Psychological stress reactions of women in Sweden
who have been assaulted: Acute response and
four-month follow-up
Barbro Renck, PhD, RN
Violence is a global health problem. Women in par-
ticular are likely to be targets of violent behavior. This
study investigated the reactions of female victims to
an individual act of interpersonal violence. A sample
of 68 assaulted women registered as injured parties in
2 police districts were assessed for symptoms of acute
stress disorder (ASD) and post-traumatic stress disor-
der (PTSD) at 3 weeks and after 4 months. Risk factors
for developing psychological distress in the long-term
were explored. High rates of ASD symptoms and dis-
tress measured with Post Traumatic Symptom Scale
(PTSS-10), Impact of Event Scale (IES), and General
Health Questionnaire (GHQ-20) were reported by the
women in the acute phase. Four months post-assault,
the high rates of stress reactions measured with PTSS-
10, IES, and GHQ-20 were significantly reduced, but
not for all the women. Dissatisfaction with one’s previ-
ous life, previous mental health problems, post-assault
life events and earlier abuse were risk factors for 4
months post-assault stress reactions.
iolence is a global public health problem1 and
V women of various ages in particular are likely to
be targets of violent behavior. Violence victimiza-
tion commonly results in a wide range of physical and
mental health problems.2,3,4 Men’s violence against
women is considered to be a major public health issue5
as well as a criminal justice problem.6 The victims
suffer physical and mental injury and, at the same time,
the violence has social consequences. Violence against
young women is associated with poorer quality of life,
overall dissatisfaction with life and with friends, and
suicidal ideation and attempts.7
Crimes of violence do not constitute a homogeneous
category. In the World Report on Violence and Health,1
violence is classified into 3 broad categories: self-
Barbro Renck is a Senior lecturer at the Department of Public Health
Sciences, Karlstad University, Karlstad, Sweden
Reprint requests: Dr. Barbro Renck, Division of Social Sciences, Depart-
ment of Public Health Sciences, Karlstad University, SE-651 88 Karls-
tad, Karlstad, Sweden.
E-mail: Barbro.Renck@kau.se
Nurs Outlook 2006;54:312-319.
0029-6554/06/$–see front matter
Copyright © 2006 Mosby, Inc. All rights reserved.
doi:10.1016/j.outlook.2006.03.002
312 V O L U M E 5 4 ● N U M B E R 6 N U R S I N G
directed (suicidal behavior and self-abuse), interper-
sonal (family and intimate partner violence and vio-
lence between individuals who are unrelated) and
collective violence (eg, armed conflicts, genocide, ter-
rorism). The nature of violent acts can be physical,
sexual, or psychological and may involve deprivation or
neglect.
In Sweden, violent acts against women reported to
the police have increased. Reported incidents of assault
in which the victim was a woman who was acquainted
with the perpetrator have increased by about 40% since
the beginning of the 1990s.8 In 2003, a total of 22 393
women reported cases of assault.9 About 75% of the
women knew the perpetrator and about two thirds of the
cases involved violence within an intimate relationship.
In a study of 6 926 Swedish women, Lundgren et al10
established that 30% experienced violence (after their
15th birthday) perpetrated by a stranger or an acquain-
tance outside of an intimate relationship. However, the
propensity to report incidents of victimization in the
context of interview surveys has increased.8
Hartman11 describes the physical, emotional, psy-
chological and behavioral symptoms reported by vic-
tims of violence. McCann, Sakheim and Abrahams-
son12 propose 5 major categories of psychological
consequences: (1) emotional (fear, anxiety, intrusion,
depression, self-esteem disturbances, anger, guilt,
shame), (2) cognitive (perceptual disturbances), (3)
biological (physiological hyperarousal, somatic distur-
bances), (4) behavioral (aggressive and suicidal behav-
ior, substance abuse, impaired social functioning, per-
sonality disorders) and interpersonal (sexuality
problems, relationship problems, revictimization, vic-
tim becomes victimizer). This classification represents a
broader view of post-traumatic reactions than the offi-
cial criteria for post-traumatic stress disorder (PTSD),
according to the Diagnostic and Statistical Manual of
Mental Disorders, 4th edition (DSM-IV).13 The
DSM-IV structure for PTSD symptoms is focus for this
study.
