Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA.
166668University of California San Francisco Health, San Francisco, CA, USA.
J Interpers Violence. 2023 Feb;38(3-4):3244-3278. doi: 10.1177/08862605221104522. Epub 2022 Jun 3.
Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.
急诊科（ED）工作人员与性侵犯（SA）幸存者之间的相互作用可能会对幸存者造成再次创伤，增加他们患创伤后应激障碍的风险，并降低他们对纵向医疗护理的利用。关于 ED 工作人员对幸存者的态度和行为的全国性趋势，包括幸存者身份的影响，知之甚少。我们进行了一项调查，以确定幸存者的身份是否会影响 ED 工作人员的行为。2021 年 6 月至 8 月期间，对性侵犯患者倡导者进行了一项全国性调查。倡导者是从强奸危机中心派遣来支持幸存者在 ED 护理期间的志愿者或工作人员。倡导者参与了一项在线调查，以确定观察六种潜在创伤性提供者态度和行为的频率。适应性提问用于探索幸存者身份对每种态度或行为的影响，以及哪些身份群体更容易受到影响。315 名倡导者对调查做出了回应。不到 10%的人表示，ED 工作人员经常或总是向幸存者表示怀疑或指责。近 75%的倡导者表示，他们经常或总是观察到 ED 工作人员对幸存者表示同情。在提供者的态度上存在差异。超过 75%的倡导者观察到幸存者的心理健康状况或药物使用情况会影响提供者的信任。当被袭击时处于醉酒状态、有精神疾病、是黑人、西班牙裔/拉丁裔或土著人、或不是 cis 女性的患者更有可能被怀疑。是白人且/或 cis 女性的患者更有可能受到 ED 工作人员的压力，要求他们完成法医检查和/或向警方报案。我们的研究根据幸存者的身份记录了 ED 工作人员对性侵犯幸存者行为的差异。鉴于性侵犯后 ED 的相互作用是幸存者未来医疗过程中的关键转折点，ED 护理方面的差异可能与创伤后康复方面的更大差异有关。
