposure to multiple interpersonal traumatic events during childhood. TRIAL REGISTRATIONS: The study was registered on the "National Trial Register (NTR)" with the number NTR7024. This registry was obtained from the International Clinical Trial Registry Platform (ICTRP) and can be accessed through the ICTRP Search Portal ( https://trialsearch.who.int/ ).

CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS.

According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.

A parental tool to screen for posttraumatic stress in children: first psychometric results.

The Children's Revised Impact of Event Scale (CRIES-13) is a brief self-report measure designed to screen children for posttraumatic stress disorder (PTSD). This study investigates the psychometric properties of a Dutch version of the CRIES-13-parent version and evaluates its correlation with the child version. A sample of 59 trauma-exposed children (8 years-18 years) and their parents completed an assessment including the CRIES-13 (child/parent version) along with the Anxiety Disorders Interview Schedule for DSM-IV: Parent version. Results demonstrated good internal consistency (α = .87) with acceptable values for the 3 subscales. A strong correlation (r = .73) with another measure of PTSD and lower correlations with a behavioral measure (r = .15 to .38) were found, confirming the convergent/divergent validity. A cutoff score ≥ 31 emerged as the best balance between sensitivity and specificity, and correctly classified 83.6% of all children as having a diagnosis of PTSD. This study provides support for the reliability and validity of the CRIES-13-parent version as a screening measure for posttraumatic stress in children.

Characteristics of the Children's Revised Impact of Event Scale in a clinically referred Dutch sample.

Early identification of posttraumatic stress disorder (PTSD) in children is important to offer them appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES) is a brief self-report measure designed to screen children for PTSD. Research regarding the diagnostic validity of the CRIES is still insufficient, has been restricted to specific populations, and sample sizes have often been small. This study evaluated the reliability and validity of the 8-item (CRIES-8) and 13-item (CRIES-13) versions of the CRIES in a large clinically referred sample. The measure was completed by 395 Dutch children (7-18 years) who had experienced a wide variety of traumatic events. PTSD was assessed using the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent version. A cutoff score of 17 on the CRIES-8 and 30 on the CRIES-13 emerged as the best balance between sensitivity and specificity, and correctly classified 78%-81% of all children. The CRIES-13 outperformed the CRIES-8, in that the overall efficiency of the CRIES-13 was slightly superior (.81 and .78, respectively). The CRIES appears to be a reliable and valid measure, which gives clinicians a brief and user-friendly instrument to identify children who may have PTSD and offer them appropriate and timely treatment.

Childhood adversity in a youth psychiatric population: prevalence and associated mental health problems.

Background: Childhood adversity can have lasting negative effects on physical and mental health. This study contributes to the existing literature by describing the prevalence rates and mental health outcomes related to adverse childhood experiences (ACEs) among adolescents registered for mental health care.Methods: Participants in this cross-sectional study were youths (aged 12-18 years) who were referred to outpatient psychiatric departments in the Netherlands. Demographic information was collected from the medical records. The Child Trauma Screening Questionnaire (CTSQ) was used to examine the presence of ACEs and posttraumatic stress symptoms (PTSS). To assess mental health problems, we used the Dutch translation of the Youth Self Report. Descriptive statistics and frequencies were used to calculate prevalence rates across the various ACEs domains. ANOVA and chi-square tests were used to explore the relationship between ACEs and mental health.Results: Of the 1373 participants, 69.1% reported having experienced at least one ACE and 17.1% indicated exposure to four or more ACEs in their lives. Although there was substantial overlap among all ACE categories, the most frequently reported were bullying (49.2%), emotional abuse (17.8%), physical abuse (12.2%), and sexual abuse (10.1%). Female adolescents (72.7%) reported significantly more ACEs than their male counterparts (27.0%). Furthermore, a higher number of ACEs was associated with significantly more self-reported general mental health problems, an elevated prevalence of both mood and post-traumatic stress disorders, and a greater presence of two or more co-existing psychiatric diagnoses (comorbid psychiatric classification).Conclusions: This cross-sectional study on childhood adversity and its association with mental health showed that ACEs are highly prevalent in youth registered for mental health care. This study provides support for a graded and cumulative relationship between childhood adversity and mental health problems.

