This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects of psychosocial interventions on mental health and well‐being for survivors of rape and sexual assault experienced during adulthood.
Rape and sexual assault are serious crimes, with the two terms being used to differentiate between different types of behaviours (offences). Sexual assault is an act of physical, psychological and emotional violation in the form of a sexual act, inflicted on someone without their consent. It can involve forcing or manipulating someone to witness or participate in sexual acts. An attempt to engage a person in such activities is referred to as attempted sexual assault. Legislation varies both between and within countries in respect of the activities that meet the criteria for sexual assault. For example, in the UK, sexual assault is based on 'touching' without consent, while the Supreme Court of Canada held that the act of sexual assault does not depend solely on contact with any specific part of the human anatomy but rather the act of a sexual nature that violates the sexual integrity of the victim. Rape is a specific form of sexual assault, defined by the World Health Organisation (WHO 2002) as "physically forced or otherwise coerced penetration – even if slight – of the vulva or anus, using a penis, other body parts or an object. The attempt to do so is known as attempted rape." (quote; p 149) There are differences in the types of acts that meet different legislative criteria for rape around the world (e.g. in some countries, rape only applies when a man commits the act against a female), but generally and broadly, the offence involves sexual penetration without consent. When children are raped or sexually assaulted, this is typically referred to as child sexual abuse (CSA), despite the fact that legislation for these offences may include the terms rape and sexual assault (e.g. rape of a minor, sexual assault of a child).
Rape and sexual assault are significantly under‐reported; for example, only 23% of the 323,450 rapes or sexual assaults against individuals aged 12 years or older reported to the USA National Crime Victimization Survey in 2016 had been reported to the police (Morgan 2017), and just 17% of sexual assaults experienced since 16 years of age in the British Crime Survey in 2013/14 (ONS 2015). Thus, it is difficult to understand the full extent of the problem, with estimates varying widely depending on the definitions used and method of data collection. There are more population‐based survey data available to estimate rape and sexual assault perpetrated by intimate partners, compared to non‐partners (WHO/PAHO 2012). The lifetime prevalence of sexual violence perpetrated by an intimate partner reported by women aged 15 to 49 years in the WHO multi‐country study ranged from 6% in Japan to 59% in Ethiopia (WHO 2005). In this study, 0.3 to 12% of women reported having been forced, after the age of 15 years, to have sexual intercourse or to perform a sexual act by someone other than an intimate partner. Estimates of prevalence using reports of perpetrators are rare. A cross‐sectional survey of a randomly selected sample of men in South Africa revealed that 14.3% reported having raped their current or former wife or girlfriend, while one in five reported raping a woman who was not a partner (i.e. a stranger, acquaintance or family member) (Jewkes 2011).
Rape and sexual assault disproportionately affect women (Walby 2016). Research into men's experiences of rape and sexual assault has been characterised by small samples sizes and varying definitions, and thus, the prevalence of rape and sexual assault perpetrated against men is largely unknown. Social and legal marginalisation, exacerbated by gender‐defined services, stigma and discrimination, all mean that the experiences of rape and sexual assault experienced by transgender people are hidden and poorly understood (e.g. see Wirtz 2018). In relation to sexual identities, the 2010 National Intimate Partner and Sexual Violence Survey showed that one in five bisexual women were raped by a partner (relative to one in 10 heterosexual women); rates of sexual violence were also higher for gay men and bisexual men, compared to heterosexual men (Walters 2013).
There is growing application of syndemic (concurrent or sequential diseases that additively increase negative health consequences) frameworks to understand the way in which different exposures or conditions (e.g. intimate partner violence (IPV) and substance misuse) co‐occur and exacerbate each other, producing new health problems such as HIV (Brennan 2012; Singer 2003). In the context of sexual violence, the approach highlights how structural factors, such as poverty and immigration status, and social aspects, such as different identities, disability, history of exploitation or sex work and lack of support systems, interact to produce health inequities and reinforce the disease burden (Willen 2017). The same factors reduce the capacity of research to bear witness to the experiences of those affected by constellations of social, political and economic factors. The limited evidence we do have on the hidden experiences of men, and other groups both silenced and at high risk, suggest trauma‐related sequelae are similar across all groups (Coxell 2010).
