DOJ-OGR-00005949.jpg

Case 1:20-cr-00330-PAE family structure was complete, i.e., whether the biological parents were living together (yes/no). Patients were then asked to confirm the presence of prior negative sexual experiences (yes/no), and whether they had a current sexual relationship (yes/no). Rape characteristics Information about date and time of the rape was ob- tained to calculate the time since rape at admission. Next, patients were requested to describe the rape. Their re- sponse was categorized into use of penetration (yes/no), group rape (yes/no), use of physical violence (yes/no), and use of threats verbally and/or with a weapon (yes/no). Also, information regarding the victim’s relationship to the assailant was obtained. The assailant was defined as a stranger when the victim had never been in contact with the assailant before the rape. Responses were used to form a closeness category (yes in case of family, (boy) friend, or mentor). Patients were also asked about the (estimated) age of the assailant (categorized into 12-17 years or >18 years), and whether the victim had used alcohol prior to the rape (yes/no). Post-rape characteristics Patients were asked when they first talked about the rape. The response was used to calculate the disclosure time and the help-seeking time. At the end of the interview, patients were asked whether they had reported to the police after the incident (yes/no), and whether they had received any medical care after the incident (yes/no). The study was performed in accordance with the precepts and regulations for research as stated in the Declaration of Helsinki, and the Dutch Medical Research involving Humans Subjects Act concerning scientific research. According to the Ethical Medical Committee of the University Medical Centre Utrecht, this act was not applicable to the present study. Written informed consent was obtained from both patients and parents. Measures Posttraumatic stress The Children’s Responses to Trauma Inventory (CRTT; Alisic, Eland, & Kleber, 2006) was used for participants aged 12-18 years. This is a 34-item questionnaire asses- sing severity of PTSD symptoms according to DSM-IV. Patients are asked to indicate to what extent a reaction to a traumatic event was present during the past week. Scores range from | to 5, with higher scores indicating more symptomatology. The four subscales: Intrusion, Avoidance, Arousal, and Other Child-Specific Reactions consist of 7, 11, 6, and 10 items, respectively. The reli- ability of this instrument is good to excellent (Cronbach’s a 0.92 for total score, 0.79 for Intrusion, 0.77 for Avoidance, 0.71 for Arousal; Alisic & Kleber, 2010). Document 397-2 Filed 10/29/21 Page 39 of 45 Predictors of delayed disclosure of rape For the purpose of the study, only the total score was analysed. Depression Children Depression Inventory (CDI; Kovacs, 1992; Timbremont & Braet, 2002) was used for participants aged 12-17 years of age. The CDI is a 27-item ques- tionnaire, assessing cognitive, affective, and behavioural symptoms of depression. The Dutch CDI has a satisfac- tory internal consistency, with Cronbach’s « ranging between 0.71 and 0.89 (Timbremont & Braet, 2002). Behavioural problems The Youth Self-Report (YSR; Achenbach & Rescorla, 2001) was used for participants aged 12-18 years. This questionnaire evaluates the teenager’s perception of be- havioural and emotional problems. YSR has shown to be internally reliable (Cronbach’s «’s ranging from 0.71 to 0.95), and convergent and discriminant validity is reported to be satisfactory (Bérubé & Achenbach, 2006). The YSR includes four broadband scales and nine narrow-band scales to assess behaviour problems. For the purpose of the study, only the total score on behaviour problems was included in the analyses. General psychopathology The Symptom Checklist-90-R (SCL-90-R; Arrindell & Ettema, 1986) was used for participants aged 12—25 years. This is a 90-item self-report inventory to assess psycho- social distress. Patients were instructed to indicate the amount they were bothered by each of the distress symptoms during the preceding week. Patients rated 90 distress symptoms on a five-point Likert scale with | being “not at all” and 5 being “extremely.” The state- ments are assigned to eight dimensions, reflecting various types of psychopathology: anxiety, agoraphobia, depres- sion, somatization, insufficiency, sensitivity, hostility, and insomnia. The Global Severity Index (GSI) can be used as a summary of the test and reflects the severity of all answered statements as a global measure of distress. Cronbach’s « has been found to range from 0.73 to 0.97. For the purpose of the study, only the GSI was analysed. Data analyses To compare demographic and post-rape characteristics between the early and delayed disclosers, chi-square tests were used. To compare multiple continuous psychological scores, MANCOVA was used with “time since trauma” as a covariate to correct for the potential influence of time since trauma. Delayed disclosure was used as a dependent variable. The strength of the univariate associations between each potential risk factor and delayed disclosure was estimated by calculating the odds ratio (OR) along with 95% confidence intervals (95% CI). To determine the strongest risk factors for delayed disclosure, each potential risk Citation: European Journal of Psychotraumatology 2015, 6: 25883 _ http://dx.doi.org/10.3402/ejpt.v6.25883 3 (page number not for citation purpose) DOJ-OGR-00005949