Dr. Katherine Muldoon, assistant professor at the University of Ottawa, senior research associate at The Ottawa Hospital, and collaborating researcher at ICES.
Pandemic restrictions were associated with reduced rates of emergency department (ED) visits for sexual assault, signaling the need for trauma and violence-informed measures during health care crises, according to a new study using ICES data.
Prior research showed a decrease in ED visits for violence and sexual assault in the early months of the COVID-19 pandemic, but less is known about health care encounters for sexual assault throughout the ongoing waves of the pandemic.
“We explored the trends in ED encounters for sexual assault, in the years and months leading up to the pandemic and throughout the four waves of COVID-19 restrictions," says lead author Dr. Katherine Muldoon, assistant professor at the University of Ottawa, senior research associate at The Ottawa Hospital, and collaborating researcher at ICES. “Unexpectedly, we found a significant increase in rates of ED encounters for sexual assault in the two months leading up to the pandemic, potentially due to increasing stress in society. There was a sharp drop immediately following March 2020, and fluctuating rates with each new wave."
The study, published in JAMA Network Open, used administrative health data to track annual patterns of ED encounters for sexual assault in Ontario, Canada, from January 11, 2019, to September 10, 2021. Within that period there were 10,523 sexual assault cases, with 88 per cent among female individuals.
The data showed that:
- ED encounters for sexual assault increased 20 to 25 percent just prior to lockdown measures. This pattern was similar across sex, age group, community size, and income levels.
- Following the first lockdown, cases dropped 50 to 60 percent and stayed below typical levels during the next four waves of COVID-19.
- There was a seasonal pattern of increasing ED visits during the summer months, which coincided with fewer COVID-19 infections and a loosening of pandemic restrictions.
Importantly, ED encounters only represent a fraction of sexual assaults that occur in the general population, as survivors may not seek care at all, may seek help from community-based services or other non-hospital settings. Lack of visible injuries may also discourage someone from visiting the ED, even though EDs can help survivors of all forms of gender-based violence receive the specialized care they need.
These findings show that health care crises affect how survivors access urgent care, and this could have long-term clinical, social, and legal consequences. Specialized and trauma-informed clinics are the best solution for encouraging survivors to come to EDs following a sexual assault, according to treatment guidelines from the Ontario Network of Sexual Assault and Domestic Violence Treatment Centres, but many hospitals do not have them. This also increases the stressors facing EDs that are already struggling as the safety net of the healthcare system.
“Survivors of sexual violence need a variety of medical, psychosocial supports and protection to help them heal in the aftermath of such experiences," says Heidi Illingworth, Executive Director of Ottawa Victim Services, a community-based agency that provides emotional support, referrals and assistance to individuals who have been victimized. “Access to urgent healthcare is especially important in some cases. Without improved public education and outreach efforts during restrictions or disruptions in hospital services, survivors may face negative outcomes. Connecting survivors to victim services provides critical support in their healing and recovery."
“The goal of trauma and violence-informed care is to minimize harm while providing the best possible care for survivors of sexual violence," said Dr. Kari Sampsel (pictured left), emergency physician and Medical Director of The Ottawa Hospital Sexual Assault and Partner Abuse Care Program and assistant professor at the University of Ottawa. “This approach should be applied when developing healthcare policies, especially during emergencies or disruptions to services."
The study, “Population-level trends in emergency department encounters for sexual assault preceding and during the COVID-19 pandemic across Ontario, Canada" was published in JAMA Network Open on December 29, 2022.
The Ottawa Hospital Sexual Assault and Partner Abuse Care Program is available 24/7 at The Ottawa Hospital Civic Campus Emergency Department to work with patients who have been the victim of gender-based violence, and help them receive the specialized care they need.