Here is his statement,

The reason for this rating is because the game contains high impact horror themes, violence, blood, gore, and sex.

In the second submission, the same game code was submitted, with a video file reflecting the final game content. The game was then approved for release with an R18+ rating. There will be only one version of Outlast 2 available worldwide. These will be the final comments made on this release.

Outlast 2, a first-person survival horror, about a couple whom are investigative journalist, searching for answers to the death of a mysterious pregnant women who is a Jane Doe. In the process they are separated in a helicopter crash and you play Blake Langermann who has to travel through a hidden village that believes it’s the end of days, to find his wife.

The game will be released on PS4, Xbox One, and Microsoft Windows on April 24, 2017.