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Introduction: Critical incidents in ambulance work are not easily compared to other risk occupations. Understanding types of incidents that can be considered critical in operational ambulance work is important to prevent work-related post-traumatic stress (PTS).Aim: This study aimed to develop a scale of critical incidents in ambulance work and assess its predictive validity in relation to the severity of PTS symptoms.Methods: A total of 1092 open-ended descriptions from Danish ambulance personnel were content analysed to develop a categorical scale that identifies types of events perceived as critical to operative ambulance personnel. Multiple regression was used to assess whether the scale predicted PTS symptoms and to assess the cumulative effect of exposure to these events.Results: The study found that the 1092 descriptions of critical events could be condensed into 28 categories of critical events. These ranged from life-threatening situations and deaths, to more daily events such as handling strong emotional reactions from patients’ relatives and working with terminally ill children. The frequency of events significantly predicted the severity of PTS symptoms with low to moderate effect (std beta = 0.2, t(375) = 3.7, p < .001), even when adjusting for known risk factors for post-traumatic stress disorder.Conclusion: This study showed that critical events in ambulance work included events that are not normally considered traumatic, and indicated that understanding the cumulative effect of these events is important when trying to prevent traumatic sequalae in ambulance personnel. The study highlighted the importance of increased focus on non-traumatic incidents that have an ongoing impact on paramedics’ mental health and well-being. The Critical Incidents Scale for Ambulance Work ‐ Denmark (CISAW-D) is a promising tool for systematic screening for exposure to critical events in ambulance work.

Police officers are frequently exposed to critical and potentially traumatic incidents in their work. Exposure to critical incidents (CI) in policing is associated with an increased risk of developing mental health problems, in particular post-traumatic stress disorder. However, the definitions and understandings of police-specific CI vary extensively. The present qualitative study aimed to enhance our understanding of the core characteristics of work-related CI that are perceived as most burdensome among Danish police officers. Using content analysis, this study coded 2960 descriptions of work-related incidents that still cause emotional reactions among 1659 Danish police officers. The content analysis resulted in the development of three main categories of CI (danger or threat, accidents, and deaths and distressing crimes) which could be conceptualized in a diversity of 28 CI categories. Hereof, the main part consisted of common and more routine police tasks of a tragic or distressing nature, e.g., traffic accidents, handling cases of severe violence, suicide, homicide, child neglect and abuse, and making death notifications. Compared to a similar Danish study conducted three decades ago, the experiences of CI appear to have a continuing and general quality over time. The CI categories are further comparable to police-specific trauma event categories identified in other countries. The findings highlight the importance of recognizing routine police assignments as potentially distressing and emotionally burdensome, and they underline the importance of focusing prevention initiatives on the accumulation of psychological strain in police work due to various CI experienced over time.

IntroductionPolice officers are frequently exposed to potentially traumatic events at work that increases risk of developing mental health problems, in particular post-traumatic stress disorder (PTSD). Individual and organisational factors may influence the detrimental effects of cumulative exposure to traumatic events. Occupational stress and lack of organisational support are associated with increased risk of PTSD among police officers. The Are You All right? (AYA) project is a prospective cohort study investigating the cumulative effect of traumatic events at work on mental health problems and absenteeism among police officers. The study also investigates whether potential risk and protective factors modify the association of traumatic events at work with mental health problems and absenteeism.Method and analysisThe AYA-study includes the entire Danish police force. Prospective survey data are collected over a 3-year period beginning in the spring of 2021. Electronic surveys are sent out at baseline with 1-year, 2-year and 3-year follow-up. Further, short surveys are sent out every third month, covering exposure to traumatic events and current mental health status. The survey data are paired with workplace register data on sickness absence. Register data on sickness absence cover the period from 2020 to 2025.Ethics and disseminationThis study was presented for evaluation at the National Ethics Committee in Denmark (reference number: 20202000-216), but according to Danish legislation, survey studies do not require approval by official Danish scientific or ethical committees. Participation in the project is based on informed consent, and data are handled in accordance with the Danish data legislation (journal number: 20/41457). Results are published in scientific journals and disseminated at international conferences.

According to police records, many rape cases are closed because victims withdraw from the police investigation. However, little is known about the causes of victim withdrawal, and findings need to ...

