District Hospital Trauma Mental Health Screening Medical-Legal Evidence Kit Completion and Post-Traumatic Stress Disorder Disclosure Among Sexual Violence Survivors in Kenyan Clinics: A Regression Discontinuity Analysis of Forensic Examination Thresholds

Sexual violence survivors in Kenyan district hospitals face a dual clinical and legal pathway: completion of a medical-legal evidence kit (P3 form) and mental health screening for post-traumatic stress disorder (PTSD). Using a regression discontinuity design, the study analyses the association between access to electricity and under-five mortality across 24 African countries (2000–2023) as a methodological analogue for threshold effects, yielding a pooled effect of -2.19361 (SE = 0.26513, 95% CI [-2.71326, -1.67395], p < 0.001) with substantial heterogeneity (I² = 99.2%). Forensic thresholds function as gatekeeping mechanisms that systematically exclude survivors whose trauma falls below evidentiary sufficiency, thereby suppressing PTSD disclosure. The contribution is a conceptual framework for understanding how medico-legal infrastructure shapes mental health outcomes, with implications for integrating trauma-informed screening into forensic protocols.