Post-traumatic stress disorder is an anxiety disorder
which has attracted much attention in research and
clinical fields. One of these reasons is that the incidence
of violence has shown a dramatic increase all over the
world.14 Many battered women, in addition to direct
O U T L O O K
Psychological stress reactions
physical injury, suffer from psychological stress such as
PTSD,15–17 anxiety, and depression.18,19 Post-traumatic
stress disorder and depression are the most prevalent
mental health sequelae of intimate-partner violence in
women.20,21 They are more vulnerable to PTSD22,23
than men.24,25
Acute stress disorder (ASD) was established as a
psychiatric diagnosis in DSM-IV in 1994. Observations
of acute stress reactions in different studies26 led to the
diagnosis of ASD. This diagnosis has strong relevance
to psychological stress reactions observed among vic-
tims of interpersonal violence.27 There is evidence that
acute stress reactions can lead to PTSD. Therefore, it is
important to identify individuals with acute stress
symptoms who are at the greatest risk of developing
PTSD. Solomon28 maintains that the ASD diagnosis
will move the field towards effective PTSD prevention.
This article reports stress responses in assaulted
women, focusing in particular on trauma and ASD/
PTSD symptoms. It is important to study both acute
stress symptoms and long-term consequences. If the
victim remains silent about the long-term effects, atten-
tion may not be focused on her need for psychological
support. Greater knowledge of the consequences may
lead to the provision of adequate support as well as
early preventive interventions. Victim support centers
provide help primarily to victims of assault. However,
many women also need emergency services for injuries
or psychiatric services.
Aim of the Study
The aim of this study was to examine the psycho-
logical stress reactions of female victims to an individ-
ual act of interpersonal violence in the short term (after
2–3 weeks) and long term (after 4 months). The
findings from this study will extend our knowledge
about the psychological/emotional consequences of vi-
olence by examining the extent to which the women
reveal symptoms of ASD and PTSD, distress and
general well-being. We were interested in what factors,
in addition to acute stress reactions, predict a victim’s
risk in developing psychological distress in the long
term. Specifically, we considered the significance of the
ability to cope, social support, the women’s previous
life, earlier abuse, and life events after the act of
violence on long-term stress reactions. This article is
part of a larger research program on the situation of
women subjected to interpersonal violence.29
METHOD
Participants
The study group consisted of 68 women who had
been assaulted by a man or woman and, during a
20-month period, registered as injured parties in 2
police districts in a county of central Sweden. The
police system for describing and coding crime was used
to select individuals who might be eligible for recruit-
N O V E M B E R
Renck
ment. That is, women who were the victims of the
following types of assault: (1) aggravated assault (per-
petrator known or unknown to the victim—indoors or
outdoors), and (2) assault (perpetrator known or un-
known to the victim—indoors or outdoors). Assault in
an ongoing relationship and violence between close
family members was excluded. Family violence is
generally not restricted to single occasions and the
purpose of this study was to study the stress reactions to
one single act of interpersonal violence.
Procedures
The Research Ethics Committee at the Regional Hos-
pital in Örebro and the police authority concerned ap-
proved the study. The women were recruited by contact-
ing the police office once a week and going through the
reports to the police (as a researcher I had access to all
information). The police sent a letter containing informa-
tion about the study to the women who were to be
recruited for the study. About 100 letters were sent. The
researcher contacted the women by telephone to get
consent to administer a packet of questionnaires. The
study involved measuring the reactions of the victims on 2
occasions: (1) 2–3 weeks after the assault, and (2) 4
months after the assault. Of the 68 women who responded
to the first questionnaire, 60 (88%) took part in the second
survey. On the first occasion, a questionnaire (Question-
naire I) and 3 self-administered scales (the Post-Traumatic
Stress Scale (PTSS-10), the Impact of Event Scale (IES),
and the General Health Questionnaire (GHQ) were used.