This study investigated the prevalence of adverse childhood experiences and associated mental health problems among Dutch youth registered for mental health care. Almost seven out of ten patients reported having been exposed to childhood adversity, and two out of ten patients reported exposure to four or more adverse childhood experiences.The results indicated a significant association between exposure to childhood adversity and mental health problems.Analysis of the data showed a cumulative effect of adverse childhood experiences, meaning that patients who reported exposure to more childhood adversity also showed more severe internalizing and externalizing mental health problems, a significant increase in both posttraumatic stress disorder and mood disorder diagnoses, and a general increase in psychiatric comorbidities.

Development of multidisciplinary sexual assault centres in the Netherlands.

Background: The professional approach of sexual assault victims has changed since the 1970s: from a fragmented model to a centralised 'gate management model', where multiple disciplines offer collaborative services at one central location. Like other countries across the globe, the Netherlands took steps towards an integrated, multi-agency support framework for victims of sexual assault. Objective: The objective of this paper was threefold: (1) to describe the development of the multidisciplinary Sexual Assault Centres (SAC) in the Netherlands, (2) to assess the characteristics of victims who attended the SAC, and the services they used (3) to analyse Strengths, Weaknesses, Opportunities, and Threats of the current framework (SWOT). Method: The development of the national network of SAC was described. Data on victims presenting at the SACs were routinely collected between 1st January 2016 and 31st December 2020. This data from the sixteen sites was combined and analysed. Also, a SWOT analysis of the SAC was performed. Results: The SAC was established between 2012 and 2018. From 2016 through 2020 almost 16,000 victims of sexual assault contacted one of the 16 SACs. The data show a steady increase in yearly cases, with a consistently high use of medical and psychological services. The SAC has several strengths, such as its accessibility, and opportunities, such as increasing media attention, that underline its quality and relevance. However, the SAC's inability to reach certain minority groups and the current financial structure are its main weakness and threat. Conclusions: Despite the growing number of victims attending the SAC and the increasing awareness of the benefits of an immediate multidisciplinary response to sexual assault, there are still deficiencies in the SAC. The SAC continues to work on these deficiencies in order to optimise efficient and effective care for all victims of sexual assault.

Antecedente: El abordaje profesional a las víctimas de agresiones sexuales ha cambiado desde la década de 1970, desde un modelo fragmentado hacia un modelo centralizado de 'administración de compuertas'. En este modelo, diferentes disciplinas ofrecen servicios de forma colaborativa en un solo lugar. Así como en muchos países del mundo, los Países Bajos han dado pasos hacia un modelo de soporte integrado y multisectorial para las víctimas de agresiones sexuales.Objetivo: El objetivo de este artículo es triple: (1) describir el desarrollo de los centros multidisciplinarios para el abordaje de las agresiones sexuales (CMAAS) en los Países Bajos, (2) evaluar las características de las víctimas que acuden a los CMAAS,y los servicios que utilizan y, (3) analizar las fortalezas, oportunidades, debilidades y amenazas (FODA) de los servicios brindados en el modelo actual.Métodos: Se describe el desarrollo de la red nacional de CMAAS. La información de las víctimas que acudieron a los CMAAS se recolectó de forma rutinaria entre el 1 de enero del 2016 y el 31 de diciembre del 2020. Se combinó y analizó la información de dieciséis centros. Asimismo, se realizó un análisis FODA de los CMAAS.Resultados: Los CMAAS se implementaron entre 2012 y 2018. Desde el 2016 hasta el 2020, casi 16 000 víctimas de agresiones sexuales se contactaron con alguno de los dieciséis CAAMS. La información recolectada muestra un incremento constante en el número de casos anuales, consistente con un alto uso de los servicios médicos y psicológicos. Los CAAMS tuvieron varias fortalezas, tales como su accesibilidad, y oportunidades, tales como la atención de los medios de comunicación que resaltan su calidad e importancia. No obstante, la incapacidad de los CAAMS de alcanzar ciertos grupos minoritarios y la estructura financiera actual fueron su principal debilidad y amenaza, respectivamente.Conclusiones: A pesar de un número creciente de víctimas que acuden a los CAAMS y a un incremento en la sensibilización de los beneficios de una respuesta inmediata y multidisciplinaria frente a la agresión sexual, aún hay deficiencias en los CAAMS. Estos continúan trabajando para superar estas deficiencias, de modo que se pueda optimizar un cuidado eficiente y efectivo para todas las víctimas de agresión sexual.

