Study On Sexual Assault Trauma Intervention Patterns, Psychosocial Factors, Brain Structural And Functional Feature In Sexual Assault Victims With PTSD

OBJECTIVE Sexual violence is a serious public health and social problem in many countries, including China. Due to the possible cultural and social differences, trauma interventions on sexual assault in Chinese mainland can not directly apply the mature patterns from western countries or that from Hong Kong and Taiwan areas. In this research, the author tried to explore a set of intervention patterns applicable for victims of sexual assault trauma in Chinese mainland setting.METHODS Based on the qualitative research design of social construcionism approach, the author explores and summarizes the appropriate intervention patterns for victims of sexual assault in Chinese mainland through the trauma intervention work on victims of sexual assault in Shenzhen.RESULTS The researches established and launched the "China Sexual Assault Prevention Web" (Spring Breeze Website), the first public assistant system and internet platform for helping victims of sexual assault. This website provided multiple services including psychological education, multiple professional assistance and social support enhancement. The author also organized a group of professionals from different disciples and service factors who could provide psychological, legal, medical, financial and shelter service for victims. Together with these professionals, the author carried out a large scale of psychological education and legal education concerning sexual assault among the general public and provided the direct psychological or legal services for victims for more than 500 times, as well as the prevention and coping training for high-risk populations for more than 1000 times.CONCLUSIONS After the four years of practical experience, the researches summarized a framework for intervention on sexual assault victims as follows:the first step is to do prevention work, such as raising the awareness of general public for sexual assault as well as the coping capacity. The second step is to carry out education campaign to reduce the misunderstanding and prejudice from the public and organizations against victims of sexual assaults. The third step is to integrate resources, facilitating victims'access to useful information and resources. The fourth step is to provide a coordinated intervention for victims, which may include psychological, legal, medical, financial, and social intervention. The fifth step is to provide long-term support for victims, which may include the support from volunteers and social workers so that victims'social support system can be enhanced. This intervention framework has still been on trail and may need future improvement and modification.OBJECTIVE Sexual assault is one of the most traumatic stressors one may experience in life. Although studies overseas can be found on the prevalence of posttraumatic stress disorder (PTSD) and associated psychosocial factors on victims of sexual assault, such studies in Mainland China are limited. The objective of this research is to study PTSD and related psychosocial factors on females assaulted in Chinese mainland.METHODS A total of 1023 questionnaires were distributed among females aged 17-45 by accidental sampling in three cities in Guangdong, China (i.e., Shenzhen, Huizhou, Guangzhou). Among those samples,946 returned completed questionnaires. The basic demographic data sheets, PTSD Checklist-Civilian Version (PCL-C), Clinician-Administered PTSD Scale (CAPS), Eysenck Personality Questionnaire (EPQ), Social Support Rating Scale (SSRS), and Trait Coping Style Questionnaire (TCSQ) were used. The data was processed for statistical analysis by SPSS 13.0 software. RESULTS 1. The prevalence of PTSD in the female victims of sexual assault was 15.25%(34/223).2. Predictors of PTSD score. The factors found to be significant associated with PTSD scores in the bivariate analysis were entered simultaneously into the final multiple regression model. Only the severity of sexual assault (P=5.12, P< 0.001), positive coping strategies (β=-0.29, P= 0.001), negative coping strategies (β= 0.42, P< 0.001) and neuroticism (β=0.31, P= 0.002) remained significant. According to Nagelkerke R2, all psychosocial factors together explained 32.8% of the variance of PTSD scores.3. Predictors of PTSD symptamotology. The negative coping strategies (β= 0.05,P< 0.001), positive coping strategies (β=-0.07, P< 0.001) and objective social support (β= 0.05, P=0.04) remained significant associated with persistent intrusive memories about the traumatic event; neuroticism(β=0.03, P= 0.021), negative coping strategies (β= 0.06, P< 0.001), positive coping strategies (β=-0.05, P< 0.001) and objective social support (β=-0.16, P< 0.001) remained significant associated with persistent avoidance of stimuli associated with the trauma;neuroticism (β= 0.03,P= 0.013), Extroversion/Introversion traits(β=0.03,P= 0.022), negative coping strategies (β= 0.05, P< 0.001), positive coping strategies (β= 0.05, P< 0.001) and subjective social support (β=-0.04, P= 0.040) remained significant associated with persistent symptoms of increased arousal. Nagelkerke R2 were 19.2%,24.7%,27.8% respectively and all psychosocial factors together explained approximately 26% of the variance of the occurrence of PTSD symptomatology.CONCLUSIONS These findings suggest that social support (objective support, subjective support, support utilization), coping strategies (negative, positive) and some personality traits (neuroticism) play a role in the development of PTSD and its degree. The differences in social support, coping strategies and personality traits between PTSD group and healthy control group suggest the risks and protective factors of PTSD among victims of sexual assault, and provide prima facie evidence for post-trauma intervention. OBJECTIVE Previous research has mainly focused on PTSD caused by various traumatic events, such as war, disaster and traffic accidents. Among others, most of the samples were male. Limited studies have