The Rothman Index predicts unplanned readmissions to intensive care associated with increased mortality and hospital length of stay: a propensity-matched cohort study.

BACKGROUND: Patients with unplanned readmissions to the intensive care unit (ICU) are at high risk of preventable adverse events. The Rothman Index represents an objective real-time grading system of a patient's clinical condition and a predictive tool of clinical deterioration over time. This study was designed to test the hypothesis that the Rothman Index represents a sensitive predictor of unanticipated ICU readmissions. METHODS: A retrospective propensity-matched cohort study was performed at a tertiary referral academic medical center in the United States from January 1, 2022, to December 31, 2022. Inclusion criteria were adult patients admitted to an ICU and readmitted within seven days of transfer to a lower level of care. The control group consisted of patients who were downgraded from ICU without a subsequent readmission. The primary outcome measure was in-hospital mortality or discharge to hospice for end-of-life care. Secondary outcome measures were overall hospital length of stay, ICU length of stay, and 30-day readmission rates. Propensity matching was used to control for differences between the study cohorts. Regression analyses were performed to determine independent risk factors of an unplanned readmission to ICU. RESULTS: A total of 5,261 ICU patients met the inclusion criteria, of which 212 patients (4%) had an unanticipated readmission to the ICU within 7 days. The study cohort and control group were stratified by propensity matching into equal group sizes of n = 181. Lower Rothman Index scores (reflecting higher physiologic acuity) at the time of downgrade from the ICU were significantly associated with an unplanned readmission to the ICU (p < 0.0001). Patients readmitted to ICU had a lower mean Rothman Index score (p < 0.0001) and significantly increased rates of mortality (19.3% vs. 2.2%, p < 0.0001) and discharge to hospice (14.4% vs. 6.1%, p = 0.0073) compared to the control group of patients without ICU readmission. The overall length of ICU stay (mean 8.0 vs. 2.2 days, p < 0.0001) and total length of hospital stay (mean 15.8 vs. 7.3 days, p < 0.0001) were significantly increased in patients readmitted to ICU, compared to the control group. CONCLUSION: The Rothman Index represents a sensitive predictor of unanticipated readmissions to ICU, associated with a significantly increased mortality and overall ICU and hospital length of stay. The Rothman Index should be considered as a real-time objective measure for prediction of a safe downgrade from ICU to a lower level of care.

Student Experiences Reporting Sexual and Gender-Based Misconduct to the Title IX Office at a Public State University.

Twenty-five survivors completed anonymous surveys about reporting sexual and gender-based misconduct to their public university's Title IX office, including case characteristics, perceptions of the reporting and response process (e.g., helpfulness, respect), and experiences of institutional betrayal and support. Measures and open-ended responses described varied misconduct incidents, reporting behaviors, case outcomes, process issues, and negative process consequences. Additionally, process perceptions correlated with institutional betrayal and support. Findings illuminate how survivors' Title IX process perceptions relate to experiencing harm or support from larger institutions, and offer insights into developing a Title IX process which maintains student rights and dignity regardless of outcome.

Universal mandatory reporting policies show null effects in a statewide college sample.

OBJECTIVE: It is widely assumed that universal mandatory reporting policies (MRPs) for sexual misconduct are important for campus safety, but there is little evidence to support these assumptions. HYPOTHESES: Given the exploratory nature of this research, no formal hypotheses were tested. We did not expect universal MRPs to be significantly associated with increased reporting or postreporting outcomes. METHOD: Data on MRPs and sexual misconduct reporting in annual security reports and to Title IX coordinators at institutions of higher education in New York (N = 188) were used to examine the prevalence of universal MRPs as well as the relationship between MRPs and reporting and postreporting outcomes. RESULTS: Descriptives showed that 44% of institutions of higher education have a universal MRP. Multivariate linear regression models indicated that universal MRPs were not significantly related to reporting in annual security reports; reports to Title IX coordinators, campus police, campus safety or security officers; or rates of referrals to additional services, no-contact orders, access to the judicial conduct process for sexual misconduct, or findings of student responsibility for sexual misconduct. CONCLUSIONS: Our findings raise concerns about the widespread implementation of MRPs and highlight the need for future research on their impact on student-survivor reporting and access to remedies and resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"I Could Never Tell My Parents": Barriers to Queer Women's College Sexual Assault Disclosure to Family Members.