Sexual assault is a serious public health and human rights problem (WHO 2013a). It has devastating effects on adult and child victims, their families, and communities. There are extensive immediate and long‐term physical and mental health consequences for survivors. The consequences for adult and child victims include injuries, substance misuse, eating disorders, post‐traumatic stress disorder (PTSD), anxiety, depression, self‐harm and suicidality (WHO 2013a). Sexual and reproductive health problems represent the largest and most persistent physical health differences between women with and without exposure to rape or sexual assault, or both. Problems include unwanted pregnancy, sexually transmitted infections (WHO 2013a), urinary tract infections, painful sex, chronic pelvic pain and vaginal bleeding (Campbell 2002). For male victims, physical health consequences include genital and rectal injuries and erectile dysfunction (Tewkesbury 2007).
The mental health burden is substantial and similar across male and female victims (Coxell 2010; Tewkesbury 2007; Walker 2005; WHO 2013a). Sexual assault was ranked among the top three most traumatic life events in the US National Epidemiologic study (n = 34,653; Pietrzak 2011). Participants in that study with a psychiatric diagnosis of PTSD were four times more likely to report exposure to sexual assault than controls, and 13% of women with PTSD had lifetime experience of sexual assault. PTSD is a psychiatric disorder that can follow exposure to psychological trauma and is associated with intrusive memories, nightmares, avoidance, and problems with sleep and concentration (Lerman 2019). These findings are consistent with the World Mental Health Survey (Liu 2017). Guina and colleagues reported no difference in PTSD symptoms and severity among men and women who had experienced sexual trauma (Guina 2016). Other mental health consequences include alcohol use disorders, eating disorders, anxiety, depression, self‐harm and suicidality (WHO 2013a). Indirect pathways to poor long‐term health outcomes are also of concern; for example, taking lifetime PTSD as a proxy, PTSD is associated with increased risk of hypertension, cardiovascular disease and gastrointestinal problems (Pietrzak 2011). Thus, the immense medical and psychological impacts of sexual violence exposure can lead to long‐term disability.
The negative effects of rape and sexual assault ripple across generations, having social and economic costs in addition to impacts on physical and mental health by affecting, for example, individuals’ capacities to work and to participate in family and community life. Rape and sexual assault produce a significant social and economic burden, with lost productivity and police and criminal justice costs, in addition to the health and mental health burden. In the UK, each adult rape has been estimated to cost over £73,000 from psychological damage to a person, the physical impacts of associated injuries and illnesses, health service use, and economic losses (Home Office 2005). In the USA, the Centers for Disease Control and Prevention estimated that the lifetime cost of rape was US$122,461 per victim, which amounted to a population economic burden of almost US$3.1 trillion (Peterson 2017). This figure relates to data showing that over 25 million adults had been raped and included medical costs (39%), lost work productivity relating to both victims and perpetrators (52%), criminal justice costs (8%), and other expenses such as victim property loss or damage (1%). There are additional impacts to consider, from lost economic output to increased use of social services, impacts on family, capacity to parent, intergenerational transmission of trauma and violence, and effects for the wider community. Thus, providing accessible, evidence‐based interventions in response to victims is not only a moral imperative, but an essential requirement to limit the consequences of rape and sexual assault across the lifespan and disrupt the costly pathways to poor health.
