Early post-rape interventions that accelerate recovery or otherwise reduce the mental health, physical health- risk, and economic impact of rape among women and adolescent girls can be of considerable value to individuals and society. The proposed study will examine the efficacy of an easily administered evidence- based preventive intervention for drug abuse and mental health problems, the Prevention of Post Rape Stress (PPRS) video. The PPRS is implemented prior to the post rape forensic medical exam, which is routinely conducted when a rape is reported to police or other authorities within 72 hours of assault. The PPRS video is designed to reduce anxiety related to the medical exam and to teach constructive coping skills to prevent or reduce post-rape drug use, as well as symptoms of PTSD, depression and anxiety. We will compare this video intervention with a video shown prior to the medical exam that includes Pleasant Imagery and Relaxation Instruction (PIRI) and that is expected to reduce post-rape anxiety and mental health problems via different mechanisms (relaxation vs. a range of other cognitive and behavioral skills targeted by the PPRS video). A third experimental condition, Standard Care, will serve as the control condition. Acute pre and post-exam anxiety and functioning at 2 weeks, 2 months, and 6 months post-rape on outcome measures including drug use and abuse, PTSD, depression, other anxiety, and HIV risk behaviors among recent rape victims will be compared across these three conditions. Potential mechanisms of action, including those that are knowledge based and those that are coping based will be evaluated and individual difference factors that may moderate effects of each type of intervention will be examined. Cost effectiveness analyses will be conducted to evaluate costs relative to outcomes observed in terms of drug abuse, PTSD, depression, and anxiety over time related to each intervention. The study will allow for replication at an independent site (Minneapolis) of findings from an initial NIDA funded study indicating reduced frequency of marijuana use (Resnick et al., 2007a) among pre- rape recent marijuana users and reduced frequency of PTSD and depression symptoms among recent female rape victims with prior history of rape (Resnick et al., 2007) associated with the PPRS video relative to standard care. The proposed study will include comparison of the PPRS to standard care as well as evaluation of a novel intervention (PIRI) that has yet to be evaluated in the acute aftermath of rape. Given the prevalence of rape and the significant mental health impact of rape, such easily administered early interventions if efficacious, could be widely implemented and could have a significant positive impact on health. Public Health Relevance: A large number of U.S. women and girls are affected by rape each year and over the course of their lives and as a result they are at risk of developing problems including drug use and symptoms of PTSD, other anxiety, and depression after an assault. The goal of this study is to evaluate two brief video interventions that address different information and coping strategies (e.g., education about the medical exam, potential reactions following rape, and active positive coping techniques vs. relaxation techniques) related to rape in terms of relative effects and mechanisms by which they may be helpful as compared to each other and standard medical care, to be shown before a standard medical exam that is conducted with recent rape victims who report the crime to police or other authorities. The video interventions contain distinct and non-overlapping information that may reduce anxiety related to the rape exam and that may teach positive coping skills that prevent or reduce drug use, PTSD, other anxiety, and depression over the weeks and months following rape.
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