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KVINNEHELSE-Kvinners helse og kjønnsperspektiver

Early intervention after rape to prevent post-traumatic stress disorder – a multicenter randomized control trial

Alternative title: Tidlig psykologisk intervensjon etter voldtekt

Awarded: NOK 8.8 mill.

Rape and sexual assault is one of the traumatic life events associated with the highest risks for developing chronic posttraumatic stress disorder (PTSD) and other mental health and psychosomatic problems. PTSD is a mental disorder characterized by involuntary, intrusive posttraumatic memories of the event, avoidance of things that reminds the victim of the rape, negative changes in emotions and beliefs about the self and the world, and hyperarousal. For most people PTSD is associated with significant functional impairment. Presently, we have adequate research-based knowledge that trauma-focused cognitive-behavioral treatments have reasonable effects in the treatment of chronic PTSD. However, we have limited evidence about effective interventions to prevent the development of chronic PTSD after traumatic life events. Given the fact that rape is an especially potent risk factor for the development of chronic PTSD it is important to investigate how we might prevent the onset of this debilitating disorder. Thus, in the present project we will conduct a multicenter randomized controlled trial to examine if a brief psychological intervention in the immediate period after rape might prevent the development of PTSD and other mental health and psychosomatic disorders. Patients who seek health care at Sexual Assault Centers immediately after rape will be eligible to participate in the trial given that they consent to participate. Patients will be randomized to either three to five sessions of prolonged exposure therapy or psychosocial follow-up services as usual. The severity of posttraumatic symptoms and other mental health and psychosomatic symptoms will be measured before and after the intervention in order to examine whether a brief specialized intervention is more effective than treatment as usual. In addition, we will strive to identify factors that might explain why some patients respond well to treatment whereas other patients do not (i.e. so-called moderators).

Rape is a common cause of post-traumatic stress disorder (PTSD) among women, as around 30-50% will develop PTSD in the aftermath of rape, leading to severe mental and physical suffering, decreased social and occupational function, increased use of health care and hence substantial human and economic consequences for both women and the society at large. There is a lack of evidence-based knowledge how to prevent the development of PTSD after rape. Women may suffer from PTSD for years before receiving therapy. Prolonged Exposure Therapy (PE) is well documented as a therapy. However, preventing the development of PTSD have the potential to spare women of the suffering, prevent both mental and somatic health problems, and also reduce health care costs. Currently a brief protocol based on PE, has been developed, modified prolonged exposure (mPE), consisting of three to five once or twice weekly 60 minutes sessions, and studies indicate that if implemented early after rape, mPE may prevent the development of PTSD. Specialized services for victims, Sexual Assault Care (SAC) centers have been established in Norway, offering forensic documentation, medical treatment and psychosocial follow-up. The follow-up service varies widely and no evidence-based preventive measures have been implemented. We propose to conduct a multi-site (SAC centers in Trondheim, Oslo, and Sandefjord) randomized control trial (RCT) in which patients are recruited early after rape, and randomized to intervention (mPE) or treatment as usual (TAU). Primary outcome is PTSD symptom severity. In order to identify a statistically significant difference, we need 50 women in each group to complete the study. Predictors and moderators of the intervention, like stress response (measured by level of cortisol) and sleep patterns (measured with actigraphy), will be explored. The planned intervention is a brief and simple program, with large potential to be implemented as routines if proven effective, and thus inform clinical guidelines.

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KVINNEHELSE-Kvinners helse og kjønnsperspektiver

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