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.

Risk factors for PTSD diagnosis in young victims of recent sexual assault.

Background: Sexual assault is associated with a high risk of developing PTSD. Little is known about the PTSD onset in children who have recently been victimized by sexual assault. It is important to identify children at risk for PTSD after sexual assault to prevent chronic problems and revictimization. Objective: The first aim of this study was to describe the development of post-traumatic stress symptoms in the four weeks after sexual assault. The second aim was to analyse whether pre-assault factors, assault-related factors, social support, and post-traumatic stress, measured at two weeks post-assault, were associated with an indication of PTSD. Method: From January 2019 to March 2021, data were collected of victims aged 8-17 years (n = 51; mean age = 15.00; SD = 1.78) who had contacted a Sexual Assault Centre. Severity of post-traumatic stress symptoms was measured at two and four weeks post-assault. The study was designed to use a multivariate logistic regression analysis. The study included female victims only. Results: Most of the victims (58.8%) showed a decline in the severity of post-traumatic stress symptoms in the four weeks after sexual assault. However, 27.4% showed an increase and 13.7% showed no change in symptoms. More than two-thirds of the children (70.6%) showed severe post-traumatic stress symptoms at four weeks post-assault, i.e. had an indication of PTSD. Since only one significant difference was found, the multivariate analysis was not executed. A significant difference was found between severity of symptoms at two weeks and an indication of PTSD at four weeks (t(49) = -5.79; p < .001). Conclusion: Children with high levels of post-traumatic stress at two weeks post-assault are at risk for PTSD indication at four weeks post-assault. Further research is needed to determine whether early trauma-based treatment for children with high post-traumatic stress symptoms can prevent the development of PTSD.

Antecedentes: La agresión sexual está asociada con un alto riesgo de desarrollar TEPT. Poco se sabe sobre la aparición de TEPTen niños que recientemente han sido víctimas de agresión sexual. Es importante identificar a los niños en riesgo de TEPTdespués de una agresión sexual para prevenir problemas crónicos y revictimización. Objetivo: El primer objetivo de este estudio fue describir el desarrollo de síntomas de estrés postraumático en las cuatro semanas posteriores a la agresión sexual. El segundo objetivo fue analizar si los factores previos a la agresión, los factores relacionados con la agresión, el apoyo social y el estrés postraumático, medidos dos semanas después de la agresión, estaban asociados con una presentación de síntomas de TEPT. Método: Desde Enero de 2019 hasta Marzo de 2021, se recogieron datos de víctimas de 8 a 17 años (n = 51; edad media = 15,00; desviación estándar = 1,78) que habían contactado con un Centro de Agresiones Sexuales. La gravedad de los síntomas de estrés postraumático se midió a las dos y cuatro semanas posteriores a la agresión. El estudio fue diseñado para utilizar un análisis de regresión logística multivariado. El estudio incluyó solo a víctimas femeninas. Resultados: La mayoría de las víctimas (58,8%) mostró una disminución en la severidad de los síntomas de estrés postraumático en las cuatro semanas posteriores a la agresión sexual. Sin embargo, el 27,4% mostró un aumento y el 13,7% no mostró cambios en los síntomas. Más de dos tercios de los niños (70,6%) mostraron síntomas de estrés postraumático severo cuatro semanas después de la agresión, es decir, tenían indicios de TEPT. Dado que solo se encontró una diferencia significativa, no se ejecutó el análisis multivariado. Se encontró una diferencia significativa entre la severidad de los síntomas a las dos semanas y una indicación de TEPT a las cuatro semanas (t(49) = −5.79; p < .001). Conclusión: Los niños con altos niveles de estrés postraumático a las dos semanas posteriores a la agresión están en riesgo de presentar síntomas de TEPT a las cuatro semanas posteriores a la agresión. Se necesita más investigación para determinar si el tratamiento precoz basado en el trauma para niños con altos síntomas de estrés postraumático puede prevenir el desarrollo de TEPT.