While there is a great deal of consensus that sexual assault and rape are highly detrimental to mental health, the conceptualisation of that harm has been the subject of debate (Campbell 2009). Early sexual assault interventions arose from a crisis theory orientation (e.g. Burgess 1974), which informed rape advocacy organisations (Koss 1987a). However, there is a lack of evidence for this approach and indications that some women with chronic symptoms needed more intensive treatment (Kilpatrick 1983). Cognitive‐behavioural interventions that built on evidence‐based anxiety treatments were adapted for this population in the 1970s, which included Stress Inoculation Training (SIT; Veronen 1983). Later, Prolonged Exposure Therapy (PET; Foa 1986) and Cognitive Processing Therapy (CPT; Resnick 1977) were developed and evaluated (see Vickerman 2009 for a review). Then, behavioural therapies, such as Eye Movement Desensitisation Reprocessing (EMDR; Shapiro 1995), received increased research attention and began to be evaluated in this population (e.g. Rothbaum 1997). These approaches sit within a trauma‐response theoretical model (Goodman 1993; Herman 1992); however, the clinical diagnosis of PTSD risks pathologising victims (Berg 2002; Gilfus 1999), has been identified as re‐traumatising and unhelpful by survivors, and perpetuates ethnocultural biases (Marsella 1996; Wasco 2003). Rape and sexual assault do not occur in social and cultural isolation (Campbell 2009). As highlighted recently by the #MeToo movement, victims have to negotiate post‐assault responses and help‐seeking in hostile and doubting environments. This is due to a pervasive culture that propagates messages that victims are to blame, that they caused the assault or rape and deserved it (Buchwald 1993; Burt 1998; Lonsway 1994; Sandy 1998), if they are believed at all. Hence, violence against women scholars have advocated for an ecologically‐informed trauma model of rape recovery (Koss 1991; Neville 1999), which takes these issues into account and highlights the different systems within which responses and support are provided, and moreover stresses the importance of social as well as psychological responses. According to Kelly’s ecological theory (Kelly 1966; Kelly 1968; Kelly 1971), individuals' and community organisations' responses are interdependent, resulting in each person having differential patterns of experiences depending on their ecological circumstances. Koss 1991 and Harvey 1996 adapted these ideas in their ecological model of rape recovery, which Campbell and colleagues used to evaluate legal, medical, and mental health systems' responses to survivors’ needs and the influences on survivors’ psychological, physical, and sexual health outcomes (Campbell 1998; Campbell 1999; Campbell 2001; Campbell 2004). The World Health Organization (WHO; Jewkes 2002; Krug 2002) and Center for Disease Control and Prevention (CDC 2004) have adapted this approach in the prevention of gender‐based violence. This means that a wide range of interventions has been developed to support or respond (or both) to victims of sexual assault and rape. These include supportive therapies, whereby counsellors and/or specific sexual assault/rape support workers, advocates or advisors give support, information and advice to survivors. They may listen to victims and help them talk over their feelings and problems (BluePages 2012). Counsellors may offer debriefing, which allows emotional processing or ventilation by encouraging recollection, ventilation and reworking of the traumatic event (Rose 2002).
Psychosocial interventions “are interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors with the aim of improving health functioning and well‐being” (IOM 2015, p 5). They vary considerably as interventions target different combinations of these factors. For example, Sikkema and colleagues describe the development of a psychosocial intervention for South African women with sexual trauma histories (Sikkema 2018). The intervention included both individual and group sessions with psycho‐education and focused on the following treatment themes: synergistic stress of sexual trauma and HIV; impact of trauma on health behaviours; safety, intimacy, power, and self‐esteem; stressor identification and appraisal; adaptive versus maladaptive coping; social support; and reduction of shame and stigma. Group education sessions (e.g. Dognin 2017) and brief video‐based interventions that provide psycho‐education and modelling of coping strategies to survivors at the time of a sexual assault nurse examination (Miller 2015) have also been developed for this population. Sexual Assault Referral Centres (e.g. NHS 2015; Vandenberghe 2018) provide a range of initial response and support services, including in the UK, independent sexual violence advisors (ISVAs) who are non‐psychologists trained to look after survivors' needs (Home Office 2017). This role was commissioned by Baroness Stern through the Home Office Violent Crime Unit in 2005. An ISVA is trained to ensure survivors receive care and understanding. Guidance sets out the core principles of an ISVA, which are to: tailor support to the individual's needs; provide accurate and impartial information; provide emotional and practical support to meet the survivor's needs; provide support before, during and after court; act as a single point of contact; ensure the safety of survivors and their dependants; and provide a professional service (Home Office 2017). Discussing the rape or sexual assault prior to court proceedings is seen as prejudicial to a trial (CPS 2002) and most psychological therapies include such discussion. For this reason, psychosocial interventions that are tailored to avoid such discussion can be a vital source of support to rape and sexual assault victims in the pre‐trial period. Although many psychosocial interventions have demonstrated effectiveness, the findings have not been well synthesised, and it can be difficult to know what treatments are effective (IOM 2015).
