A Systematic Literature Review Stephanie Lanthier, Janice Du Mont and Robin Mason

1. Determining “best” practices in responding to delayed disclosure by female sexual assault victims in health care settings A Systematic Literature Review Stephanie Lanthier, Janice Du Mont and Robin Mason

2. Image: http://projectunbreakable.tumblr.com/

3. Background: Disclosure of Sexual Assault • Sexual assault is a pervasive yet underreported violent crime (Du Mont & White, 2007). Less than 10% of sexual assaults are formally reported to the police (Brennan & Taylor Butts, 2010; Sinha, 2013). • Research shows that the majority of women do eventually disclose to someone (Ahrens et al., 2010; Golding et al., 1989; Neville & Pugh, 1997). • Disclosure often occurs weeks, months or years after the assault (Dunleavy 2012; Esposito, 2006; Filipas & Ullman, 2001).

4. Background: Health Consequencesand Health Seeking • Sexual assault victims report poorer health and use medical services more frequently than non-victims (Golding et al., 1989; Resnick et al., 2000; Ullman & Brecklin, 2003; Ullman & Siegel, 1995). • They can present with a variety of physical, uro-gynaecological, obstetric and/or mental health issues (Taylor et al., 2012). • It is important that health care providers in a variety of settings are able to respond appropriately to the delayed disclosure of sexual assault.

5. Purpose To determine “best” practices in responding to delayed disclosure of sexual assault by examining helpful and unhelpful responses by health care providers. Image: The Awareness Center Inc.

6. Methods: Search Strategy(April 2013) Key Terms Databases OVID Medline PubMed PsycINFO Embase • “sexual assault”, “disclosure”, “social support”, “post assault”, “reaction”, “clinician”, “provider”, “formal” etc. Limited search to 1985-present; English

7. Methods: Analysis

8. Records identified through database searching and reference lists of key articles (N=1166) Duplicate records (N=383) Title screen (N=779) Titles excluded (N=601) Abstracts assessed for eligibility (N=178) Abstracts excluded (N=129) Full-text articles assessed for eligibility (N= 49) Full-text articles excluded (N=25) Studies included (N=24)

9. Methods: Exclusion Criteria

10. Results: Summary

11. Results: Responses

12. Results: Helpful Responses

13. Results: Unhelpful Responses

14. Results: Unhelpful Responses

15. Summary: “Best” Practices

16. Implications: Practice After receiving a sympathetic reaction from her doctor, one survivor said: “It made me feel good, like I, wow, it’s not the end you know?” (Ahrens et al., 2009) • Health care providers require more training on recognizing indicators of past sexual assault and knowing how to respond to delayed disclosure in a helpful way. • Implementing “best” practices is a first step in achieving this improved response.

17. Acknowledgements Special thanks to: Mona Frantzke, BSc, MLSc, Medical Librarian, Health Sciences Library, Women’s College Hospital

18. References Ahrens, C.E. (2006). Being silenced: The impact of negative social reactions on the disclosure of rape. American Journal of Community Psychology, 38, 263-274. Ahrens, C.E., Cabral, G. & Abeling, S. (2009). Healing or hurtful: Sexual assault survivors’ interpretations of social reactions from support providers. Psychology of Women Quarterly, 33, 81-94. Ahrens, C.E., Campbell, R., Ternier-Thames, N.K., Wasco, S. & Sefl, T. (2007). Deciding whom to tell: Expectations and outcomes of rape survivors’ first disclosures. Psychology of Women Quarterly, 31, 38-49. Ahrens, C.E., Stansell, J. & Jennings, A. (2010). To tell or not to tell: The impact of disclosure on sexual assault survivors’ recovery. Violence and Victims, 25, 631-648. Diaz, A., Edwards, S., Neal, W.P., Ludmer, P., Sondike, S.B., Kessler, C., Medeiros, D. & Nucci, A.T. (2004). Obtaining a history of sexual victimization from adolescent females seeking routine health care. The Mount Sinai Journal of Medicine, 71(3), 170-173. Dunleavy, K. & Slowick, A.K. (2012). Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: Patient-centered and trauma-cognizant management by physical therapists. Physical Therapy Journal, 92(2), 339-351. Esposito, N. (2006). Women with a history of sexual assault: Healthcare visits can be reminders of a sexual assault. American Journal of Nursing, 106(3), 69-73. Filipas, H.H. & Ullman, S.E. (2001). Social reactions to sexual assault victims from various support sources. Violence and Victims, 16(6), 673-692. Ullman, 1996a Ullman, 1996b Ullman & Filipas, 2001 Ullman & Najdowski, 2009 Ulllman & Siegel, 1995

