Date of Award

1-7-2022

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Amanda Gilmore, PhD

Second Advisor

Karen Nielsen, PhD

Abstract

Introduction: More than 43% of women report experiencing sexual violence during their lifetime. Experiencing SA, especially violent SA, is associated with depression, substance abuse, suicidal ideation, and suicide attempt. Receiving a SA medical forensic exam (SAMFE) in the emergency department is typically the first line of acute care after an assault, providing an opportunity for prescribing necessary medications, forensic evidence collection, and treating physical injuries. Little is currently known how procedures during the exam and characteristics of the SA itself predict suicidal behavior and overdoses after an assault.

Methods: Participants included women who received a SAMFE within 120 hours of an assault (n=239). Information on demographic characteristics, medications prescribed during their SAMFE visit, and SA characteristics as well as information on poisoning and suicide-related diagnoses were collected from the electronic medical record.

Analysis: An initial logistic regression was performed to assess whether receiving prescription psychiatric medication during SAMFE visits predicted suicide-related diagnoses. A latent class analysis was also performed to identify classes of assault survivors’ experiences. The identified classes were then assessed for differences in proportions of suicide-related and poisoning diagnoses in the year following the exam.

Results: Women who received psychiatric prescription medication during a SAMFE had 5.41 times greater odds of receiving a suicide-related diagnosis within one year (p=0.007). The latent class analysis identified two classes of assault severity among survivors. Survivors in Class 1 had more typically assaults, while survivors in Class 2 experienced more violent assaults with a higher probability of experiencing anal penetration, genital and non-genital injury, and weapon use. A two-proportion z-test found that Class 2 comprised a higher proportion of poisoning diagnoses in the sample (p=0.029).

Conclusion: These findings highlight the prescribing of psychiatric medication or documenting characteristics of severe SA as markers for suicide and self-harm interventions. Future studies should focus on developing these interventions for implementation in acute care settings and promote the ease of follow-up psychological care after an assault.

DOI

https://doi.org/10.57709/26715600

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