Research for mental healt and judgments on the verdicts of sexual assault cases at first and second admissions to Düzce University Medical Faculty Forensic Medicine Clinic between 2005 and 2012

Objective: The aim of this study is to examine personal and environmental factors that may affect the concept of "physical and mental health deterioration? described in the subclause 5 of the Article 102 and the subparagraph 6 of the Article 103 of Turkish Penal Cod (TPC), which entered into force in 2005, and to study whether the presence of the concept of "physical and mental health deterioration? is appropriate in Turkish Penal Cod. Materials and methods: In this study, we retrospectively analyzed 68 patients who were examined during the acute period and at least six months after the date of the event in Duzce University School of Medicine, Department of Forensic Medicine Outpatient Clinic from June 2005 to June 2012. We evaluated the effects of demographic characteristics and pre-event, event and post-event events and people-related factors on mental health. Results: In this study, we found Binary Logistic Regression model, which is used to determine the risk factors affecting mental health deterioration, significant p<0,05. Accordingly, in comparison with the patients without psychiatric evidence in their initial examination, we observed an 11.32-fold increase in the risk of mental health deterioration in the patients with psychiatric evidence in their initial examination (p=0,002). In comparison with other forms of action, 12.52-fold increased risk (p = 0.003) in deterioration of mental health was observed in the form of action that the organ inserted through the anal way. In the alleged sexual assault case, in comparison with the situation in which liberty deprivation crime was not committed, we found a 6.92-fold increase (p=0,05) in the risk of mental health deterioration in the situation in which unlawfully restricts of the freedom was committed. Compared to the cases who were familiar with the defendants, 15.88-fold increase in the risk of deterioration in mental health (p = 0.027) was observed when the cases were not familiar with the defendants. In the statistical analysis other than Binary Logistic Regression, there was a significant difference between age groups by gender (p <0.05). The difference was due to the fact that the number of male patients was more than the number of females in the age group 0-12. As a result of the sexual act of 23 attackers out of 92(%27,4), victim's mental health deteriorated. As a result of the sexual act of 5(%62,5) out of 8(%8,7) in which the patient was not familiar with the attacker, victim's mental health deteriorated. There was a significant difference (p=0,039 n=92). 35 out of 68 patients(%51,5) have been subjected to sexual activities more than once at different times. 5 (7,4%) of them lived in orphanages before the incident, three (4,4%) patients were sent to foster care by court order after the incident. The conclusion that the physical and mental health of 6(%24) of 25 patients with no claim of penetration deteriorated as a result of the alleged sexual assault was reached, and there was no statistically significant difference between whether or not there was penetration and whether or not victim's physical and mental health deteriorated ( =0,877 df=1 p=0,349). There was statistically significant difference between the presence or absence of a personality disorder and whether or not the patient had his/her own consent ( =6,982 df=1 p=0,008). There was statistically significant difference between whether the patient were examined other than Duzce Univercity Forensic Medicine Department and whether his/her mental and physical health deteriorated ( =8,336 df=1 p=0,004). 3 cases whose initial examinations were after 3 months or more from the date of the event were diagnosed with post-traumatic stress disorder(PTSD) during their initial examinations. During the second examination of 1(%33,3) of these cases, there was no evidence which had become as a result of the alleged sexual assault and which filled psychiatric diagnostic criteria. In this case, the patient claimed that had psychiatric treatment between his first and second examination; but the other 2 cases continued to have PTSD in their second examination. In our study, 3 of 12 patients who claimed they had the alleged sexual intercourse with their consent and 18 of 56 patients who claimed they had the alleged sexual intercourse with no consent, the court compromised that these patients had mental and physical health deterioration. In our study, 6 cases who were diagnosed with PTSD were also diagnosed with acute stress disorder during their first examination. 6(%50) of 12 patients diagnosed with acute stress disorder during the first examination had PTSD and 1(%8,3) of them had depression. Discussion and conclusion: In our study, we found that psychiatric diagnosis at first examination, occurrence of anal sexual action, the sexual action in the form of deprivation of liberty and whether the patient recognize the attacker have affects on mental health deterioration as a result of the sexual act; but the other factors about the occurence of an attack had no statistically significant impact on mental health deterioration. These findings suggest that one's personal characteristics and his/her social environment and its effects are the dynamic factor on the deterioration of mental health, and the psychological response to similar actions may have different natures. Psychological reactions that occur as a result of sexual assaults are variable and other different stressful life events, the absence of social support and additional diagnoses in the period after trauma have negative impact on the treatment process. It is reported that a small number of patients had complete remission, a large part of the patients had slight residual symptoms, and %10 of the patients had chronic course of symptoms. In this study, we determine that the factors that cause deterioration of mental health did not occur with the absolute effect of any of the investigated factors, and in accordance with the principle of ?there is no illness;there is ill.?, which is one of the basic medical rules, we think that the factors which affect the deterioration of mental health have variations. Therefore, in accordance with the fundamental aspects of the law, we suggest that the concept of physical and mental health deterioration in the articles 102 and 103 of TPC should be kept in order to ensure individual rights and to ease the public conscience about assessment of the deterioration of mental health. But we thought that after repeated efforts by increasing the number of cases is expected to be able to make a more accurate assessment.