Suicidal Thoughts and Behaviors among Women Sexual Assault Survivors: A Proof-of-Concept and Feasibility Study

683,000 women are sexually assaulted annually in the US, and are at high risk of developing chronic posttraumatic stress disorder (PTSD). Sexual assault and PTSD are key risk factors for suicidal thoughts and behaviors (STBs). STBs are a major public health problem, with nearly 12.3 million Americans experiencing suicidal ideation affecting and 50,000 dying annually by suicide. Individuals who experienced sexual assault are 3-4 times more likely to make a suicide attempt compared to those who have not been sexually assaulted. Indeed, in our observational study of 706 women sexual assault survivors, half had likely PTSD and the majority reported clinically significant depression and hopelessness, indicating high risk for STBs. However, despite limited extant work suggesting that the period after sexual assault may be a high-risk time for the development of STBs, there is a dearth of prospective research studying STBs in the aftermath of sexual assault. Further, 100,000 women annually seek emergency care after sexual assault and are offered preventive interventions for pregnancy and sexually transmitted infections, but not the more common mental health sequelae of PTSD and STBs. Addressing the critical unmet need for preventive interventions for PTSD after sexual assault would reduce the public health burden and personal suffering associated with both PTSD and STBs. Anxiety sensitivity (AS; fear of anxious arousal) is a malleable risk factor that prospectively predicts PTSD among sexual assault survivors in pilot data, is associated with STBs, and can be reduced with brief digital therapeutics that lead to reductions in PTSD and STBs. Theoretically, AS may cause PTSD-related physiological arousal to be interpreted as threatening and to be avoided. Therefore, individuals with high AS may consider suicide as an escape for intolerable PTSD-related sensations. The proposed AFSP Early Career Researcher Innovation Grant will leverage an existing clinical trial framework provided by the applicant’s K23 to assess STBs using self-report measures (i.e., Beck Scale for Suicidal Ideation; Suicidal Behavior Questionnaire-Revised; brief ecological momentary intervention [EMA] questionnaires) after sexual assault, their associations with PTSD, and whether targeting AS may produce clinically significant reductions in STBs. Women presenting for emergency care after sexual assault (N=53) will complete assessments at the emergency visit and 1 week, then will be randomized to either the active intervention or standard of care (SOC) control. Outcomes will be assessed by EMA over 6 weeks, and 6 week and 6 month self-report follow-ups. In this context, the applicant will receive training in the design and conduct of STBs as an outcome of emergency care-based RCTs. Training goals will be supervised by a content expert with knowledge on STBs comorbid with PTSD and utilizing EMA to assess STBs, as well as a track record of NIH funding and excellent mentorship. The research and training goals of the current proposal set the stage for an R01 mechanistic clinical trial and allow for the candidate to integrate STBs as important outcome into her independent research career focused on reducing the public health burden of sexual assault-related PTSD.