Danish Medical Bulletin - No. 4. November 2008. Vol. 55 Page 234

ABSTRACT OF DISSERTATION

Assessment of the importance of forensic examination for victims of sexual violence

Emphasis on legal consequences and prevention of postassault trauma

Ole Ingemann Hansen, MD

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This PhD dissertation was accepted by the Faculty of Health Sciences of the University of Aarhus, and defended on October 3 2008.

Official opponents: Berit Schei, Norway, and Peter Mygind Leth.

Tutor: Ole Brink.

Correspondence: Ole Ingemann Hansen, Institute of Forensic Medicine, University of Aarhus, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.

E-mail: oih@forensic.au.dk

ABSTRACT

Public surveys have estimated a prevalence of 4000-5000 Danish women a year being victims of sexual violence. Many victims have negative health outcome and many for quite a long time postassault. Therefore, knowledge about sexual violence to a greater extent is essential in order to prevent the act, and in case it had happened, to secure and practise the best treatment available. The foundations of several rape crisis centres have made this need possible. Also, from a judicial point of view, the clinical forensic evidence collection misses thoroughly examination in whether it suits the present daily demands.

The objective of the present PhD dissertation was to analyse the epidemiologic, forensic, legal, and health-related aspects of sexual violence. Specifically, determining the risk factors of assault, legal conviction, and development of posttraumatic stress and somatoform symptoms in order to prevent assaults, improve forensic examination, and optimise medical and psychological follow-up.

Register data from the WeDSAC, the IFM and the police departments in Greater Aarhus were pooled. To illustrate the late health consequences, a follow-up questionnaire survey was carried out.

The annual incidence rate was 29 per 100,000 females (12-87 years) and 1 per 100,000 males (12-87 years). Contributing to the dark figure as many as 34% of the victims were registered only at the WeDSAC. 45% fulfilled the diagnostic criteria for current PTSD, and another 24% had subclinical PTSD several years postassault. Young people had a four times higher risk and the consumption of alcohol doubled the risk for the assault to happen in a public place. The risk factor most strongly associated with conviction was the report of severe coercion by the perpetrator (OR 7.1; 95% CI 1.8-27.3). None of the evidence or documentation obtained by forensic investigation was shown to correlate with conviction as the legal outcome. Both somatoform symptoms were strongly associated with PTSD, indicating that pain functions as an independent conditioned stimulus for PTSD.

This study has contributed to our knowledge of sexual violence through a new approach because of the inclusion of victims not seen by either the police or the medical examiner. Prevention of assault is important because many victims had treatment-demanding PTSD several years postassault. New approaches concerning the impact of the forensic report on early police decisions are required, along with research as to how long a time the psychological follow-up should continue.

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