Assault victims may require medical help for post-traumatic stress syndrome: Matara study 

By Ruwan Laknath Jayakody 

Victims of assaults should be made aware that they may need to seek medical help for both anxiety and depression which may follow an assault, as the symptoms of post-traumatic stress syndrome can be both protracted, and debilitating and disabling, a study conducted in the Matara District found. 

This finding, citing a personal communication to the author from the Consultant in Accident and Emergency at the St. George’s Hospital in London, England, K.L.H. Stevens, which noted that the said syndrome may affect patients more seriously in the wake of a personal assault than subsequent to involvement in a major incident such as a train crash, was made by R.H.A.I. Rathnaweera (attached to the Ruhuna University’s Medical Faculty’s Forensic Medicine Department) in an original article on “A study on the victims of assaults in Matara” which was published in the Medico-Legal Journal of Sri Lanka’s Second Volume’s Second Issue in December 2015. 

Assault is a crime as per the law. Rathnaweera pointed out that the term is oft confused with battery, which involves physical contact. While the specific meaning of assault varies among countries per their Penal Codes, it can, Rathnaweera explained, refer to an act that causes another to apprehend immediate and personal violence, or in the more limited sense, a threat of violence caused by an immediate show of force. And although assault in certain United States (US) jurisdictions is broadly defined as being any intentional physical contact with another person without their consent, in the majority of the US, and in England and Wales and all other common law jurisdictions, this is defined as battery. 

On the other hand, certain jurisdictions have incorporated the definition of civil assault into the definition of the crime, making it a criminal assault to intentionally cause another person to apprehend a harmful or offensive contact (per S. Bute’s “Letter: The roots of violence”). A civil assault is an assault considered as a tort and not a crime where even though the same assaultive conduct can be both a tort and a crime, the civil assault isolates the legal elements that result in civil liability, and the assailant in such a case is liable in a civil action while the victim may be entitled to monetary damages from the assailant. 

In Sri Lanka too, Rathnaweera noted, assault is an increasingly common cause of injury. 

Hence, Rathnaweera conducted a retrospective study to identify demographic and social factors, assault characteristics and injuries sustained in a given population. Approximately 3,000 victims are referred to the Judicial Medical Officer’s office at the Matara General Hospital for medico-legal examination following physical injury, with the majority of such being victims of physical assaults. This study considered all the physical assault cases thus referred from 1 January 2012 to 1 December 2012. 

The total number of trauma cases was 2,820, out of which, less than half (1,381-48%) were due to alleged assaults. 

The majority of the victims of assault were male (67%) and had received the majority of the injuries (1,310/70% out of 1,857 injuries). Women comprised 33% of victims and had received 547 injuries (30%). 

The age of the victims ranged from three years to 85 years. There were 339 victims between the ages of 21 and 30 years and 326 victims between the ages of 31 and 40 years. Adults between 21 to 50 years of age (67%) were the main victims of assaults. In both sexes, there was a progressive reduction in the number of victims with increasing age. 

Of both the male and female victims, three quarter were unmarried. 

The commonest form of injury was abrasions (666) followed by contusions (429), lacerations, fractures, cuts, stabs, burns and dislocations. 

The upper limb was the commonest target (555), followed by the face (521), chest, head, lower limb and abdomen. 

A total of 1,396 were blunt force injuries (86%) and 187 were sharp force injuries, followed by burns. The majority of the assaults were carried out with fists and the feet, followed by clubs, while 8.5% of men and 3% of women were stabbed with knives or swords. Women were most commonly punched and kicked and received proportionately more widespread injuries than men. 

The category of hurt was non grievous in 1,023 (74%), grievous in 305 (22%), endangering life in 38 (2.5%) and fatal in the ordinary course of nature in 15 (1.5%). 

There was a progressive daily increase in the number of patients who were assaulted throughout the week from Monday (8%), to Sunday (25%). 

The majority of the cases were reported between 6 p.m. to 10 p.m. (510-36%) followed by incidents between the hours of 2 p.m. to 6 p.m. (307). Most of the incidents had taken place between 2 p.m. and 10 p.m. (59%). 

One third of the male victims and all the female victims stated that they had not taken alcohol in the six hours prior to the assault. 

Over half of the patients (54%) knew why they had been assaulted. 

Men were most commonly assaulted in the street near pubs (40%) while women were at home (almost half – 47%) with one third of women being assaulted in the street. 

A total of 1,242 (90%) assailants were known to the victim, 231 being relatives. The majority of the injuries were caused by a person known to the victim (90%). A total of 11 victims were unable to identify the sex of their attacker. 

In 85% of assaults, the assailant was a man, in 8% a woman, and in 2% both men and women. 

Over 80% of male assailants were estimated to be aged between 15 and 34-years-old, and a similar proportion of female assailants to be between 15 and 24 years. 

In half of the cases, men were assaulted by a single assailant while 69% of women were assaulted by a single attacker with all female domestic assaults being from a single hand. 

Discussing the findings, Rathnaweera noted that the majority of the victims were single, young men, assaulted late at night, during the weekend, in the vicinity of, or inside, pubs. The majority of these victims had drunk alcohol prior to the assault, and its role as a major causative and contributory factor in the incidence of assault is generally recognized (Bute, and the Home Office Research Study 108 on “Drinking and disorder: A study on non-metropolitan violence”), showing a broad correlation between the stated recent alcohol intake and blood ethanol levels. Studies (R.N. Norton’s “Mortality from interpersonal violence in Great Britain” and J.P. Shepherd, C. Scully, M. Shapland, M. Irish and I.J. Leslie’s “Characteristics of victims attending an inner city hospital”) have however shown that although the majority of victims who had been assaulted on the street had been drinking, one third of them had not been rendered more aggressive or more prone to attack through alcohol consumption. 

With regard to the pattern of injuries, while a preponderance of facial trauma represented an appreciable work load, the physical injuries were mainly of the soft tissue. 

If you feel that you or someone you know may be affected by this content or may require help the following institutions would assist you: 

The National Institute of Mental Health: 1926 

Sri Lanka Sumithrayo: 0112 682 535 

Shanthi Maargam: 0717 639 898 

Courage Compassion Commitment (CCC) Foundation: 1333