Queer women are at high risk of college sexual victimization, but they face barriers to formal support services. As a result, informal support is critical. This study uses data from 40 open-ended interviews to explore family members' reactions to queer women's disclosures and examine whether their family is a reliable source of informal support. Findings indicate that family reactions are often more harmful than helpful. In comparison to research focused on heterosexual survivors, we find family reactions to be more extreme and disparaging of queer survivors' sexual identities. In fact, family members' negative reactions may pose barriers to accessing formal services.

Alcohol Use Before Sexual Violence and Cognitive Appraisals: Differential Associations With Barriers to Help-Seeking.

The current study examined two cognitive appraisals-labeling (identifying an unwanted sexual experience as sexual violence) and self-blame-as potential mechanisms between survivor alcohol use before sexual violence and three help-seeking barriers (minimization, negative treatment, and social-emotional barriers) among non-service-seeking sexual violence survivors. Participants were 141 undergraduate women who completed self-report measures. Three parallel mediation models were tested. Survivors who were drinking were more likely to label their victimization as sexual violence and, in turn, perceived fewer minimization and greater social-emotional barriers. Further, survivors who were drinking blamed themselves more and, in turn, perceived greater negative treatment and social-emotional barriers.

Analyzing the shifting state of college sexual violence compelled disclosure policies: National trends, empirical findings, and implications.

Following federal and state law, institutions of higher education (IHE) have implemented mandatory reporting (MR) policies, requiring some employees to report sexual violence they learn about to university officials regardless of victim/survivor consent (i.e., compelled disclosure). Proponents argue that MR policies are beneficial (e.g., provide survivors with support), while critics argue that MR policies that limit survivor autonomy can be harmful. Given the tension between purported goals of MR policies and potential risks to survivors, the current work provided a comprehensive analysis of IHE MR policies in the United States. First, we reviewed laws shaping MR policies. Second, we analyzed MR policies from a nationally representative sample of Title IV eligible IHEs in the United States. Third, we discussed the findings in connection to extant research on MR policies, identifying key patterns and remaining gaps. Our analysis suggested that federal and state policymaking has increasingly expanded reporting mandates for IHE employees. The majority of IHEs designated all or nearly all employees as mandatory reporters, but there was more variability in the breadth of MR policies compared to the previous research. The content of MR policies mostly offered minimal instructions for employees (e.g., to whom to report) and rarely mandated trauma-informed responses (e.g., how to respond to disclosures). In light of empirical evidence, which finds that those who are most knowledgeable about survivors' needs and the process of reporting to the university (including survivors) are less supportive of MR policies, our findings further indicate that current MR policies focus on compliance over victim/survivor support. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Does the affirmative consent standard increase the accuracy of sexual assault perceptions? It depends on how you learn about the standard.

OBJECTIVE: Colleges and universities are increasingly adopting affirmative consent standards of sexual assault, in which consent is defined as conscious and voluntary "yeses" given throughout a sexual interaction. We examined the impact of affirmative consent standards on perceptions of assault and consent. HYPOTHESES: We hypothesized that in sexual assault scenarios involving physical force or verbal coercion, exposure to the consent standard would increase perceptions of assault and decrease perceptions of consent relative to not being exposed to the standard. We then explored whether dehumanization of the perpetrator or the victim mediates the association between assault type and sexual assault perceptions and how this relation changes on the basis of exposure to the affirmative consent standard. METHOD: We exposed 909 participants (predominantly women: n = 574; predominantly White: n = 677; age: M = 28.61 years, SD = 11.10; students: n = 363, Mechanical Turk workers: n = 546) to an affirmative consent standard in a written policy, a video using a "cup-of-tea" metaphor to describe the consent standard, or no information on the standard. Participants rated perceptions of assault, consent, and dehumanization of a man and woman involved in a sexual interaction involving physical force, verbal coercion, or a consensual agreement. RESULTS: Participants who saw the affirmative consent video were more likely to perceive physical assault as assault compared with participants in the no-exposure control condition. Participants who read the affirmative consent definition were no more or less likely to perceive physical assault as sexual assault compared with participants in the control condition. Participants exposed to the text definition perceived the consensual interaction as more assaultive than did participants in the video and control conditions. Perpetrator dehumanization also emerged as a mediator of the relation between assault type and assault perceptions. CONCLUSIONS: These results suggest that exposure to consent standards sometimes aids sexual assault decision-making but also leads to confusion, even in scenarios in which consent is normally discernable. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants.