been carried out in the neuroimaging on PTSD of femal and raped PTSD. This study examined changes in brain gray matter and function in victims of rape (VoR) with and without posttraumatic stress disorder (PTSD), and healthy comparisons (HC).METHODS The study included 13 VoR with PTSD,10 VoR without PTSD, and 23 HC subjects. We used voxel-based morphometry to explore changes in brain gray-matter density (GMD) by 1.5 T high-resolution functional magnetic resonance images (fMRI). The functional tasks including the emotional counting term Stroop, the symptom provocation BLOCK, the picture Event-related (ER) memory recall paradigms. Voxel-based morphometry were implemented by using the Statistical Parametric Mapping software (SPM2). However, due to too many head movements during MRI scanning and data quality factors, a total of five subjects (2 PTSD,2 non-PTSD, and 1 HC) were removed. As a result, the final samples consisted of 11 VoR with PTSD,8 VoR without PTSD, and 22 HC.RESULTS 1. Results of MRI:Compared with HC, VoR with PTSD showed significant GMD reductions in the bilateral medial frontal cortex, superior frontal cortex, right middle frontal cortex, middle temporal gyrus and fusiform cortex, and significant GMD increases in the left middle frontal cortex, bilateral precentral cortex, left inferior parietal lobule, postcentral cortex, superior temporal gyrus, inferior temporal gyrus, right insula, Pyramis, culmen and declive.2. Results of fMRI:(1) The emotional counting term Stroop. Compared with HC, VoR with PTSD showed an decreased activation in the bilateral middle frontal cortex, right medial frontal cortex, left superior frontal cortex, inferior frontal cortex, anterior cingulated cortex, precentral cortex, left postcentral cortex, bilateral superior temporal gyrus, middle temporal gyrus, right insula, parahippocampal gyrus, thalamus, fusiform cortex and declive responses in trauma related terms compared with neutral terms. It showed an decreased activation in the bilateral superior frontal cortex, middle frontal cortex, right inferior frontal cortex, medial frontal cortex, left anterior cingulated cortex, bilateral precentral cortex, postcentral cortex, left precuneus, right inferior parietal lobule, cingulated cortex, parahippocampal gyrus, bilateral insula, superior temporal gyrus, middle temporal gyrus, inferior temporal gyrus, fusiform cortex, middle occipital gyrus, right cuneus, bilateral lingual gyrus, culmen and declive in trauma related term compared negative terms. (2) The symptom provocation BLOCK:Compared with HC, VoR with PTSD showed an increased activation in the left superior frontal cortex, bilateral middle frontal cortex, inferior parietal lobule during neutral film; showed a decreased activation in the left medial frontal cortex, inferior frontal cortex, anterior cingulated cortex, right inferior parietal lobule, cuneus, uvula of vermis and node, an increased activation in the left middle temporal gyrus during trauma related film. (3) The picture Event-related (ER):Compared with HC, VoR with PTSD showed a decreased activation in the bilateral medial frontal cortex, inferior frontal cortex, anterior cingulated cortex, right middle frontal cortex, posterior cingulated cortex, postcentral cortex, left precentral cortex and middle temporal gyrus, an increased activation in the bilateral parahippocampal gyrus, inferior parietal lobule, superior temporal gyrus, right thalamus, left declive in trauma related pictures; showed a decreased activation in the bilateral medial frontal cortex, left precentral cortex, anterior cingulated cortex, middle temporal gyrus, right cingulated cortex, posterior cingulated cortex, postcentral cortex and declive; showed an increased activation in the left superior frontal cortex, middle frontal cortex, insula, parahippocampal gyrus, uncus, thalamus, inferior parietal lobule, left cuneus, right culmen and declive in novel neutral pictures. (4) Abnormal structural and functional findings in the same brain areas. Compared with HC, VoR with PTSD showed abnormal structure and function in the bilateral medial frontal cortex (BA10), right superior frontal cortex (BA10), middle frontal cortex (BA10), left middle frontal cortex(BA6), right insula (BA13), bilateral precentral cortex (BA4), right middle temporal gyrus (BA21), left inferior temporal gyrus (BA22), right culmen and declive. Compared with VoR without PTSD, VoR with PTSD showed significant abnormal structural and functional brain areas in the left superior frontal cortex (BA6), right middle frontal cortex (BA6,9), precentral cortex (BA6), middle temporal gyrus (BA21), superior temporal gyrus (BA22), parahippocampal gyrus (BA20), bilateral inferior parietal lobule (BA40).CONCLUSIONS 1. The trait of brain neural circuitry in VoR of PTSD showed a decreased activation in the frontal cortex and anterior cingulated cortex, a creased activation in the thalamus and parahippocampal gyrus, and impaired or deficit in attentional and emotional function were caused in some brain areas including frontal, parietal lobule, temporal gyrus, limbic system, cerebellum in the trauma related stimulates.2. There are some differences between trauma information and normal negative information processing in PTSD brain neural circuitry of emotion, cognition and attention control.3. The differences of brain structure and function between VoR of non-PTSD and PTSD suggest that the increased density in these brain regions may be involved in the biological foundation to avoid PTSD after serious psychosocial adversity.4. To our knowledge, the following phenomena are reported for the first time:the PTSD brain showed dysfunction during novel neutral pictures stimulus, the abnormal grey matter density of inferior parietal lobule, the cerebellum abnormal activation derived from Stroop task, the bilateral thalamus abnormal activation derived from Event-related are involved in PTSD. Those may be related to the diversity in PTSD populations, such as different trauma histories or female gender, and further researches will be needed to test and verify these aspects.