Women have been the focus of interventions and services for rape and sexual assault; male, transgender and gender non‐conforming/non‐binary populations experience significant barriers in respect of accessing such interventions. This is also reflected in the evaluation literature, with services specifically for non‐female populations receiving little or no evaluation and samples in evaluations of interventions being predominately female. Furthermore, the preponderance of white/Caucasian women attending services and participating across studies of interventions to date, further underscores the importance of undertaking this review; many subgroups remain hidden (e.g. men and boys) or highly vulnerable to abuse (migrant people, minority ethnic people, LGBT (lesbian, gay, bisexual and transgender) people, those involved in sexual exploitation and sex work), or both, and this is reflected in both practice and research contexts. This review has the potential to draw together experiences across studies among individuals typically under‐represented in research, who share certain social, gender, ethnic and economic characteristics, to determine if the approaches under investigation respond differently for subgroups of survivors.
For the purposes of this review, we will include a wide range of psychosocial interventions (for definitions, see the list of psychological therapies on the Cochrane Common Mental Disorders (CCMD) website (cmd.cochrane.org/psychological‐therapies‐topics‐list)). These include: (a) formal Cognitive Behavioural Therapy (CBT) and Trauma‐Focused CBT (TF‐CBT), and CBT‐based techniques; (b) integrative therapies including SIT, PET, CPT; (c) behaviour therapies, such as EMDR and relaxation techniques, many of which are based on cognitive‐behavioural processes (Freeman 2005); (d) third‐wave CBT such as Acceptance and Commitment Therapy and mindfulness; (e) humanistic therapies such as supportive and non‐directive therapy; (f) other psychologically‐orientated interventions such as art therapy; meditation; and narrative therapy; and (g) psychosocial interventions such as support and services delivered by mentors, support workers, advisors, or advocates (for example, independent sexual assault advisors (ISVAs), in the UK), and support groups.
Cognitive‐behavioural processes can also be subclassified into three major classes (Dobson 2009): (1) cognitive re‐structuring, which focuses on internal underlying beliefs and thoughts with the aim of challenging maladaptive thought patterns; (2) coping skills therapy, which targets the identification and alteration of cognitions and behaviours that may increase the impact of negative external events; and (3) problem‐solving therapies, which combine cognitive re‐structuring and coping skills therapy to change internal thought patterns and optimise responses to external negative events. Each of these three classes have a slightly different target for change, demonstrating the wide range of psychological interventions based upon cognitive‐behavioural principles (Dobson 2009).
Clinical and policy guidelines inform responses to rape and sexual assault (e.g. NICE 2018; WHO 2013b), but gaps remain in our knowledge of the most effective ways of intervening to improve health outcomes and prevent further victimisation. While there is moderate evidence on the consequences of sexual trauma (Description of the condition), it is less clear what happens to people’s health and well‐being over time, including in response to different interventions. Although post‐traumatic stress is strongly associated with rape and sexual assault (e.g. Liu 2017), and there are theoretical understandings on the importance of early community response to mitigate it, the effectiveness of interventions in promoting survivor well‐being is unclear. There is good evidence for the effects of psychological treatments in reducing mental health issues in children who have experienced sexual trauma (Gillies 2016), with CBT for sexually abused children with symptoms of post‐traumatic stress showing the best evidence for reduction in mental health conditions (MacDonald 2012; MacMillan 2009). However, these conclusions cannot be extrapolated to adults who have experienced sexual trauma, and there has been no recent systematic review or meta‐analysis examining the effects of intervention on this population.