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.

Examining recipient and provider perceptions of mental health treatments and written exposure therapy for posttraumatic stress disorder with a Spanish-speaking sample.

Treatments of Posttraumatic Stress Disorder (PTSD) often evidence high rates of dropout, ranging from 25% to 40%, among English-speaking samples. Written Exposure Therapy (WET), a novel manualized treatment for PTSD, evidences lower dropout rates and noninferiority to CPT, one of the most efficacious interventions for PTSD. Spanish-speaking Latinxs often experience greater dropout and barriers to care. WET appears promising for this population, but acceptability and perceived barriers to WET have not been examined among Spanish-speaking Latinxs. The present study assessed perceptions and acceptability of a Spanish-language version of WET among Spanish-speaking Latinxs who scored greater than 45 on the Spanish-language version of the PCL-IV, indicating likely PTSD (n = 20) and providers (n = 12). Participants completed a mixed-methods interview regarding reasons they/clients would not want to receive the treatment, why they/clients would want to receive the treatment, potential solutions for any identified barriers, and reasons for not seeking mental health services generally. Providers, but not potential recipients, identified low literacy as a barrier for WET. Providers and potential recipients identified time as a barrier to WET and other mental health services, but the time reduction was perceived as a potential facilitator of WET. Results also suggest no specific cultural barriers were identified for WET (e.g., provider cultural competency) and that Spanish WET may reduce time-related barriers and is perceived as effective and acceptable among Spanish-speaking Latinxs. Additional work is needed to expand the reach of the intervention, given that mental health services were often perceived as untrustworthy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development of and Preliminary Evidence for a Psychological Service Barriers Measure Among College Sexual Assault Survivors.

Sexual assault is a widespread problem on college campuses, and survivors rarely use campus supports. However, there is no established measure of service barriers for this population. This study develops and provides preliminary evidence for a measure of psychological service barriers. Data were collected from 100 college sexual assault survivors. Results provide evidence for three factors: social-emotional barriers, negative treatment barriers, and minimization barriers. Additional tests offer evidence for consistency and reliability in these factors over time and across campus supports. This work offers preliminary evidence for the psychometric properties of this measure and lays the groundwork for future validation research.

Examining Support for University-to-Police Reporting Policies for Sexual Assault: The Role of Survivors' Consent.

In several states, bills have been introduced that require universities to report sexual assaults to law enforcement. Opponents argue that such policies can compel survivors to disclose against their will, stripping survivors of autonomy and harming campus communities. We used a mixed method approach to examine people's support for reporting policies that do and do not consider survivor consent: compelled police disclosure (requires a report regardless of victim consent) and consented police disclosure (requires a report if the victim consents). We examined individual characteristics and attitudes associated with support for these approaches (i.e., had experienced sexual assault, trust in police). Participants (1,045 adults in the United States) were randomly assigned to read one of three policy statements, and we collected quantitative and qualitative survey data. Participants were less supportive of compelled police disclosure than consented police disclosure. People who supported compelled disclosure frequently focused on the crime and potential social benefits, were more likely to be non-victims, and held greater trust in the police. People who supported consented disclosure focused on the victim's needs, were more likely to be survivors, and held less trust in the police. Survivor consent should be considered in the discussion of university-to-police reporting policies for sexual assault.

Internalized Body Stigma as a Barrier to Accessing Preventative Healthcare for Young Women.

Internalizing stigma toward the body can have negative implications for women's sexual health. In the current study, we examined how young women's internalized stigma toward their body shape, genitals, and menstrual periods are associated with their use of preventative healthcare services for sexual health. Additionally, we tested two mechanisms that may mediate the relationship between internalized body stigma and preventative care: self-objectification (in the form of a loss of autonomy) and comfort communicating with a healthcare provider. We collected and analyzed survey data from 685 undergraduate women. We tested a serial mediation model, such that the internalization of body stigma predicted greater self-objectification, greater self-objectification predicted less comfort communicating with a provider, and discomfort communicating with a provider predicted lower receipt of preventative care. Results partially supported the proposed serial mediation model, such that internalizing stigma towards body shape, genitals, and menstrual periods was associated with discomfort communicating via greater self-objectification. Internalized stigma toward genitals and menstrual periods were significant predictors of preventative care use, even when accounting for self-objectification and communication. Findings suggest that interventions to address genital and menstrual stigma could be especially beneficial for enabling young women to seek preventative care.

