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Assessment of the importance of forensic examination for victims of sexual violence ¿ emphasis on legal consequences and prevention of postassault trauma

Ole Ingemann-Hansen  


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Accepted by: Faculty of Health Sciences University of Aarhus
Defended on: October 3, 2008
Official opponents: Prof. Berit Schei , PhD Peter Mygind Leth
Tutors: Assoc. Prof. Ole Brink , Dr. Annie Vesterbye , Prof. Svend Sabroe

Published in the PhD Database: October 4, 2008


English 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 quit 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 Specific, 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. Forty-five percent 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.



Danish abstract
Denne ph.d.-afhandling omfatter tre originalartikler baseret på epidemiologiske studier udført på Center for Voldtægtsofre, Århus Sygehus, Retsmedicinsk Institut, Aarhus Universitet samt ved Østjyllands Politi.
Befolkningsundersøgelser har anslået, at 4000-5000 danske kvinder hvert år udsættes for voldtægt eller voldtægtsforsøg. Mange har det dårligt meget længe efter. Derfor er større viden om voldtægtens indhold essentiel for at forhindre det sker, og hvis det sker da at sikre bedste sundhedsmæssige behandling. Med centre for voldtægtsofres oprettelse er der nu mulighed for at få nuanceret viden om en større andel af dem der udsættes for seksualiseret vold. Samtidigt mangler opgørelser over rettens brug af den retsmedicinske undersøgelse, og om den er tilpasset nutidens behov.
Formålet med studiet var at analysere de epidemiologiske, retsmedicinske, retslige og helbredsmæssige aspekter af seksualiseret vold, herunder påvisning af særlige risikofaktorer for overgreb, dom og helbredsmæssige konsekvenser.
Undersøgelsen er baseret på ofre der i en femårig periode har angivet sig udsat for voldtægt eller voldtægtsforsøg i Århus Amt. En spørgeskemaundersøgelse blev foretaget for at bestemme omfanget af posttraumatisk belastningsreaktion og forekomsten af underlivs- og rygsmerter i efterforløbet af den seksualiseret vold.
Den årlige incidens rate var for kvinder 29 pr. 100.000 indbyggere i alderen 12-87, for mænd 1 pr. 100.000. Det fandtes et mørketal på 1.3. 45% opfyldte diagnosekriteriet for PTSD og yderligere 24% havde subklinisk PTSD. Overgriberens brug af fysisk vold sås signifikant hyppigere ved partner- og overfaldsvoldtægt. Unge havde en 4 gange forhøjet risiko, og indtagelse af alkohol fordoblede risikoen for at et overgreb skete et offentligt sted. Den stærkest associerede faktor for dom var rapporteret brug af svær vold fra overgriberens side (OR 7,1; 95% CI 1,8-27,3). Ingen af de retsmedicinske fund var associeret med det retslige udfald dom. Begge somatoforme symptomer var associeret med PTSD, hvilket kunne indikere, at smerten kan fungere som en uafhængig betinget stimulus for PTSD.

Studiet frembyder ny viden inden for seksualiseret vold ved at inddrage ofre ikke anmeldt og ikke lægeundersøgt. Forebyggelse er vigtig, da rigtig mange af ofrene har en behandlingskrævende posttraumatisk belastningsreaktion selv flere år efter overgrebet. Fremtidige præventive tiltag kan målrettes de påviste risikogrupper. Nye undersøgelser om politiets brug af den retsmedicinske erklæring og om den psykologiske opfølgnings varighed er påtrængende.