Relative to IPV, sexual violence has received less attention in the research literature, and several prior or ongoing reviews focus on psychological interventions for IPV (Arroyo 2017; Tan 2018; Trabold 2018). While there is some overlap in the populations of interest, in that many sexual assaults and rapes occur within IPV, rape and sexual assault is not exclusive to IPV and there is a larger group of individuals who experience sexual trauma as adults who require support or interventions. Those reviews that have looked at rape and sexual assault have tended to focus on women (Parcesepe 2015) and children (Gillies 2016; MacDonald 2012), indicating that the experiences of men and transgender survivors are less represented in the literature. Similarly, the representation of sexual minorities and ethnic minorities is typically minimal in intervention studies, with studies rarely sufficiently powered to detect benefits and costs for specific user groups or subgroups of survivors. By pooling subgroups from different studies, the current review will have the potential to address some of the gaps on what works for whom, and under what circumstances. Other reviews have focused on diagnosis or outcome (i.e. PTSD) (Roberts 2015), psychological therapies (Bisson 2013) or combined pharmacotherapy and psychological therapies (Hetrick 2010) for PTSD, rather than the population/exposure (rape and sexual assault survivors). For most of the reviews, sexual assault and rape victims or survivors are children or adolescents or are a subset of the population. While these reviews are helpful in understanding appropriate therapies to combat PTSD specifically, not all sexual assault or rape victims experience PTSD, and the impacts of sexual trauma are broader than PTSD. Campbell and colleagues published a review in 2009 (Campbell 2009) and Regehr and colleagues a systematic review in 2013 (Regehr 2013) on interventions to reduce distress in adult victims of sexual assault and rape. These reviews are relevant; however, they are now 10 and six years out of date, respectively, and there have been developments in terms of interventions since their publication. The proposed review will examine the broader range of impacts of sexual trauma for all victims who experience rape and sexual assault as adults. Each of the previous two reviews included six studies and we identified 10 eligible studies in our scoping review. Hence, this review is feasible and addresses an important gap in the current literature.
To assess the effects of psychosocial interventions on mental health and well‐being for survivors of rape and sexual assault experienced during adulthood.
Any study that allocated individuals or clusters of individuals by a random or quasi‐random method (whereby the method of allocation was not truly random such as alternate allocation, allocation by birth date, day shift etc.) to a psychosocial intervention for adult victims of rape or sexual assault compared with no intervention, usual care, waiting list, or minimal or active comparison (see 'Comparator intervention' under Types of interventions).
Studies will be eligible for inclusion in the review if they used random assignment to treatment and comparison groups or employed one of the following designs: quasi‐randomised controlled trial (RCT) (non‐randomised experimental design trials); cluster‐RCT (instead of individual randomised trials, groups will be randomised) or cross‐over trial (longitudinal studies where the participant receives a sequence of different treatments).
All adults aged 18 years and older, of any gender, who have experienced rape or sexual assault as an adult (i.e. aged 18 years and older), irrespective of a mental health diagnosis. Types of sexual assault will include rape, attempted rape, forced oral sex, anal sex, penetration with objects, touching of intimate parts and any sexual contact where consent was not given, as well as forcing or manipulating someone to witness sexual acts. We will include studies of participants who screened positive for exposure to sexual violence, even if they do not report what those behaviours were. We will include studies involving subsets of eligible participants provided that the subset includes at least 50% of those randomised and can be analysed separately. We will include studies of participants recruited in any setting (e.g. community, forensic, criminal justice, and health).
We will exclude samples made up entirely of individuals (adult or child) who were victims of rape, sexual assault, or sexual abuse during their childhood (aged 17 years and under), as well as samples of children (i.e. those younger than 18 years of age).