The Tonic Immobility Scale in adolescent and young adult rape victims: Support for three-factor model.

OBJECTIVE: A substantial number of sexual assault victims report experiencing some form of peritraumatic tonic immobility (TI). A self-report questionnaire that is widely used to assess TI retrospectively is the Tonic Immobility Scale (TIS). This study explored the factor structure of the TIS in a clinical sample of adolescent and young adults. METHOD: The sample comprised 131 female rape victims, aged 13-25, who were referred for specialized trauma-focused treatment. An exploratory factor analysis (EFA) was performed. RESULTS: The EFA showed support for a three-factor model, with factors TI, Fear, and Detachment. Item correlations ranged from .32 to .57 for TI, from .14 to .35 for Fear, and .29 for the two Detachment items. CONCLUSIONS: We found support for a three-factor solution distinguishing TI, fear, and detachment, suggesting the need to further develop the TIS with different subscales in varying age groups and clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial.

Background: About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape. Objective: To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape. Method: This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time. Results: Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time. Conclusions: The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.

Antecedentes: Aproximadamente el 40% de las víctimas de violación desarrollan trastorno de estrés postraumático (TEPT) dentro de los tres meses posteriores a la agresión. Teniendo en cuenta el alto impacto personal y social del TEPT, existe una necesidad urgente de intervenciones tempranas (es decir, dentro de los tres meses posteriores al incidente) para reducir el estrés postraumático en las víctimas de violación.Objetivo: Evaluar la efectividad de la intervención temprana con terapia de desensibilización y reprocesamiento por movimiento ocular (EMDR en su sigla en inglés) para reducir los síntomas de estrés postraumático, sentimientos de culpa y vergüenza, disfunción sexual, y otras disfunciones psicológicas (es decir, psicopatología general, ansiedad, depresión, y síntomas disociativos) en víctimas de violación.Método: Este ensayo controlado aleatorizado incluyó a 57 víctimas de violación, que fueron asignadas al azar a dos sesiones de terapia EMDR o al tratamiento habitual ("espera vigilante") entre 14 y 28 días después de la violación. Los síntomas psicológicos se evaluaron antes del tratamiento, después del tratamiento, y 8 y 12 semanas después de la violación. Se utilizaron modelos lineales mixtos y ANCOVAs para analizar las diferencias entre las condiciones a lo largo del tiempo.Resultados: Los tamaños del efecto dentro del grupo de la condición EMDR (d = 0.89 a 1.57) y la condición de control (d = 0.79 a 1.54) fueron grandes, lo que indica que ambas condiciones fueron efectivas. Sin embargo, no se encontró que la terapia EMDR fuera más efectiva que la espera vigilante para reducir los síntomas de estrés postraumático, la psicopatología general, la depresión, la disfunción sexual, y los sentimientos de culpa y vergüenza. Aunque se encontró que la terapia EMDR era más efectiva que la espera vigilante para reducir la ansiedad y los síntomas disociativos en la evaluación posterior al tratamiento, este efecto desapareció con el tiempo.Conclusiones: Los hallazgos no apoyan la noción de que la intervención temprana con terapia EMDR en víctimas de violación sea más efectiva que la espera vigilante para la reducción de los síntomas psicológicos, incluyendo los síntomas del estrés postraumático. Se necesitan más investigaciones sobre la efectividad de las intervenciones tempranas, incluida la espera vigilante, para este grupo objetivo específico.

Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault.

Objective: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). Method: Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. Results: The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up (g = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention (g = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. Discussion: Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.

Objetivo: revisar la seguridad y eficacia de intervenciones tempranas tras abuso sexual para reducir o prevenir trastorno de estrés postraumático (TEPT).Método: se realizaron búsquedas sistemáticas sobre estudios (1980-2018) que examinaron la eficacia de intervenciones para TEPT dentro de 3 meses tras un abuso sexual.Resultados: la revisión identificó 7 estudios (n=350) con alto riesgo de sesgos, que investigaron 5 intervenciones. Sólo 2 estudios reportaron sobre seguridad. El contacto con los autores de 6 estudios no proporcionó indicios de ocurrencia de eventos adversos. Dos estudios reportaron la eficacia de usar el diagnóstico de TEPT como una variable dependiente, pero no encontraron diferencias entre los grupos. Todos los estudios reportaron sobre eficacia usando la severidad de TEPT como variable dependiente. Para el meta-análisis, 4 estudios (n=293) fueron incluidos, brindando reducciones significativamente mayores de la severidad de TEPT que el cuidado estándar a los 2 y 12 meses de seguimiento (g=−0.23, 95% IC [−0.46, 0.00]), pero no respecto a 1 y 6 semanas post-intervención (g=−0.28, 95% IC [−0.57, 0.02]). La heterogeneidad de las intervenciones impidió mayores análisis.Discusión: los hallazgos sugieren que las intervenciones tempranas pueden llevar a efectos duraderos sobre la severidad de TEPT tras abuso sexual. Sin embargo, debido a la disponibilidad limitada de los datos, es imposible sacar conclusiones definitivas sobre la seguridad y eficacia de las intervenciones tempranas, y su potencial para prevenir TEPT.

Early intervention with eye movement desensitisation and reprocessing (EMDR) therapy to reduce the severity of posttraumatic stress symptoms in recent rape victims: study protocol for a randomised controlled trial.

Background: It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. Objective: This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Methods: Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. Conclusions: The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape.

Antecedentes: Se ha estimado que más del 40% de las víctimas de violación desarrollan un trastorno de estrés postraumático (TEPT), una estadística que es relativamente alta en comparación a otros tipos de trauma. El TEPT puede afectar la salud psicológica, sexual, y física de las víctimas. Por lo tanto, existe una necesidad urgente por intervenciones tempranas para prevenir la aparición de TEPT en este grupo objetivo.Objetivo: Este ensayo controlado aleatorio (RCT en sus siglas en inglés) examina la eficacia de una terapia temprana de Desensibilización y Reprocesamiento por Movimiento Ocular (EMDR en sus siglas en inglés) orientada a reducir la severidad de los síntomas de estrés postraumáticos en las víctimas recientes de una violación.Método: Los sujetos (N=34) son individuos de 16 años y más, que se presentan en uno de los cuatro Centros de Agresión Sexual participantes en los Países Bajos dentro de los 7 días posteriores a la violación. La intervención consiste de dos sesiones de terapia EMDR entre el día 14 y 28 luego de la violación, mientras que el grupo control recibe tratamiento habitual, el que consiste en un monitoreo cuidadoso de las reacciones de estrés en dos contactos durante un mes posterior a la violación, a cargo de un encargado del caso. La evaluación inicial (línea base), de post-tratamiento, y de seguimiento a las 8 y 12 semanas posteriores a la violación serán usadas para medir el desarrollo de los síntomas de estrés postraumático. Además, la eficacia de la intervención en el funcionamiento psicológico y sexual será determinada. Los análisis de modelos mixtos lineales serán usados.Conclusión: Los resultados de este RCT ayudarían a la difusión y aplicación de los tratamientos preventivos basados en la evidencia para el TEPT luego de una violación.