Although research indicates that specialized sexual assault (SA) services are effective in terms of promoting postassault recovery and improving legal outcomes, little is known about how to best support survivors facing co-occurring difficulties and inequalities (e.g., preexisting mental health issues, substance abuse, poverty). This deficiency in knowledge was also expressed by service providers at Danish SA centers (SACs), who described this using the term “vulnerable survivors.” Therefore, the present study aims to address this knowledge gap by exploring (a) how service providers understand vulnerability in the context of SA and (b) how service provision is currently approached for these survivors. Interviews were conducted with 18 service providers representing five professional groups (psychologists, social workers, forensic doctors, nurses, police) and analyzed using Interpretative Phenomenological Analysis. A total of eight themes emerged from the analysis, including service providers’ descriptions of what characterizes vulnerability in survivors and broader perspectives on service provision for these survivors. Survivors considered least likely to attain desired supports were also those perceived to be most vulnerable with regards to risk and experiences surrounding sexual victimization (e.g., individuals with preexisting mental health issues). Service providers also believed that a large proportion of those served experience ongoing vulnerabilities that are difficult to manage within existing support models. The results thus suggest that survivors’ needs cannot be met if vulnerabilities are overlooked or ignored. At the same time, the concept of vulnerability warrants caution since vulnerabilities are often placed within individual survivors, but the formal support system also appears vulnerable in its ability to meet the diverse needs and priorities of those served. The implications for SA services across the globe are discussed, including a need for more individually tailored and trauma-informed responses to SA that simultaneously address co-occurring difficulties and inequalities in survivors.

Background: Despite knowledge about the extensive and often long-lasting consequences of sexual assault, many survivors remain underserved by formal support systems (e.g. medical, mental health and criminal justice systems). Reasons for underutilizing services are as diverse as the survivors themselves, and little is known about which survivors are most underserved and why they are underserved. Objective: To help organize existing findings on this topic, a systematic scoping review was conducted to identify adult survivors of sexual assault, who may be particularly underserved when attempting to obtain services in Western countries. Method: Five databases (PsycINFO, Embase, MEDLINE, Scopus and CINAHL) were systematically searched for studies published in English from 2000 onwards using terms such as ‘sexual assault’, ‘help seeking’, ‘formal support’, ‘barriers’ and variations thereof. Results: A total of 41 studies were included in the present scoping review, resulting in seven main categories of underserved survivors: Ethnic and cultural minorities, Disabilities, Financial vulnerability, Sexual and gender minorities, Mental health conditions, Problematic substance use, and Older age. Barriers encountered by survivors with these characteristics included limited access to formal supports and insufficient training and awareness among service providers about how to best support survivors. Conclusions: Recommendations include the need for more survivor-centred, culturally appropriate and trauma-informed services and more attention to survivors belonging to underserved groups in policy, practice and research., HIGHLIGHTS • We found: Survivors of sexual assault from historically marginalized groups face numerous barriers to service utilization. • This means: A more survivor-centered, culturally appropriate and trauma-informed approach to sexual assault service delivery is needed.

BACKGROUND Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. OBJECTIVE The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV. METHODS We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses. RESULTS A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD –0.01; 95% CI –0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI –0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI –0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI –0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD –0.13; 95% CI –0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD –0.11; 95% CI –1.04 to 0.82; I2=0%; 5 trials, 1267 women). CONCLUSIONS There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124

This study examined level of acute psychological distress and perceived social support in 64 victims of rape and the association with police case decisions and victims’ willingness to participate in the investigation. The results of independent-sample t tests revealed that victims’ unwillingness to participate in the investigation was significantly associated with a higher level of psychological distress in the acute phase following the assault. The results suggest that victims of rape who disengage with the police investigation may do so because of a high level of acute psychological distress. Clinical implications are discussed.

This study examined intimate partner stalking experienced by 196 mothers stalked by the father of their children. Respondents completed a questionnaire concerning experiences of stalking and level of support by the authorities. Results revealed higher rates of harassing than violent stalking. In many cases, the children were also targeted by the stalking. Encounters with several agencies were common, but respondents were often not recognized as victims of stalking and demoralized by extensive case proceedings. This study calls for a special sensitivity of professionals encountering stalked parents in their work and highlights a need for coordination and cooperation among multiple agencies.

Research shows that the majority of reported rapes is never continued for prosecution but is closed during the police investigation. Studies suggest that rape assaults corresponding to stereotypes about “the real rape” and “the good victim” have a higher likelihood of continuing for prosecution. The aim of the present study was to investigate, if selected characteristics of rape stereotypes influenced investigational outcomes within a Danish police district participating in a multidisciplinary rape response team. The study was based on all reported rapes or rape attempts within a Danish police district over a three-year period (n = 248). Logistic regression analysis was used to investigate, if selected assault and victim characteristics influenced the likelihood of case continuing for prosecution. The following four prominent characteristics of rape stereotypes were selected for investigation: stranger perpetrator, no victim intoxication during the assault, presence of victim resistance and victim physical injuries, respectively. Results indicated that prominent characteristics of rape stereotypes significantly influenced whether the case was continued for prosecution. However, the independent effects of the investigated characteristics were not distinctively supportive of an investigative bias toward rape stereotypes. Even so, no victim intoxication during the assault and more physical injuries were found to increase the likelihood of case continuing for prosecution in this sample of reported rapes. Results are discussed in relation to the possible influence of a coordinated multidisciplinary rape response approach that characterized this sample.

