The proposed two-year research project will compare, in a controlled experimental design, a programmatic preventive intervention plus standard post-rape hospital exam procedures versus standard post-rape hospital exam procedures alone in reducing frequency and intensity of post-rape psychopathology. The preventive intervention will be delivered via video-tape and will address those areas of psychological functioning identified by our pilot studies of other investigators as negatively affected by rape (i.e., PTSD, depression, substance abuse, & panic). All participants will also be offered the option of remaining overnight as inpatients. Reasons for the inpatient stay are two-fold. First, the therapeutic effects of such a stay, as well as the interaction between such a stay and the video intervention are unexplored. Second, in addition to outcome measures of psychological functioning we propose to include assessment of acute post-rape plasma cortisol, one day post-rape a.m. urinary cortisol, and 6 week and 4 month post-rape a.m. urinary cortisol. The measures of cortisol may constitute more objective biological correlates of the acute stress response and recovery processes that may be correlated with psychological and behavioral indices of functioning. The validity of cortisol analyses will be increased if obtained in a standard manner at a fixed time after women have remained in a controlled setting overnight. The study will begin with a 3-month baseline, during which dependent measures, including cortisol measures, are collected and the video intervention is developed and produced. Approximately 60 participants (45 as inpatients the day of the post-rape forensic exam) will complete this preliminary phase of the study. For the next 21 months, approximately 246 women will complete the forensic exam and consent to release records and cortisol measures. Approximately 156 of the 246 women will also consent to participate in the preventive intervention/follow-up study phase (125 as inpatients the day of the post-rape forensic exam). These 156 women will return for 6 week and 4-month follow-up exams in the outpatient clinic between 7:00am and 9:00am, during which time cortisol and psychological functioning measures will also be obtained. This number of subjects was selected to provide sufficient power to detect between group differences, if they exist. To eliminate bias in treatment assignment, patients presenting to the hospital on even dates will receive standard outpatient hospital-based treatment procedures, while victims presenting on odd days will receive the preventive video intervention + standard outpatient hospital-based rape treatment procedures. No deviation from this schedule will be permitted for the duration of the project, and subjects receiving either condition against schedule mandates will be dropped from the study, thereby preventing systematic bias in treatment assignment.
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