What is the purpose of this study?

Recent decades have seen a proliferation of rape crisis response programs. One aim of such programs has been to optimize the forensic medical care rape victims receive in the immediate aftermath of an assault. Little empirical research, however, has explored the effectiveness of these programs, or other types of interventions, in reducing or preventing exam-related distress and longer-term mental health problems among rape survivors. Numerous authoritative studies document that there is a strong relationship between levels of distress in the first days after a rape and the later development of posttraumatic stress (PTSD), panic, anxiety and depressive disorders. Because the forensic examination performed in hospital emergency rooms shortly after an assault can increase victims' distress, an intervention that prevents or reduces this exam-related distress could help alleviate victims' risk of future psychopatholgy. This study examines

1. The effects of a newly developed, video intervention in reducing the distress of rape survivors at the time they undergo a forensic exam, and
2. Whether this early, post-rape video intervention also affects rape survivors' likelihood of developing PTSD or other psychopathologies.

What is important about the method of intervention presented in this study?

Rape victims who report the crime to police undergo a forensic examination usually at a hospital emergency room. Such an exam asks rape survivors to verbally recount the assault and to submit to a pelvic-vaginal exam. One reason these procedures can increase a victim's distress is because they act as strong reminders of the rape. Crisis counselors do explain forensic medical procedures to rape survivors in hospital emergency rooms, and they may also give other information about mental health issues and services pertinent to rape survivors. The video intervention developed for this study is important for several reasons:

1. It is the only economically feasible, nonthreatening, preventative, emergency room based intervention that has been designed and empirically tested to reduce distress in rape survivors at the time of the forensic exam and to reduce their risk of becoming emotionally ill in the aftermath of the rape.
2. It both explains the forensic exam in clear, succinct terms and demonstrates how the exam is conducted using actors as rape victims.
3. It advises victims about the risks of future mental health problems and healthy ways to cope with later emotional responses to the rape.
4. It standardizes the information given to rape victims in hospital emergency rooms.
5. The video intervention is brief and easy to administer. This enables it to accomplish its goals without overtaxing either hospitals' or victims' time or financial resources while at the same time taking into account the extreme distress most rape victims are experiencing at the time of the forensic exam.

How was the study conducted?

Of the 80 rape survivors considered for participation in the study, approximately 25% were deemed inappropriate for reasons such as mental retardation, acute psychosis, substance abuse, severe injury or extreme distress. All participants had reported the crime to police and consented to a forensic exam. A pseudo-random assignment to groups resulted in 33 women receiving standard post-rape services before the forensic exam (i.e., control group: counseling before the forensic exam by a rape crisis worker at the hospital) and 15 women received the video intervention (i.e., watched the newly developed video before their forensic exam). Distress was measured using the Subjective Units of Distress Scale (SUDS) before and after the exam. The Beck Anxiety Inventory (BAI) measured study participants' anxiety after the exam and at the six-week follow-up. PTSD symptoms were measured using the Post-traumatic Symptom Scale-Self-Report version (PSS-SR) at the six-week follow-up. Participants reported their reactions and opinions to both the standard services (control group) and the video intervention on the Medical information questionnaire.

What are the study's findings?

Victims' level of distress before the forensic exam was strongly associated with post-rape PTSD symptoms at the six-week follow-up interview. However, study participants who watched the video differed in a number of ways from those that received the standard, rape crisis services and did not watch the video. Specifically, video watchers

1. Reported less distress immediately after the forensic exam
2. Had significantly lower anxiety scores on the BAI
3. Reported that they were better able to attend to and understand the information presented on the video than those who had a crisis counselor present the information
4. Reported (85%) that the video made it easier to undergo the forensic exam - only 50% of those who received the information from a crisis counselor said that the information made undergoing the exam easier.

What are the implications of this study?

1. A video program may have advantages over face-to-face, emergency room counseling by rape crisis workers in reducing rape survivors' distress about forensic examinations, in preventing later psychological problems, and in ensuring that rape victims receive standardized intervention messages.
2. Addressing rape survivors' anxiety at the time of the forensic examination may be the most opportune moment to intervene to prevent the development of PTSD and other rape-related psychopathology.
3. A video presentation gives rape crisis workers an additional effective tool.

Reviewed by Priscilla Schulz, September 1999