Post-Traumatic Stress Disorder Among Sexual Assault Survivors Undergoing Forensic Evaluation: A Systematic Review

Abstract

Background: Sexual assault is a severe traumatic event associated with long-term psychological consequences, including post-traumatic stress disorder (PTSD), depression, anxiety, self-harm, substance use, and impaired social functioning. Survivors undergoing forensic evaluation represent a particularly vulnerable group because medico-legal examination may occur soon after the assault and may be accompanied by distress, fear, stigma, shame, and concerns related to legal proceedings. Objective: This systematic review aimed to evaluate the prevalence and determinants of PTSD among survivors of sexual assault undergoing forensic or medico-legal evaluation. Materials and Methods: A systematic literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, and manual reference screening. Studies reporting PTSD, post-traumatic stress symptoms, or trauma-related psychological morbidity among survivors of sexual assault assessed in forensic, medico-legal, emergency, sexual assault referral, or crisis evaluation settings were included. Observational studies, cross-sectional studies, cohort studies, and forensic clinic-based studies were considered. Reviews, editorials, case reports, studies not involving sexual assault survivors, and studies without extractable PTSD-related data were excluded. Data were synthesized descriptively because of heterogeneity in population characteristics, timing of assessment, PTSD instruments, forensic settings, and follow-up periods. Results: A total of 32 studies involving 8,746 survivors of sexual assault were included. The reported prevalence of PTSD ranged from 21.4% to 68.9%, with a pooled descriptive estimate of 42.7%. PTSD symptoms were more frequently reported when assessment occurred after the acute post-assault period compared with immediate forensic examination. Important determinants included severity of assault, physical injury, perceived threat to life, repeated assault, childhood sexual abuse, prior psychiatric illness, low social support, self-blame, delayed disclosure, substance-facilitated assault, intimate partner or known perpetrator assault, and ongoing legal stress. Survivors undergoing forensic evaluation frequently reported intrusive memories, avoidance, hyperarousal, sleep disturbance, fear, shame, guilt, and functional impairment. Conclusion: PTSD is highly prevalent among survivors of sexual assault undergoing forensic evaluation. Forensic and medico-legal services should integrate trauma-informed care, early psychological screening, crisis counseling, safety assessment, referral pathways, and follow-up mental health support. Identification of high-risk determinants can help prioritize survivors requiring urgent psychological intervention.