"Call for Help Immediately": A Discourse Analysis of Resident Assistants' Responses to Sexual Assault Disclosures.

Formal support providers can play a critical role in sexual assault survivors' well-being (e.g., providing resource referrals). In a university setting, resident assistants (RAs) are key support providers with a unique relationship to survivors based on their dual roles as help-provider and peer. We examined 305 RAs' responses to student sexual assault disclosure scenarios. Employing a critical discourse analysis, we identified four discourses used by RAs in their discussion of resources: controlling, gatekeeping, minimizing, and empowering. Due to power dynamics between RAs and residents, we conclude that empowering discourses would facilitate survivors' access to other resources (e.g., sexual assault center).

Bystander Response to Sexual Assault Disclosures in the U.S. Military: Encouraging Survivors to use Formal Resources.

Experiencing military sexual assault (MSA) results in serious mental health consequences. Sexual assault survivors often disclose to informal sources of support, and how these individuals respond can have a significant effect on survivors' wellbeing. Bystander intervention is one mechanism through which institutions, such as the U.S. Military, aim to teach informal support providers to respond positively and effectively to sexual assaults. One bystander response that survivors may find helpful is the discussion of formal resources (e.g., counseling options, reporting options). The current study examined factors associated with U.S. Service members' intentions to encourage sexual assault survivors to report and seek mental health counseling, including individual characteristics (rank, gender, personal experience of MSA) and perceptions of military sexual assault response efforts (exposure to sexual assault training, leader response to sexual assault, service barriers). The study also examined contextual factors (branch) and interactions between individual and contextual predictors. We analyzed survey data from 27,505 active duty Service members collected by the U.S. Department of Defense. As expected, rank, gender, experience of MSA, training exposure, leader response, and service barriers were associated with Service members' intentions to encourage MSA survivors to report and seek-help. Bystander responses to disclosures can have a significant effect on survivors' response to the assault, and these findings can help in identifying why bystanders may or may not encourage the use of formal resources after receiving a sexual assault disclosure.

Advocating alternatives to mandatory reporting of college sexual assault: Reply to Newins (2018).

Our recent article "Compelled Disclosure of College Sexual Assault" examines college and university policies requiring most, if not all, employees to report student disclosures of sexual assault to university authorities, with or without student consent. We provided evidence that these mandatory reporting policies have become ubiquitous in American higher education, despite limited evidence of their safety or efficacy. Commenting on our article, Newins offers helpful advice for psychologists navigating the role of "responsible employee," such as seeking out information about their campus policy for reporting sexual assault disclosures and informing students of reporting mandates. The comment concludes with a call for researchers to investigate the many questions that remain unanswered about these policies. We agree with Newins's recommendations and, in this reply, encourage psychologists to push the envelope further. In addition to better understanding and managing reporting responsibilities, psychologists should advocate for policies that respect survivor autonomy, dignity, and right to self-determination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Compelled disclosure of college sexual assault.

Sexual assault is a widespread problem on college campuses. In response, many institutions are developing policies mandating that certain employees report any student disclosure of sexual assault to university officials (and, in some cases, to police), with or without the survivor's consent. These policies, conceptualized here as compelled disclosure, have been prompted and shaped by federal law and guidance, including Title IX and The Clery Act. Proponents of compelled disclosure assert that it will increase reports-enabling universities to investigate and remedy more cases of sexual assault-and will benefit sexual assault survivors, university employees, and the institution. However, many questions remain unanswered. How broad (or narrowly tailored) are contemporary compelled disclosure mandates in higher education? Do any empirical data support assumptions about the benefits of these policies? Are there alternative approaches that should be considered, to provide rapid and appropriate responses to sexual violence while minimizing harm to students? The current article begins with an overview of federal law and guidance around compelled disclosure. Next, a content analysis of a stratified random sample of 150 university policies provides evidence that the great majority require most, if not all, employees to report student sexual assault disclosures. A review of the literature then suggests that these policies have been implemented despite limited evidence to support assumptions regarding their benefits and effectiveness. In fact, some findings suggest negative consequences for survivors, employees, and institutions. The article concludes with a call for survivor-centered reforms in institutional policies and practices surrounding sexual assault. (PsycINFO Database Record