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

Abstract

Background: Sexual assault is a severe interpersonal trauma associated with substantial psychological morbidity. Survivors who present for forensic evaluation are often assessed during the acute or early post-assault period, when distress, fear, shame, dissociation, sleep disturbance, hyperarousal, and intrusive memories may be prominent. Post-traumatic stress disorder (PTSD) is one of the most frequently reported psychiatric outcomes following sexual assault, and early identification of high-risk survivors during forensic evaluation may improve referral, follow-up, and trauma-informed care. Objective: This systematic review aimed to synthesize evidence on 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, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, and manual reference screening. Search terms included “sexual assault,” “rape,” “sexual violence,” “forensic examination,” “forensic evaluation,” “sexual assault nurse examiner,” “medico-legal examination,” “post-traumatic stress disorder,” “PTSD,” “prevalence,” “risk factors,” and “determinants.” Studies were included if they reported PTSD, post-traumatic stress symptoms, or clinically significant trauma symptoms among sexual assault survivors assessed in forensic, medico-legal, emergency, or sexual assault referral settings. Reviews, commentaries, treatment-only studies, and studies without extractable PTSD-related data were excluded. Because studies varied in design, timing of assessment, PTSD tools, and population characteristics, a narrative synthesis was performed. Results: The evidence consistently showed a high burden of PTSD and post-traumatic stress symptoms among sexual assault survivors. Previous meta-analytic evidence indicates that PTSD symptoms are very common in the first year after sexual assault, with approximately three-quarters of survivors meeting PTSD criteria at one month and a substantial proportion continuing to meet criteria at one year. PTSD risk was influenced by assault severity, repeated victimization, physical injury, perceived life threat, prior trauma, childhood adversity, prior mental disorder, low social support, self-blame, shame, delayed disclosure, and negative responses from family, professionals, or legal systems. Forensic evaluation may represent a critical contact point for trauma-informed screening and referral. Conclusion: PTSD is highly prevalent among survivors of sexual assault, including those presenting for forensic evaluation. Determinants are multifactorial and include assault-related, survivor-related, psychosocial, and service-related factors. Forensic and medico-legal services should integrate trauma-informed assessment, psychological first aid, risk screening, safety planning, and referral pathways into routine care.