19. References Golding, J.M., Siegel, J.M., Sorenson, S.B., Burnam, M.A. & Stein, J.A. (1989). Social support sources following sexual assault. Journal of Community Psychology, 17, 92-107. Lessing, J.E. (2005). Primary care provider interventions for the delayed disclosure of adolescent sexual assault. Journal of Pediatric Health Care, 19, 17-24. Littleon, H.L. (2010). The impact of social support and negative disclosure reactions on sexual assault victims: A cross-sectional and longitudinal investigation. Journal of Trauma & Disassociation, 11, 210-227. Long, S.M., Ullman, S.E., Long, L.M., Mason, G.E. & Starzynski, L.L. (2007). Women’s experiences of male-perpetrated sexual assault by sexual orientation. Violence and Victims, 22, 684-701. Mazza, D., Dennerstein, L., & Ryan, V. (1996). Physical, sexual and emotional violence against women: A general practice-based prevalence study. The Medical Journal of Australia, 164, 14-17). Muganyizi, P.S., Hogan, N., Emmelin, M, Lindmark, G., Massawe, S., Nystrom, L., & Axemo, P. (2009). Social reactions to rape: Experiences and perceptions of women rape survivors and their potential support providers in Dar es Salaam, Tanzania. Violence and Victims, 24(5), 607-626. Muganyizi, P.S., Nystrom, L., Axemo, P. & Emmelin, M. (2011). Managing in the contemporary world: Rape victims and supporters experiences of barriers within the police and the health care system in Tanzania. Journal of Interpersonal Violence, 26(16), 3187-3209.

20. References Plumbo, M.A. (1995). Delayed reporting of sexual assault: Implications for counseling. Journal of Nurse-Midwifery, 40(5), 424- 427. Popiel, D.A. & Susskind, E.C. (1985). The impact of rape: Social support as a moderator of stress. American Journal of Community Psychology, 13(6), 645-676. Starzynski, LL., Ullman, S.E., Filipas, H.H., Townsend, S.M. (2005). Correlates of women’s sexual assault disclosure to informal and formal support sources. Violence and Victims, 20(4), 417-432. Sturza, M.L. & Campbell, R. (2005). An exploratory study of rape survivors’ prescription drug use as a means of coping with sexual assault. Psychology of Women Quarterly, 29, 353-363. Ullman, S.E. (1996a). Correlates and consequences of adult sexual assault disclosure. Journal of Interpersonal Violence, 11(4), 554-571. Ullman, S. E. (1996b). Do social reactions to sexual assault victims vary by support provider? Violence and Victims, 11(2), 143-157. Ullman, S.E. & Filipas, H.H. (2001). Correlates of formal and informal support seeking in sexual assault victims. Journal of Interpersonal Violence, 16(10), 1028-1047. Ullman, S.E. & Najdowski, C.J. (2009). Correlates of serious suicidal ideation and attempts in female adult sexual assault survivors. Suicide and Life-Threatening Behavior, 39(1), 47-57. Ullman, S.E. & Siegel, J.M. (1995). Sexual assault, social reactions and physical health. Women’s Health: Research on Gender, Behavior, and Policy, 1(4), 289-308.

21. Questions? Image: http://www.shutterstock.com/