Psychological Distress and Post-Traumatic Stress Symptoms among Medical Students in Vietnam: Associations with Non-Contact and Contact Sexual Violence Exposure

Technical Summary: Psychological Distress and Post-Traumatic Stress Symptoms among Medical Students in Vietnam

Problem Statement
Medical students globally face significant mental health challenges, yet the specific burden of psychological distress (PD) and post-traumatic stress symptoms (PTSS) among students in lower-resource settings like Vietnam remains insufficiently characterized. While sexual violence (SV) is a known public health crisis and a violation of human rights, its prevalence and specific associations with mental health outcomes among Vietnamese medical students are understudied. Existing literature often categorizes SV broadly, failing to distinguish between contact SV (non-consensual physical interaction, ranging from touching to rape) and non-contact SV (intrusive behaviors without physical contact, such as verbal harassment or exhibitionism). Furthermore, there is a lack of data regarding sex-specific differences in these associations within the Vietnamese context, where cultural norms regarding male entitlement and victim-blaming may influence reporting and outcomes. This study addresses the need to describe the prevalence of SV victimization by sex and other characteristics and to test for sex-specific associations between SV exposure and symptoms of PD (depression, anxiety, stress) and PTSS.

Methodology
The study employed a mixed-methods cross-sectional design, with the quantitative component reported here.

• Setting and Sample: Conducted in May 2025 at a medical university in Northern Vietnam. The target population included 5,000 undergraduate students in years 2–5. A stratified random sampling method was used to select 600 participants, resulting in 555 completed surveys (92.5% response rate).
• Instruments:
  • Mental Health Outcomes: Psychological distress was measured using the 21-item Depression, Anxiety, and Stress Scales (DASS-21) for the past week. Post-traumatic stress symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) for the past month. Both instruments demonstrated high internal consistency (Cronbach's alpha > 0.90 for total scores).
  • Primary Exposure: Past-year sexual violence exposure was measured using the Sexual Experiences Survey–Victimization (SES-V), a 45-item validated tool distinguishing between non-contact SV (10 items) and contact SV (35 items).
  • Covariates: The analysis controlled for age, sex assigned at birth, sexual orientation, ethnicity, living arrangement, prior relationship status, and sexual partner history.
• Statistical Analysis: Descriptive statistics summarized participant characteristics. Group differences in mental health scores (which were right-skewed) were analyzed using the Kruskal–Wallis test and Wilcoxon rank-sum tests with Bonferroni correction. Multivariable Ordinary Least Squares (OLS) regression models were used to examine associations between SV exposure types and mental health outcomes, including interaction terms to test for sex-specific moderation.

Key Results

• Prevalence of Exposure: Overall, 31.92% of students reported some form of SV in the past year. Non-contact SV was reported by 21.26% of students (significantly higher in females: 26.24% vs. males: 16.12%). Contact SV was reported by 10.66% of students, with no statistically significant difference between sexes (females: 10.28% vs. males: 10.99%).
• Demographic Correlates: Contact SV was significantly more prevalent among sexual minority students (50.94%) compared to heterosexual students (6.37%). It was also higher among students with prior relationship experience and those with diverse sexual partner histories (e.g., 77.78% of students who had sex with both males and females reported contact SV).
• Mental Health Associations: A clear dose-response relationship was observed. Median PTSS scores increased from 11 (unexposed) to 20 (non-contact SV) to 30 (contact SV). Similarly, median PD scores rose from 7 (unexposed) to 11.5 (non-contact SV) to 21 (contact SV).
• Regression Findings:
  • Contact SV was a robust independent predictor of heightened severity across all mental health domains, including depression, anxiety, stress, and all PTSS subscales (intrusion, avoidance, negative alterations, arousal).
  • Non-contact SV was significantly associated with increased anxiety, stress, and PTSS, but not with depression in the adjusted models.
  • Sex Differences: No significant interaction effects were found between SV exposure and sex assigned at birth. This indicates that the psychological impact of both contact and non-contact SV on PD and PTSS severity is similar for male and female students, despite differences in exposure prevalence.

Key Contributions

1. Differentiation of SV Types: The study provides granular data distinguishing the mental health impacts of contact versus non-contact SV in a Vietnamese medical student population, revealing that while both are harmful, contact SV carries a heavier burden, particularly regarding depression.
2. Inclusivity of Risk: The findings challenge the assumption that contact sexual violence is exclusively a female issue in this context, demonstrating similar prevalence rates between male and female students and confirming that male victims experience comparable levels of psychological distress and PTSS.
3. Vulnerability of Sexual Minorities: The research highlights a critical disparity, identifying sexual minority students as a high-risk group for contact SV, with prevalence rates significantly exceeding those of heterosexual peers.
4. Contextual Evidence: It fills a gap in the literature regarding sexual violence and mental health in lower-resource, non-Western settings, specifically within the high-stress environment of medical education in Vietnam.

Significance and Claims
The paper claims that Vietnamese medical students exposed to sexual violence face a heavy mental health burden, characterized by elevated psychological distress and post-traumatic stress. The authors assert that:

• Trauma Continuum: There is a continuum of trauma where non-contact SV acts as a chronic stressor linked to anxiety and PTSS, while contact SV represents a more severe trauma linked to depression and broader psychological impairment.
• Universal Impact: The psychological consequences of sexual violence do not differ significantly by sex; therefore, prevention and response strategies must be inclusive of all genders.
• Institutional Responsibility: Medical institutions in lower-resource settings must move beyond gender-restricted approaches. The authors call for the establishment of comprehensive, trauma-informed psychological support, confidential counseling, and targeted interventions that address both contact and non-contact stress exposures, with specific attention to high-risk groups such as sexual minorities and students with diverse partner histories.

The study concludes that while sexual violence is a pervasive issue in higher education globally, the specific patterns observed in Vietnam—particularly the high prevalence of contact SV across sexes and the severe mental health toll—necessitate urgent, inclusive institutional action to protect student well-being.