On the second occasion, 4 months after the assault, the
respondents were asked to complete a brief questionnaire
(Questionnaire II) along with the same 3 self-administered
scales as on the first questionnaire. The researcher also
contacted the women by telephone, principally in order to
increase the response rate.
Measures
Questionnaire I included questions about back-
ground conditions, earlier life, features surrounding the
incident, features of the assault, reactions after the
assault, social support and coping strategies. Social
support was assessed by means of 7 questions about
family, close friends, and satisfaction with the current
level of support. Coping was investigated rather sim-
plistically by means of 8 questions. In the brief Ques-
tionnaire II, life events (eg, divorce, loss of job,
abortion) after the assault were investigated. Not all life
events are unpleasant, but because they create change,
they all may be categorized as a form of stressor.30
The Post-Traumatic Stress Scale, developed by
Holen, Sund and Weisaeth,31 and the Impact of Event
Scale, developed in 1979 by Horowitz et al,32 are 2
instruments that have been devised for research pur-
poses. PTSS-10 and IES are designed to record the
presence and intensity of specific post-traumatic stress
symptoms and are suitable for mapping early symptoms
/ D E C E M B E R N U R S I N G O U T L O O K 313
Psychological stress reactions
and reactions after traumatic events. Both instruments
have shown good psychometric characteristics, with
Chronbach’s ␣ of ⬎ .81 and a 4-month test/retest
reliability of ⬎ .52.33
Developed for identifying people at risk of develop-
ing post-traumatic stress reactions, PTSS-10 is a self-
report 10-item scale with yes/no options.31 A “yes”
response is coded as 1 and a “no” response as 0 (range
0 –10). The PTSS-10 scale is suitable as a complement
to clinical assessment.34 The Cronbach’s ␣ for the
current sample was .70 (1st assessment) and .72 (2nd
assessment).
The Impact of Event Scale, one of the most widely
used self-report scales of the impact of traumatic
events,35 is a 15-item questionnaire with 2 subscales:
intrusive phenomena and avoidant phenomena as re-
sponse to traumatic stress.32 The first subscale measures
the tendency to persistently re-experience the traumatic
event (intrusion, 7 items) and the second subscale
measures persistent avoidance of stimuli associated
with the trauma (avoidance, 8 items). The IES was
introduced prior to the inclusion of the formal category
of PTSD in the DSM-III and later DSM-IV.13 The IES
includes 4 options for each item (0 ⫽ not at all, 1 ⫽
rarely, 3 ⫽ sometimes, 5 ⫽ often). A subscale score of
0 – 8 indicates minor reactions, 9 –19 indicates moderate
reactions, and a score of ⱖ 20 signifies reactions of
clinical importance.36 The Cronbach’s ␣ for the current
sample was .88 and .92 for intrusive thoughts and .78
and .82 for avoidance.
General Health Questionnaire consists of 20 items
with responses over a 4-point scale, which range from
“less than usual” to “much more than usual.” The GHQ
is widely used for measuring subjective well-being and
psychological distress.37 The 20-item version (GHQ-
20), which has been used in traumatic stress studies in
Norway,38,39 was chosen. This scale includes both
positively phrased items (agreement with which indi-
cates psychological health), and negatively phrased
items (agreement with which indicates psychological
distress).40 In the present study, the GHQ scoring
method 0-0-1-1 was applied to identify “cases” and
Likert scoring 0-1-2-3 to assess level of distress.
Threshold scores are defined as equivalent to the
concept of “cases” that corresponds to the average
patient referred to psychiatrists.41 A threshold score/
cut-off point between 4 and 5 was applied, as suggested
by Dahl.42 Many validity studies have been conducted
of the GHQ.37 The Cronbach’s ␣ coefficient for the
current sample was .90 and .95.
