Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial

Suzannah K Creech, Carey S Pulverman, Christopher W Kahler, Lindsay M Orchowski, M Tracie Shea, Golfo Tzilos Wernette, Caron Zlotnick, Suzannah K Creech, Carey S Pulverman, Christopher W Kahler, Lindsay M Orchowski, M Tracie Shea, Golfo Tzilos Wernette, Caron Zlotnick

Abstract

Importance: Sexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers.

Objective: To test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks.

Design, setting, and participants: The Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months.

Intervention: SHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition.

Main measures: Health risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review.

Results: SHE did not impact women's number of health risks (all p's > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ2 (1, n = 153) = 4.38, p = .036, rs = .16), and self-report (χ2 (1, n = 130) = 5.89, p = .015, rs = .21). SHE was found to be an acceptable intervention.

Conclusions: SHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time.

Trial registration: Clinicaltrials.gov identifier NCT02957747.

Keywords: hazardous drinking; intimate partner violence; posttraumatic stress disorder; sexual assault; women.

Conflict of interest statement

Dr. Zlotnick has one conflict of interest to report; her spouse, Dr. Gordon, has served as a physician advisor consultant to a technology company, Soberlink. This company manufactures breathalyzer equipment. Soberlink technology was not used in this study. The authors have no other conflicts of interest to report.

© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

Figures

Figure 1
Figure 1
CONSORT table for the randomized controlled trial of the SHE intervention.
Figure 1
Figure 1
CONSORT table for the randomized controlled trial of the SHE intervention.

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