The experimental intervention consists of any type of psychosocial and psychological intervention that targets recovery from sexual assault or rape, including the following.
Formal CBT, TF‐CBT and CBT‐based techniques.Integrative therapies, including Stress Inoculation Training (SIT; Veronen 1983), Prolonged Exposure Therapy (PET; Foa 1986) and Cognitive Processing Therapy (CPT).
Behaviour therapies such as EMDR and relaxation techniques. Third wave CBT (e.g. Acceptance and Commitment Therapy, mindfulness). Humanistic therapies (e.g. supportive and non‐directive therapy).Other psychologically‐orientated interventions (e.g. art therapy, meditation, trauma‐informed body‐based practices (e.g. embodied relational therapy, yoga and Tai Chi), narrative therapy).
Other psychosocial interventions, including support services delivered by mentors, support workers, advisors or advocates such as ISVAs in the UK, support groups, and coping interventions.
We will include interventions of any duration or frequency of treatment so long as the treatment meets the criteria stated above.
For all interventions, mode of intervention delivery will include one or more of the following: face‐to‐face; telephone; or computer‐based delivery. We will include both individual and group delivery of the intervention.
Comparator interventions will consist of inactive controls, such as usual care, no treatment, delayed provision of psychological interventions (or waiting‐list conditions), or pharmacological treatment only, and minimal interventions such as information provision. However, we will not exclude studies on the grounds that an active control group has been used (e.g. where an intervention from one category (CBT) is compared to an intervention from another category (psychosocial intervention), or different intensities or dosages of an intervention are compared). We recognise that there will be instances where researchers employ an active comparison condition for pragmatic or ethical reasons (e.g. the importance of offering some care or treatment to a survivor and that research studies may replicate this when designing or delivering an evaluation). In our analyses, we will strive to pool studies that conduct similar types of comparisons (i.e. active versus inactive or active versus active).
We will not select studies based on the nature of the outcomes assessed. The review is designed to measure the effects of psychological therapies and psychosocial interventions for survivors of rape and sexual assault experienced during adulthood, based on a wide range of indicators of a person's health and well‐being, particularly mental health and well‐being. We are also mindful about evaluating harm and adverse consequences from therapies and other interventions.
Treatment efficacy, PTSD symptoms: response to treatment, determined by differences in scores for PTSD symptoms, assessed by independent observer or self‐report. Validated observer‐rated instruments include the Clinician‐Administered PTSD Symptom Scale (Kulka 1988), Clinician‐Administered PTSD Scale (CAPS; Blake 1990; Blake 1995), and the PTSD Symptom Scale ‐ Interview (PSS‐I; Foa 1993). Validated self‐report measures include the PTSD Symptom Scale ‐ Self‐Report (PSS‐SR; Foa 1993; Rothbaum 1990), Impact of Event Scale (IES; Horowitz 1979), Impact of Event Scale ‐ Revised (IES‐R; Weiss 1997), and PCL‐5 (Bovin 2016), which is the self‐reported PTSD Checklist for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5; APA 2013).
Treatment efficacy, depressive symptoms: response to treatment, determined by differences in scores for depressive symptoms, assessed by independent observer or self‐report measures, including the Hospital Anxiety and Depression Scale (HADS; Zigmond 1983), Beck Depression Inventory (BDI; Beck 1961), Center for Epidemiologic Studies Depression Scale (CES‐D; Radloff 1977), Patient Health Questionnaire (PHQ; Spitzer 1999), and Hamilton Depression Rating Scale (HAM‐D; Hamilton 1960).
Treatment acceptability: the number of participants who dropped out of the intervention (as distinct from attrition), including in studies of two intervention types and other assessments of acceptability (e.g. measures of patient/client satisfaction).
Adverse effects, such as counts of mortality, completed suicides, and attempted suicides, or worsening of symptoms (specifically, group differences on PTSD, depression, self‐harm and suicidality ‐ see below for tools), including those summarised in narrative form, or using a tool such as the Negative Effects Questionnaire (Rozental 2018). We will record whether or not studies made reference to this outcome.