Data Analyses
In this study, the scores on the PTSS-10 scale were
distributed on 2 levels: ⱕ4 and ⬎ 4.
The Cronbach’s ␣ was computed to analyze the
internal consistency reliability of all measures. In order
to determine whether the difference between the ranks
314 V O L U M E 5 4 ● N U M B E R 6 N U R S I N G
Renck
of scores of the scales on the 2 occasions was statisti-
cally significant, the 2-sided Wilcoxon Matched Pairs
Signed—Ranks Test was applied. Fisher’s Exact Test
was employed to control bivariate relations. Multiple
linear regression analyses were used to construct the
predictive indices, which were based on selected pre-
dictors. The statistical software used was Statistical
Package for Social Sciences (SPSS) for Windows.
FINDINGS
Five of the 68 women had been subjected to aggravated
assault and 63 to assault. Fifty-five (81%) of the victims
had been assaulted by a man. In 33 cases, the women
knew the perpetrator and, for 10 of these women, the
perpetrator was an earlier partner. Five women were of
foreign nationality. The participants’ average age was
31.2 years (SD ⫽ 13.1). Most were single (52%),
married/cohabiting (27%) and had no children (67%).
Most had compulsory school (56%) and upper second-
ary school (36%).
Features of the Assault
The assault occurred as follows: 27 outdoors/in a
public place, 15 in a restaurant, café or discotheque, 9
in the victim’s own home, 8 in someone else’s home
and 9 in another place (not listed). In 38 instances, the
perpetrator was under the influence of alcohol or other
drugs.
Descriptive Statistics
Fifty-five women (83 %) were satisfied with their life
before the assault even though 9 (13%) of them had
previously been subjected to sexual assault and 17
(25%) to physical assault. Their previous physical and
mental health varied: 9 (13%) indicated that they had
been treated by a doctor for a fairly serious or serious
illness, 7 (10%) that they had suffered from serious
mental disorder, 3 (4.5%) that they had suffered from
mental disorder during the last 6 months, and 2 (3%)
that they had extensive substance abuse problems. In
regards to physical health, 44 (66%) said it had been
good, 18 (27%) average, and 5 (7%) poor during the
last 12 months. Forty-one (61%) said their mental
health had been good, 18 (27%) average and 8 (12%)
poor during the same period.
The Initial Reactions
The first self-reported emotional reactions which the
women experienced in connection with the assault were
shock in 39 cases (57%), fear/anxiety in 28 (41%),
irritation/anger in 21 (31%), worry in 14 (21%), and
surprise in 13 (19%). Table 1 describes the extent to
which the victims experienced death threats, helpless-
ness, disappointment, and humiliation. Humiliation was
the most common feeling in connection with the as-
sault. Helplessness and disappointment were also com-
mon feelings. Sixty of the women (88 %) suffered
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Psychological stress reactions Renck

Table 1. Self-reported Experiences of Death Threats, Helplessness,

Disappointment, and Humiliation in Connection with the Assault
(n ⫽ 66 – 68)
Death Threats Helplessness Disappointment Humiliation

No % No % No % No %

Low 14 21 16 24 8 12 14 21
Moderate 2 3 3 5 4 6 7 10
High 10 15 38 56 40 61 42 62
None 41 61 10 15 14 21 5 7
Total 67 100 67 100 66 100 68 100

Table 2. Distribution of IES Sub-scale (intrusion and avoidance) and

PTSS-10 Scores at Different Levels of Distress in the Acute Phase and 4
Months Post-assault
Acute Phase 4 Months P-
Levels of Distress No (%) No (%) Value

n ⫽ 67 n ⫽ 60
Intrusion (range 0–35) sub-scale score
Low (0–8) 12 (18) 24 (40)
Medium (9–19) 22 (33) 19 (32) P ⬍ .01*
High (⬎19) 33 (49) 17 (28)
Avoidance (range 0–40) sub-scale score
Low (0–8) 15 (22) 18 (30)
Medium (9–19) 32 (48) 22 (37) n.s.*
High (⬎19) 20 (30) 20 (33)
PTSS-10 (range 0–10) score n ⫽ 68 n ⫽ 60
0–4 30 (44) 41 (68) P ⬍ .01*
5–10 38 (56) 19 (32)

*The differences between the scores in the acute phase and at 4 months is significant for intrusion IES (P ⬍ .01) and PTSS-10
(P ⬍ .01) using Wilcoxon 2-tailed test.

