In the United States, more than one-in-two (54.3%) women will experience contact sexual violence, also referred to as sexual assault, in their lifetime (Basile et al., 2022). Sexual assault, defined as unwanted or nonconsensual sexual touching as well as oral, anal or vaginal penetration due to force, drug or alcohol incapacitation, or verbal coercion, is associated with elevated risk for short- and long-term physical health problems (Golding, 1999; Jakubowski et al., 2021), including physical pain (McLean et al., 2012; Short et al., 2022; Ulirsch et al., 2014), and mental health conditions including posttraumatic stress disorder (PTSD), suicidality, and substance use disorders (Dworkin et al., 2017). One form of sexual assault, rape, is associated with a population economic burden of nearly $3.1 trillion (2014 U.S. dollars) over victims’ lifetimes (Peterson et al., 2017).

Rape is the traumatic event associated with the highest conditional probability of developing PTSD (Kessler et al., 1995). PTSD includes recurrent and distressing intrusive recollections of the trauma, avoidance of people, places and things that remind one of the trauma, negative affect and cognitions about oneself, and heightened arousal including irritability, hyperarousal, and sleep disturbances (American Psychiatric Association and American Psychiatric Association, 2013). Meta-analyses indicate that nearly 75% of sexual assault survivors meet criteria for PTSD one month after assault and 41.5% meet criteria for PTSD 12 months after assault (Dworkin et al., 2021).

In nationally representative samples, 21% of women rape victims sought post-assault medical care, which may include a sexual assault nurse exam (SANE) (Zinzow et al., 2012). Similar to Screening, Brief Intervention, and Referral to Treatment (SBIRT) models for substance use disorders (Horn et al., 2017), SANE care may provide an opportunity to screen for PTSD risk and provide early interventions to prevent the onset or worsening of PTSD. Indeed, early detection and intervention may be critical to preventing a chronic and impairing course of PTSD (e.g., Gilmore et al., 2021; Kearns et al., 2012; Rothbaum et al., 2012). Interventions delivered in the immediate aftermath of sexual assault have been associated with reductions in PTSD and depression symptoms (Gilmore et al., 2021). However, risk stratification tools that could be used at the time of SANE care to identify those most likely to benefit from an intervention have not been derived and validated.

Numerous instruments have been developed to screen for PTSS in acutely injured trauma survivors (see Jensen et al., 2022 for review). Acute stress symptom severity, being a woman, having less education, being exposed to prior trauma, and having comorbid psychiatric and substance use diagnoses have been associated with elevated PTSD risk (Russo et al., 2013; Shalev et al., 2019). Importantly, with few exceptions (Pijpers et al., 2022; Tiihonen Möller et al., 2014), most of these studies have been conducted in mixed gender samples with varied trauma exposure and relatively low rates of PTSD (e.g., 11.8% overall in Shalev and colleagues [2019] study). Sexual assault survivors are more likely to be women (vs men; Basile et al., 2022),1 and to have substantially elevated PTSD rates (75% at 1 month and 41% at 12 months; Dworkin et al., 2021) and thus may require tailored risk prediction tools. The current study sought to develop and perform initial validation of a brief and easy-to-administer stratification tool for persistence of elevated PTSD symptoms six months after sexual assault. The analysis was performed with data from the Women's Health Study, a large-scale prospective study of women presenting for SANE care after exposure to sexual assault. In addition to examining the predictive utility of this tool for elevated PTSS six months after assault, we also validated the utility of the tool in predicting elevated PTSS one year after sexual assault.