Scand J Prim Health Care IW3; I I : 8-I4

Who consults for rape? Sociodemographic characteristics of rape victim attending a medical rape trauma service at the Emergency Hospital in Oslo. Lisbeth Bang

Scand J Prim Health Care Downloaded from informahealthcare.com by 46.4.71.3 on 05/20/14 For personal use only.

Department of General Medicine, Emergency Hospital, Oslo, Norway

Bang L. Who consults for rape? Soeiodemographiccharacteristicsof rape victims attending a medical rape trauma service at the Emergency Hospital in Oslo. Scand J Prim Health Care 1993; 11: 8-14. Abstract. Objective - To consider the number of victims of rape and attempted rape in a city (Oslo) who sought treatment when m e d i i help had been made availnhk. To examine the sociodemographic characteristics of the patient group that applied for help. Design - Prospective study. Sefting A rape trauma service (RTS) established at the Emergency Hospital in Oslo. The service is free, open around the dock, and independent of police notification. Partic@itunk All patients attending RTS from 1 January to 31 December. Res& 164 women and four men applied for medical treatment in 1987, four times as many as in 1985, before RTS was started. Their ages varied between 14 and 89 years, with a median of 27 years. Women aged 1&39 yeam were significantly over-represented in relation to the general female population of Oslo. Married women were significantly under-represented among the female patients, both married women raped by their spouses and married women raped by other men. 45 patients stated that they had been sexually assaulted on a previous occasion without reporting the incident or applying for help. Concluswn Compared with the police an available medical service for rape victims reached four times as many rape victims as in 1%, from a larger share of the population.

-

-

-

-

Key words: rape victim, medical services for rape trauma,sociodemographic data, tendency to seek help. Lisbeth Bang, MD, Department of General Mediane, Emergency Hospital, Oslo, Norway.

Introduction Rape trauma was first acknowledged internationally as a medical issue because of its impact on health in the late sixties and early seventies (1.2). Surveys (3, 4) and studies of victims of rape and sexual assault (2, 5-7) provide ample documentation to establish an association between rape trauma and higher levels of mental disorders, various chronic symptoms of somatic illness, and certain gynaecological disturbances. The after-effects of rape have recently been recognized under the diagnosis “post traumatic stress disorder” in the diagnosis list DSM I11 (Diagnostic and statistical manual of mental disorders). S c u d I Prim Healrli Care 1993: I1

Medical and psycho-social emergency care and follow-up should be provided for rape victims in order to prevent and diminish the development of trauma (1, 2, 6 , 7). Before 1986, a rape victim was not accepted by the emergency department of any somatic hospital in Scandinavia unless visibly injured by bruises and cuts that needed medical treatment. The public authorities regarded rape as a matter exclusively for criminal jurisdiction. In Norway in 1985 Oslo Municipal Board of Health was the first public health authority to consider the impact of rape on health ( 8 ) . At present, rape is not defined or explained in international systems of classification. ICD-9 (In-

Who consults for rape? patienis 180-

I60 .. 14?

found a prevalence of 14% for marital rape and of 19% for non-marital rape; the annual incidence rate of rape was estimated to be three per cent. A similar rate of prevalence was found in a survey conducted in London (lo). Until the Rape Trauma Service (RTS) opened in Oslo in January 1986 the Norwegian procedures for medical examination of rape victims were based exclusively on police requirements for securing evidence. According to the statistics from the Oslo police for the period 196+1985, only one third to half of the rape victims were actually examined medically. The purpose of RTS is to make medical and psycho-social treamenf available in a way that meets the needs of each patient, and to encourage rape victims to seek help immediately after the assault. RTS is open round the clock. All treatment is optional, and the patient chooses whatever suits her, or him, best. In contrast to the rest of the ordinary health services, the treatment is free. This also applies to all follow-up consultations and treatment. Persons subjected to rape are classified as needing immediate help. The emergency part of the RTS is based at the emergency treatment hospital, Oslo Kommunale Legevakt (OKL). OKL receives patients with acute health and social problems and serves the population of Oslo and people visiting Oslo. The Oslo Board of Health established the RTS so that patients aged 14 years or older are treated at OKL; and patients younger than 14 years are treated at the Department of Pediatrics at Aker hospital in Oslo. RTS provides psycho-social follow-up in collaboration with oupatient clinics in Oslo. During the first year of service 141 patients applied for help and the annual number of adult rape patients who received medical treatment increased more than fourfold from 1985, the year before the service started, to 1987 (Fig. 1). The larger number of adult rape patients who receive medical treatment is thought to be a result of medical services being made available without having to inform the police. The purpose of this study was to consider the number of victims of rape and attempted rape in a city (Oslo) who sought treatment when medical help had been made available. A second objective was to examine the sociodemographic characteristics of the patient group that applied for help. Another aim was the need, in future, to direct the information about the service at specific groups of the population.

n

..

1985 1986

1987

WFwGca

c6bm

Mil. Mlmsn(

F;g. I . Number of rape cases in Oslo before and after the start of RTS in January 1986. Scand J Prim Health Care Downloaded from informahealthcare.com by 46.4.71.3 on 05/20/14 For personal use only.

9

ternational classification of diseases) classifies rape under code E used for supplementary classification of external causes of injury purposely inflicted by other persons: E 960 Fight, brawl, rape. ICPC (International classification of primary care) classifies rape under code X 82 as an injury to the female genital system. Rape is a specific legal term to be used only in a higher court sitting with a jury. Norwegian, Swedish and Danish law define rape as forced penetration (vaginal, rectal o r oral) by one or more other persons without the consent of the victim. The term rape is generally used in the media to describe an act during which a woman is assaulted and forced to subject to vaginal penetration by a stranger. No popular or professional terminology has been developed to describe the act when the offender is wellknown to the victim. Historically, most assaults have remained unreported. The surveys referred to in this article use the terms rape, sexual assault, and sexual abuse. The term rape covers the acts referred to in the legal definition of rape; the term sexual assault covers a wider range of acts: those included in the legal definition of rape, acts of indecent assault, for example, forced masturbation and genital touching, and acts of gross indecency, for example, indecent exposure andor indecent use of pornographic pictures, etc. In a Norwegian survey the term sexual abuse was used to focus on situations involving a close relationship between victim and offender; while the acts committed by the offender complied with the legal definition of rape. Little knowledge has been acquired in Scandinavia on the prevalence and annual incidence of rape to adults. Schei (4) found a prevalence figure of 10% for marital sexual abuse and of five per cent for nonmarital sexual abuse. A Californian survey (9)

Scund I Prim Heulrh Cure IW3: 11

L. Bang

10

-

Table I. Age an actual and expected profile of female patients according to the proportion of women in each age group recorded in the Oslo Census 1989.

Scand J Prim Health Care Downloaded from informahealthcare.com by 46.4.71.3 on 05/20/14 For personal use only.

Age (years)

Observed number of patients

Expected number of patients

N

N (”/.I

(Yo)

10 (6)

14-19 20-29 30-39 > 40

34(21) 71 (43) 44 (27) 15 (9)

28 (17) 92 (56)

Total

164 (100)

164 (100)

34 (21)

68

:::,”:” .. 3Q.Qx

P 5 -4.

PC.ooo01 pc.oooO1 P