Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

Kate Walsh; Nicole Short; Yin Yao Ji; Xin Ming An; Kristen D Witkemper; Megan Lechner; Kathy Bell; Jenny Black; Jennie Buchanan; Jeffrey Ho; Gordon Reed; Melissa Platt; Ralph Riviello; Sandra L Martin; Israel Liberzon; Sheila A M Rauch; Kenneth Bollen; Samuel A McLean

doi:10.1016/j.jpsychires.2024.04.013

Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

J Psychiatr Res. 2024 Apr 9:174:54-61. doi: 10.1016/j.jpsychires.2024.04.013. Online ahead of print.

Authors

Kate Walsh¹, Nicole Short², Yin Yao Ji³, Xin Ming An⁴, Kristen D Witkemper³, Megan Lechner⁵, Kathy Bell⁶, Jenny Black⁷, Jennie Buchanan⁸, Jeffrey Ho⁹, Gordon Reed¹⁰, Melissa Platt¹¹, Ralph Riviello¹², Sandra L Martin¹³, Israel Liberzon¹⁴, Sheila A M Rauch¹⁵, Kenneth Bollen¹⁶, Samuel A McLean¹⁷

Affiliations

¹ Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA; Department of Gender & Women's Studies, University of Wisconsin-Madison, Madison, WI, USA.
² Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychology, University of Nevada, Las Vegas, NV, USA.
³ Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA.
⁴ Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA.
⁵ University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA.
⁶ Tulsa Forensic Nursing, Tulsa Police Department, Tulsa, OK, USA.
⁷ SAFE Austin, Austin, TX, USA.
⁸ Denver Health, Denver, CO, USA.
⁹ Hennepin Assault Response Team (HART), Hennepin Healthcare, Minneapolis, MN, USA.
¹⁰ Christiana Care, Newark, DE, USA.
¹¹ University of Louisville, Louisville, KY, USA.
¹² University of Texas Health San Antonio, Texas, USA.
¹³ Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA.
¹⁴ Department of Psychiatry and Behavioral Sciences Texas A&M University, Bryan, TX, USA.
¹⁵ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Veterans Affairs Atlanta Healthcare System, Atlanta, GA, USA.
¹⁶ Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA.
¹⁷ Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, North Carolina, USA. Electronic address: samuel_mclean@med.unc.edu.

PMID: 38615545
DOI: 10.1016/j.jpsychires.2024.04.013

Abstract

This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.

Keywords: Bedside screener; Elevated posttraumatic stress; Prediction tool; Sexual assault; Sexual assault nurse exams.