Predictors of delayed disclosure of rape in female adolescents and young adults.

BACKGROUND: Delayed disclosure of rape has been associated with impaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency. The purpose of this study was to compare various demographics, post-rape characteristics, and psychological functioning of early and delayed disclosers (i.e., more than 1-week post-rape) among rape victims, and to determine predictors for delayed disclosure. METHODS: Data were collected using a structured interview and validated questionnaires in a sample of 323 help-seeking female adolescents and young adults (12-25 years), who were victimized by rape, but had no reported prior chronic child sexual abuse. RESULTS: In 59% of the cases, disclosure occurred within 1 week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12-17 years [odds ratio (OR) 2.05, confidence intervals (CI) 1.13-3.73], penetration (OR 2.36, CI 1.25-4.46), and closeness to assailant (OR 2.64, CI 1.52-4.60) contributed significantly to the prediction of delayed disclosure. CONCLUSION: The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services.

Enhanced screening for posttraumatic stress disorder and comorbid diagnoses in children and adolescents.

BACKGROUND: Posttraumatic stress disorder (PTSD) can be a debilitating disorder and often co-occurs with other psychiatric disorders, such as mood, behavioral, and anxiety disorders. Early identification of PTSD and psychiatric comorbidity is highly relevant in order to offer children appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES-13) is a reliable and valid self-report measure designed to screen children for PTSD. However, this measure is not useful as a screen for psychiatric comorbidity in children with probable PTSD. OBJECTIVE: This study evaluated the screening accuracy of the CRIES-Plus, that is, the CRIES-13 combined with 12 additional items to detect psychiatric comorbidity. METHOD: The CRIES-Plus was completed by 398 Dutch children (7-18 years) exposed to various traumatic events. Psychiatric diagnoses were assessed using the Anxiety Disorders Interview Schedule for DSM-IV: Child version. RESULTS: Six additional items were significantly associated with mood disorders, three items were associated with behavioral disorders, and five items with anxiety disorders. Additional items associated with mood and anxiety disorders demonstrated good discriminatory ability, with cut-off scores of ≥14 and ≥10, respectively. Items associated with behavioral disorders had poor to fair discriminatory ability, with no clear cut-off point. CONCLUSIONS: Our findings support the use of the CRIES-Plus to screen for PTSD and comorbid disorders which may help clinicians in assigning appropriate follow-up diagnostic and clinical care.

Salivary cortisol and dehydroepiandrosterone sulfate in adolescent rape victims with post traumatic stress disorder.

BACKGROUND: In chronic sexual abuse victims with post traumatic stress disorder (PTSD), the hypothalamic pituitary adrenal (HPA) axis can be dysregulated. In single rape victims, PTSD symptoms are hypothesized to function as a chronic stressor leading to similar HPA-axis dysregulation. The objective of the current study was to assess HPA-axis functioning in female adolescents with rape-related PTSD, but no prior sexual trauma, in comparison to non-victimized controls. METHOD: Salivary cortisol and dehydroepiandrosterone sulfate (DHEAS) were measured in 52 female adolescent rape victims with PTSD and 37 healthy adolescents at 0, 15, 30, 45 and 60 min after awakening, both under basal conditions and after 0.5 mg dexamethasone administration. RESULTS: Compared to age-matched controls, adolescent rape victims with PTSD showed significantly reduced cortisol and DHEAS levels. No group differences for the effect of dexamethasone suppression were found. Both the event of rape and PTSD diagnosis, and not factors such as sleep duration, smoking, education or oral contraceptives, accounted for the neuroendocrine differences between rape victims and controls. CONCLUSIONS: The results show evidence for a dysregulated HPA-axis in female adolescent victims of single sexual trauma with PTSD. The finding of hypocortisolism is consistent with endocrine dysfunctioning in chronic sexual abuse victims and may have clinical implications with regard to treatment possibilities.