Anxiety symptoms, assessed with self‐report scales such as the Beck Anxiety Inventory (BAI; Beck 1988), State‐Trait Anxiety Inventory (STAI; Spielberger 1970), or Generalised Anxiety Disorder ‐ Seven‐item Scale (GAD‐7; Kertz 2013; Spitzer 2006).
Dissociation symptoms, measured using instruments such as the Dissociative Experiences Scale (DES; Bernstein 1986), or the Dissociative Experiences Scale‐II (DES‐II; Bernstein 1986; Carlson 1993).
Global mental health functioning/distress, which is frequently measured by either the Global Severity Index (GSI), Positive Symptom Distress Index (PSDI) and Positive Symptom Total (PST) of the SCL‐90‐R (Derogatis 1983), or by the Behavior And Symptom Identification Scale (BASIS‐32; Eisen 1999).
Feelings of guilt or self‐blame (or both) experienced by survivors, measured by self‐report tools such as the Trauma‐Related Guilt Inventory (TRGI; Kubany 1996), Rape Attribution Questionnaire (RAQ; Frazier 2003), South African Stigma Scale (Singh 2011), Social Support Appraisal (SSA) scale (Vaux 1986), Rape Aftermath Symptom Test (RAST; Kilpatrick 1988), or Inventory of Interpersonal Problems (IPP; Horowitz 1988).
substance use, measured by a number of established scales, including the Michigan Alcoholism Screening Test (MAST; Selzer 1971), Drug Abuse Screening Test (DAST; Skinner 1982), Addiction Severity Index (ASI; McLellan 1980: McLellan 1992), Alcohol Use Inventory (AUI; Chang 2001), Drug Use Disorders Identification Test (DUDIT; Berman 2005), or the Alcohol Use Disorders Identification Test (AUDIT; Pradhan 2012).
Quality of life, which is commonly measured by self‐report measures such as the WHO Quality of Life scale ‐ Abbreviated Version (WHOQOL‐BREF; Skevington 2004) and EuroQol‐5 Dimensions (EQ‐5D; Brooks 1996).
Self‐harming or suicidality often measured by the Deliberate Self‐Harm Inventory (DSHI; Gratz 2001), Self‐Harm Behaviour Questionnaire (SHBQ; Guttierez 2001), or the Self‐Injury Questionnaire (SIQ; Santa Mina 2006).
Sexual violence assessment, measured by instruments such as the Sexual Experiences Survey (SES; Koss 1987b) and the Abuse Assessment Screen (AAS) (Basile 2007; NSVRC 2011). These tools differ in terms of their method of delivery; their appropriateness for screening for females, males, or both; the setting in which screening is to occur; the total number of questions they contain; and the number of questions that are specific to sexual violence (Basile 2007; NSVRC 2011).
We will include all time points; however, the primary time point for treatment efficacy will be three months post‐treatment. We will classify short‐term time points as zero to six months, medium‐term as six to 12 months, and long‐term as 12 months or longer.
We will search the databases and trials registers listed below for published and unpublished studies. We will adapt the MEDLINE strategy in Appendix 2 for the other sources using appropriate indexing terms and syntax. We will not apply any limitations on publication date, place or language of any research; we will not exclude any potentially relevant studies and we will include research from different backgrounds and disciplines. The Information Specialist for Cochrane Developmental Psychosocial and Learning Problems will search all of the databases listed below, with the exception of the Common Mental Disorders Controlled Trials Register, which will be searched by the Information Specialist for Cochrane Common Mental Disorders.
Cochrane Central Register of Controlled Trials (CENTRAL; current issue) in the Cochrane Library, which includes the Developmental, Psychosocial and Learning Problems Specialised Register.
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR; current to June 2016). See Appendix 3 for one of the core strategies (MEDLINE) used to populate CCMDCTR. Full details are available at cmd.cochrane.org/specialised‐register.