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

BACKGROUND: Medical students face significant mental health challenges, yet psychological distress and post-traumatic stress remain insufficiently characterized in lower-resource settings like Vietnam. Among potential stressors, sexual violence (SV) exposure represents a critical but understudied risk factor. This study evaluated the severity of psychological distress (PD) and post-traumatic stress symptoms (PTSS) among medical students in Northern Vietnam and examined their associations with past-year non-contact and contact SV exposure. METHODS: A cross-sectional survey was conducted in May 2025 using REDCap among a probability sample of 555 medical students (years 2-5). Mental health outcomes were evaluated using validated instruments: the 21-item Depression, Anxiety, and Stress Scales (DASS-21) for past-week PD and the PTSD Checklist for DSM-5 (PCL-5) for past-month PTSS. Past-year non-contact and contact SV exposures were measured using the Sexual Experiences Survey-Victimization (SES-V). Multivariable linear regression modeled adjusted associations between SV exposure types and mental health symptom severity, testing for sex-specific differences. RESULTS: Overall mental health symptom scores escalated significantly with SV exposure. Median PTSS scores increased from 11 among unexposed students to 20 for non-contact SV and 30 for contact SV ( p < 0.001). Similarly, median PD scores increased from 7 (unexposed) to 11.5 (non-contact SV) and 21 (contact SV) ( p < 0.001). Adjusted linear models demonstrated robust associations where both non-contact and contact SV exposure were strong independent predictors of heightened PD and PTSS severity, with no significant moderation by sex. In terms of exposure prevalence, 21.26% of students reported non-contact SV (higher in females: 26.24% vs. males: 16.12%) and 10.66% reported contact SV. CONCLUSIONS: Vietnamese medical students exposed to sexual violence experience a heavy mental health burden marked by elevated psychological distress and post-traumatic stress symptoms. To protect student mental health in lower-resource settings, medical institutions must establish comprehensive trauma-informed psychological support, confidential counseling services, and targeted intervention strategies addressing both contact and non-contact stress exposures. HIGHLIGHTS: Prior-year non-contact and contact sexual violence are common in medical students in Northern Vietnam.Non-contact sexual violence is more common among female than male students.Contact sexual violence is more common among sexual-minority than heterosexual students.Non-contact and especially contact sexual violence are positively associated with psychological distress and post-traumatic stress.Inclusive, preventive and response services are needed to address sexual violence and its psychological impacts.