In a sample of female victims of sexual assault (n = 122) this study examined the possibility of a positive or negative change in outlook on life 3 and 12 months following the assault and associations to posttraumatic stress disorder (PTSD). The majority of women reported a negative change or no change in outlook on life following the sexual assault. The group of women who reported a negative outlook on life 3 months following the sexual assault had a significant higher level of PTSD severity 12 months following the assault. More research is needed to enhance our understanding of the causal relationship between life changes and psychological distress following sexual assaults.

Eating disorders (EDs) comprise a variety of symptoms and have a profound impact on everyday life. They are associated with high morbidity and mortality. The objective of this study was to analyse published data on health-related quality of life (HRQoL) in EDs so as to compare the results to general population norm data and to investigate potential differences between ED diagnostic groups. A systematic review of the current literature was conducted using a keyword-based search in PubMed and PsychInfo. The search covered anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) and used the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a measure of HRQoL. Of the 102 citations identified, 85 abstracts were reviewed and seven studies were included in the meta-analysis. AN patients were included in five studies (n=227), BN in four studies (n=216), EDNOS in two studies (n=166) and BED in four studies (n=148). We tested for between-study variation and significant differences between the diagnostic groups. The results confirmed a significantly lower level of HRQoL in all EDs compared to a population mean. It was not possible to establish any differences between the diagnostic groups.

This study investigated attrition in reported rape crimes in the earlier processing phases, including decisions by the police and the prosecution regarding case closure. Furthermore, this study examined potential differences in attrition patterns and legal decisions regarding case closure between a group of victims in contact with a specialized multidisciplinary treatment unit for rape victims compared to a group of victims not in contact with this unit. The study was conducted as a case-file analysis of all rape cases reported to a regional Danish police department (n=282) over a three-year period. Most cases were closed in the initial processing phases, with the police closing 61.7 % of the cases and the prosecution closing 53.7 % of the cases referred by the police. Insufficient evidence and the victim’s unwillingness to participate in the investigation were important factors for attrition. We found no significant differences in attrition patterns or legal reasons regarding case closure between the group of victims who had been in contact with the specialized multidisciplinary treatment unit for rape victims and those who had not. More research is needed to explore effects of specialized multidisciplinary treatment units for rape victims on the legal process following a rape crime.

Background : Research has documented severe mental health problems in female victims of intimate partner violence (IPV). Therefore, providing effective treatment is pivotal. Few studies have investigated the effects of intervention programs on reducing the harmful consequences of IPV. Objective : The present study examined the effects of a specific three-phase intervention program for female victims of IPV on psychological symptoms (PTSD, anxiety, and depression) and perceived social support. Given that many of the women dropped out before and during the intervention program, potential differences in initial levels of psychological symptoms, perceived social support, as well as descriptive variables were explored between the women who completed the whole program and the groups of women who dropped out prematurely. Method : The initial sample consisted of 212 female victims of IPV. Symptoms of PTSD, depression, anxiety, and level of perceived social support were measured with validated scales before the start of the intervention and after completion of each treatment phase. Results : Results showed a significant effect of the intervention program on reducing psychological symptoms and increasing levels of perceived social support. Effect sizes ranged from medium to very high. Significant positive effects were found for each of the treatment phases. There were no significant differences between the women who completed the whole program and those women who dropped out prematurely in terms of initial level of symptoms and perceived social support as well as descriptive characteristics. Conclusions : Specifically developed intervention programs for female victims of IPV are effective in reducing the harmful personal consequences of IPV. Future studies should consider employing controlled study designs and address the issue of high drop out rates found in intervention studies. Keywords: Intimate partner violence; domestic violence; psychological treatment; psychological support; social support; mental health consequences; posttraumatic stress disorder; depression; anxiety Responsible Editor: Sheila Sprague, McMaster University, Canada. This paper is part of the Special Issue: Intimate partner violence and mental health . More papers from this issue can be found at http://www.eurojnlofpsychotraumatol.net (Published: 12 September 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 24797 - http://dx.doi.org/10.3402/ejpt.v5.24797