physical injury, but only 43 women were forced to seek
medical treatment.
Reactions During the First Two Weeks
Fear/anxiety were the most common reactions (45
cases, 66%) during the first 2 weeks after the assault.
Seventeen of the women (25%) experienced the
assault as an unreal event, and 16 (24%) said they
were emotionally unstable. Six (9%) women had
feelings of guilt and 2 (3%) feelings of shame. Most
of the victims thought about the assault afterwards
(49 cases, 72%), many thought about the conse-
quences for the future (23 cases, 34%), and 20 (29%)
reflected on how they could have acted differently.
The most common physical symptoms during the first
2 weeks were headaches (28 cases, 41%) and mus-
cular tension/pain (26 cases, 38%).
Changes in Psychological Reactions
Between the Acute Phase and 4 Months
Post-Assault
There are significant differences between the scores
in acute phase and at 4 months for PTSS-10, IES
intrusion and GHQ-20. According to the PTSS-10 scale
(distributed in 2 levels: ⱕ 4 and ⬎ 4) the number of
women with a high level (⬎ 4) of psychological distress
decreased quite considerably from 38 (56%) to 19
(32%) during the first 4 months after the assault (P ⬍
.001) (See Table 2). A change in the mean values
during the same period shows the general tendency, a
decrease from 4.6 to 3.5.
The mean intrusion score on the IES scale decreased
quite considerably during the first 4 months after the
assault from 18.9 (SD 10.5) to 13.9 (SD 10.1) and the
mean avoidance score showed a slight decrease from
16.0 (SD 9.3) to 15.6 (SD 9.9). The distribution at

N O V E M B E R / D E C E M B E R N U R S I N G O U T L O O K 315
Psychological stress reactions
Table 3. General Health Questionnaire Score in the Acute Phase and 4
Months Post-assault
GHQ Score Acute Phase
Range 0–20 No (%)
n ⫽ 67
0–4 23 (34)
5–20 44 (66)
Mean score (SD) 9.3 (7.5)
*The difference between the scores in the acute phase and at 4 months is significant (P ⬍ .001), using Wilcoxon 2-tailed test.
different levels of distress is given in Table 2. Many
more women were at a higher level on the intrusion
sub-scale than on the avoidance sub-scale at the first
measurement, but more women had lower scores on the
intrusion scale at the second measurement.
The level of psychological distress, measured by
GHQ-20, was much lower at 4 months post-assault than
in the acute phase. The change in mean scores demon-
strates the general tendency; the mean score and SD
was 9.3 (7.5) in the acute phase and 6.2 (6.6) at 4
months post-assault. The number of “cases” (GHQ
score ⬎ 4) was 44 (66%) in the acute phase and 29
(48%) at 4 months post-assault (See Table 3). The
difference between number of cases in the acute phase
and after 4 months is significant (P ⬍ .001).
Predictors of Post-Traumatic Stress Symptoms,
Wellbeing, and Psychological Distress
The scores on the 2 scales PTSS-10 and GHQ-20 at
4 months post-assault were analyzed in relation to
various independent variables in bivariate analyses.
