Rape trauma is often followed by persistent post-traumatic stress disorder (PTSD), a form of chronic anxiety which causes significant distress, morbidity and suicidality; it may also impair recovery after rape. However, not all rape victims develop chronic PTSD, thus it is important to understand which risk factors might increase the likelihood of this complication. There is evidence that family history (FH) of anxiety serves as a risk factor for PTSD in a variety of populations and this proposal examines the hypothesis that an FH of anxiety disorder occurs more frequently in rape victims who develop chronic PTSD than in those who do not, and that the risk will be similar to a group of anxious controls. It also examines the hypothesis that a positive family history for anxiety will act as an independent risk factor for post-rape PTSD after taking into account aspects of the trauma. Although co-morbid depression is often observed in association with PTSD, we expect that familial depression will not be a risk factor for developing PTSD, and that there will be no increased familial depression among PTSD probands. To accomplish these objectives, we will compare rape victims with groups of age and sex matched non-psychiatric controls, and controls with depression and anxiety. Five groups will be defined as follows: Group A will comprise rape victims with PTSD, recruited from the Psychiatry Department (n=30) (A1) and from the rape crisis center or advertisement (n=30) (A2). Group B will comprise psychiatric rape victims without PTSD recruited from the Psychiatry Department (Group B1) (n=30), and from the rape crisis center or advertisement (B2)(n=30). Group C will comprise major depressed controls without a history of rape or PTSD (n=30). Group D will comprise anxiety disorder patients without a history of rape or PTSD (N=30). Group E will comprise two non-psychiatric control groups, one of whom will be rape victims recruited by advertisement or from the centers (n=15, E1), and the other being non-rape controls (n=30) recruited by advertisement. Approximately 675 first degree relatives will be interviewed by trained raters, and information will be obtained through close relatives of unavailable relatives. The SCID will be used for establishing psychiatric diagnoses. Familial morbid risk (MR) will be calculated by the Kaplan-Meier method, and Breslow and Mantel-Cox statistics. Log linear models will be also be used. We will also perform multivariate analysis of possible risk factors for development of PTSD after rape, to examine the role of familial anxiety in combination with measures of trauma, and of personality variables (neuroticism, extraversion). The study may have important practical value, since recognition of vulnerability to chronic PTSD after rape will enable counselors to identify those for whom short term rape crisis counseling may be insufficient to achieve recovery. In such people, longer term or specialized treatment may be necessary.
| Connor, K M; Davidson, J R (1997) Familial risk factors in posttraumatic stress disorder. Ann N Y Acad Sci 821:35-51 |
| Davidson, J R; Colket, J T (1997) The eight-item treatment-outcome post-traumatic stress disorder scale: a brief measure to assess treatment outcome in post-traumatic stress disorder. Int Clin Psychopharmacol 12:41-5 |