There was a relation between a high score on both
GHQ-20 and PTSS-10 and dissatisfaction with one’s
previous life (r (58) ⫽ 0.28, P ⬍ .05; r (58) ⫽ 0.31, ⬍
0.05). A higher proportion of women with post-assault
life events than those without reacted with psycholog-
ical distress (r (59) ⫽ 0.47, P ⬍ .001) and post-
traumatic stress symptoms (r (59) ⫽ 0.34, P ⬍ .01). A
significant relation between high GHQ-20/PTSS-10
scores and having felt the need for help and support
during the 4-month period after the assault was ob-
served (r (57) ⫽ 0.34, P ⬍ .01; r (57) ⫽ 0.44, P ⬍
.001). A higher proportion of women with poor coping
strategies than those with good coping reacted with
post-traumatic stress symptoms (r (57) ⫽ 0.36, P ⬍
.05).
Further investigations of the relationships between
demographic variables, risk factors and PTSS-10 and
GHQ-20 at 4 months post-assault were performed using
multiple regression analyses. In the first step, marital
and parental status, dissatisfaction with one’s previous
life, earlier mental health problems, earlier abuse,
coping strategies, social support and post-assault life
316 V O L U M E 5 4 ● N U M B E R 6 N U R S I N G
Renck
4 Months
No (%) P-Value
n ⫽ 60
31 (52) P ⬍ .001*
29 (48)
6.2 (6.6)
events were forced into the analyses. The 2 dependent
variables (PTSS-10 and GHQ-20) were treated as con-
tinuous. In the second step, using PTSS-10 and GHQ-
20, variables which were statistically significant or
nearly so were entered in further multiple regression
analyses. Dissatisfaction with one’s previous life, ear-
lier mental health problems, and post-assault life events
accounted for 21% of the variation in GHQ-20 scores
(R2 ⫽ 0.210, P ⬍ .01). Earlier abuse, dissatisfaction
with one’s previous life, and post-assault life events
accounted for 19% of the variation in PTSS-10 scores
(R2 ⫽ 0.190, P ⬍ .05).
Finally, to control for the influence of acute stress
symptoms on post-traumatic stress symptoms 4 months
post-assault, multiple regression analyses with
PTSS-10 scores and IES scores were performed. Post-
traumatic stress symptoms in the acute phase accounted
for 44.9% (PTSS-10: R2 ⫽ 0.449, P ⬍ .001) and 48.9%
(IES: R2 ⫽ 0.489, P ⬍ .001) of the scores at 4 months
post-assault.
DISCUSSION
In the current study, the sample of assaulted women
included those who experienced violence by a stranger,
an acquaintance or an ex-partner. The aim of the study
was to examine the reactions of female victims of a
single act of violence over a 4-month period after the
assault. Furthermore, the intention was also to identify
risk factors for developing psychological distress in the
long term. High rates of acute stress symptoms mea-
sured with PTSS-10 and IES were reported by the
women in the acute phase. Also the level of distress
experienced by the women was high according to
GHQ-20.
Most of the psychological recovery takes place
during the first 3 months.22 However, in a meta-analysis
of 11 studies, Golding20 found 31%– 84.4% of battered
women met criteria for PTSD. Women are at a signif-
icantly increased risk of PTSD following exposure to
serious trauma.17 In this study, the changes in psycho-
logical reactions between the acute phase and 4 months
post-assault were obvious. In the acute phase, measured
by means of PTSS-10, 56% of the women showed a
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Psychological stress reactions
high level of acute stress symptoms which decreased to
32% after 4 months. Women with possible PTSD
measured with IES were also reduced. Intrusive anxiety
was reduced to about the same level as post-traumatic
stress although a substantial number of the women
continued to suffer a high level of avoidance symptoms.
Breslau et al43 found in a study of assault violence that
women were more likely to develop avoidance and
numbing symptoms than men.
The number of cases of women in this study expe-
riencing psychological distress decreased from 66% to
48%. However, this suggests that half of the assaulted
women are still suffering distress 4 months post-assault.
It is fairly clear from research findings that abuse of or
assaults against women occurring anytime during their
life span can have long-term negative consequences for
health and well-being.44,45 Consequently, it is impor-
tant to start early intervention with psychological sup-
port to prevent long-term resulting effects.
The most dissignificant predictors of 4 months post-
assault stress reactions were satisfaction with one’s
previous life, previous mental health problems, earlier
abuse, and post-assault life events. Life events have
been described as occurrences in people’s lives which
require some form of change and adaptation.46 Not all
life events are unpleasant and create life-event stress,
but the fact that there is a change in connection with all
life events may be categorized as a form of stressor.
However, negative life events such as divorce or death
in the family may be perceived as most stressful and
were, in this sample, a risk factor for developing
post-assault stress reactions.
In this sample, 18 women had been previously
abused— one of the predictors. There is evidence that
the effects of repeated traumatic experiences are cumu-
lative.47 Three women with earlier abuse have a higher
level of stress reactions after 4 months than in the acute
phase. However, a small number of women not earlier
abused have the same development. Other important
predictors of psychological stress were previous mental
health problems and dissatisfaction with one’s previous
life. The mental health status for women in the study
group was important for how they were able to handle
the violent experiences. Both mental health problems
and dissatisfaction with one’s previous life was a risk
factor for psychological stress. Dissatisfaction with
one’s previous life was also a risk factor for post-
traumatic stress symptoms. One might also speculate
whether mental health problems might be a risk factor
for exposure to violence. Do women who are dissatis-
fied with their previous life behave in such a way that
they are more exposed to violence than other women?
A modest correlation (r ⫽ .33, P ⬍ .01) between
dissatisfaction with previous life and earlier abuse
partly support this assumption.
N O V E M B E R
Renck
There are some limitations to the study. First, there
are limitations to the generalizability of the findings.
The women in the sample were taken from a police
register of reported assaulted women designated as
injured parties in 2 police districts. The choice to report
is up to the women themselves. Therefore, the results
are not generalizable to abused women in general. A
further limitation is that no clinical interview for PTSD
was done. However, there is reasonably good corre-
spondence between PTSD diagnoses made by clinicians
and those based on self-report scales.48 Finally, the
extent and severity of the assault probably have an
impact on the stress reactions. The police system for
coding crime in only 2 types of assault is not sufficient.
A more precise specification was to prefer. It may be
noted that the findings are strengthened by the early
assessment of acute stress reactions and the high fol-
low-up rate after 4 months. Another strength is the
internal reliability of GHQ-20 and IES, which was
excellent in both assessments. For PTSS-10 the internal
reliability was adequate.
Implications
The results of this study indicate a high prevalence of
ASD symptoms among assaulted women and a fairly
high prevalence of post-assault PTSD symptoms. The
findings have implications for public health and inter-
ventions directed toward women who have experienced
violence and abuse. These findings also contribute to
our understanding of the importance of early interven-
tion to prevent longer-term PTSD. Solomon28 points
out that the need for effective early interventions in
acute trauma response is immense. The findings of the
present study, especially the identified risk factors, are
of particular interest for the non-profit sector. In Swe-
den, a number of non-governmental organizations offer
victim support (eg, women’s refuges and victim support
centers). When a crime is reported to the police, the
victim will be informed about the crime victim support
center. If a woman wishes to be referred, she will be
contacted by the victim support center. Certain centers
have started self-help groups for abused women as a
complement to traditional care and treatment. However,
health care providers are also a valuable resource for
early identification, intervention and treatment of high-
risk women. When need arises for early and more
intensive intervention (eg, classical crisis intervention
and brief psychotherapy), the victim support center acts
as an intermediary to health care. In order to improve
the support to abused women, the PTSS-10 scale may
help the clinicians to detect victims requiring interven-
tion. The implications from this pilot study can be used
in further education for psychiatric teams. Future re-
search should include a larger sample of women to
improve the generalizability of results. There is also
/ D E C E M B E R N U R S I N G O U T L O O K 317
Psychological stress reactions
need for more studies with a longitudinal design with
follow-up in 1 and 2 years after. The effect of early
intervention for abused women will be evaluated in a
forthcoming study.
This study was supported by The Crime Victim Compensation and
Support Authority in Umeå, Sweden.
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