Maximizing the reach of universal child sexual abuse prevention: Protocol for an equivalence trial

Background

Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities.

Methods

The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3).

Conclusion

Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools.

Clinical trial registration

NCT06195852.

Sexual Abuse, Commercial Sexual Exploitation, and Cumulative Adversity Among Sexually Diverse and Non-Sexually Diverse Girls in the Juvenile Justice System

Despite awareness about high rates of sexual abuse among girls in the juvenile justice system, little is known about the additional risk conferred upon sexually diverse (SD) youths, as well as the combined vulnerability of sexual abuse and commercial sexual exploitation of children (CSEC) - frequently a survival behavior amplifying disproportionate juvenile justice contact among SD and non-SD juvenile justice-involved (JJI) girls. In a sample of JJI-girls, we compared SD (n = 52) with non-SD (n = 46) JJI-girls on sexual victimization (e.g. sexual abuse occurring within different relationship-types, CSEC), and broader developmental adversity burden disadvantage (cumulative trauma/loss exposure-types) and distress (posttraumatic stress disorder [PTSD]; cumulative stressor-reactivity, grief-specific, and adversity-related symptoms), health distress/impairment, and sexual and physical health-risk indicators. While comparable on childhood sexual abuse frequency, SD JJI-girls reported greater cumulative sexual abuse severity across relationship-types, higher sexual abuse within non-familial contexts, and more CSEC involvement. They also reported more social determinants of health (e.g. trauma/loss exposure-types) and showed elevations on all health-risk indicators, and most cumulative adversity burden indicators, despite comparable PTSD severity. Our findings emphasize the need to consider multiple sexual victimization facets, including the combined vulnerability of sexual abuse and CSEC, and utilize cumulative developmental assessment approaches among youths vulnerable to maltreatment and exploitation.

Identifying PTSD and Complex PTSD Profiles in Child Victims of Sexual Abuse

Post-traumatic stress disorder (PTSD) symptoms are frequent in child victims of sexual abuse. Authors argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed that Complex PTSD (C-PTSD) involving alterations in attachment, biology, affect regulation, consciousness, behavioral regulation, cognition, and self-concept, may better describe children experiencing chronic trauma at an early developmental stage. The aim of the study was to disentangle the diversity of profiles in child victims of sexual abuse based on the C-PTSD framework. Latent profile analysis was used to identify distinct subgroups in a sample of 861 sexually abused children aged 6 to 12. Children and their non-offending parents completed questionnaires evaluating PTSD symptoms and measures documenting alterations in development characteristics of C-PTSD. Latent profile analysis identified a best-fitting model consisting of three profiles: PTSD (40.7% of children), Resilient (32.8% of children), and C-PTSD (26.5% of children). Compared to others, children in the C-PTSD profile were more likely to have experienced more forms of interpersonal trauma and showed impairments in several domains. Findings underscore the importance of tailoring interventions to efficiently address the needs of young victims of sexual trauma.

Somatic Problems in Children Disclosing Sexual Abuse: The Mediating Role of Alexithymia and Dissociation

Child sexual abuse (CSA) is linked to heightened levels of medically unexplained symptoms. Research indicates that victims of CSA display alexithymia and dissociation symptoms. Alexithymia and dissociation may potentially contribute to developing somatic complaints in CSA victims. They represent mechanisms through which psychological distress is avoided and could then manifest as physical symptoms like somatic problems (e.g. headaches, nausea, stomachache, etc.). This study aimed to investigate if alexithymia and dissociation are mechanisms explaining the link between CSA and somatic complaints. The sample included 245 children who had disclosed child sexual abuse and 100 non-abused children aged 6-12 years old. Results of a sequential mediation model revealed that the CSA-somatic complaints relationship was mediated by alexithymia and dissociation. This study suggests that intense negative emotion leads children to focus on external stimuli to reduce psychological suffering. To mitigate somatic problems in victims of CSA, treatment should target overregulation of affect, namely alexithymia, and dissociation. In the long term, this could prevent unnecessary diagnostic testing and delay in appropriate interventions.

Gender-related stigma toward individuals with a history of sexual or physical violence in childhood

BACKGROUND

Stigma is a key barrier to disclosing traumatic experiences of violence in childhood with adverse consequences for help-seeking behaviour. Disclosing behavior differs by gender and the form of violence experienced. However, there is a lack of comprehensive studies that address societal perceptions of males and females with a history of sexual or physical violence in childhood. Therefore, our aim is to focus on the impact of gender on the perception of individuals who experienced sexual or physical violence in childhood.

METHODS

We conducted a study on a representative sample of the German general population in terms of age and gender. Participants were randomly assigned to brief case vignettes addressing sexual or physical violence in childhood. Analyses base on a sample of n = 659 individuals (50.1% female). Stigma was assessed through examining respondents' readiness to address specific traumas in conversation and respondents' attitudes toward the individuals in the vignettes. Mann-Whitney U tests were applied to check for differences between female and male victims and survivors as well as female and male respondents.

RESULTS

Our results reveal that male victims and survivors face higher negative stereotypes (harm, unpredictability) and evoke communication barriers more often when compared to female victims and survivors, especially in male respondents. Sexual violence is associated with more distinct gender differences than physical violence.

CONCLUSIONS

Findings reflect greater stigma toward male victims and survivors of sexual violence than female ones. Men had a greater tendency to stigmatize - especially toward their same-gender peers. Socially ingrained gender roles may act as a basis for different communication cultures and the notion of victim-perpetrator constellations in which males are not envisaged as victims.

Effectiveness of school-based interventions on child sexual abuse knowledge in children with disabilities: Systematic review and meta-analysis

BACKGROUND

Children with disabilities (CWDs) constitute a substantial segment of the population who encounter abuse, emphasizing the need to comprehend the influence of school-based interventions on this susceptible group.

AIM

This systematic review and meta-analysis aimed to identify and evaluate the effectiveness of school-based interventions in enhancing child sexual abuse (CSA) knowledge among CWDs.

PARTICIPANTS

This meta-analysis incorporated seven published studies, encompassing 387 CWDs.

METHODS

Our study synthesizes findings from seven experimental and quasi-experimental studies, adhering to the PRISMA guidelines. The study was registered in PROSPERO. The literature search, conducted between September 25, 2023, and October 2, 2023, employed various databases and keywords relevant to the study's scope. The research question and articles' eligibility were assessed using the Population, Intervention, Comparison, Outcomes, and Study type (PICOs). The meta-analysis was conducted using the Comprehensive Meta-Analysis (CMA) software.

RESULTS

The school-based intervention greatly impacted CWDs' CSA knowledge scores (Hedges's g = 1.026 [95% CI: 0.845; 1.208], z = 11.074, p = 0.000). The findings of this meta-analysis demonstrate that Questionnaire/scale-based knowledge measurement (Hedges's g = 2.586 [95% CI: 0.920; 4.252], z = 3.043, P = 0.002) and Vignette-based knowledge measurement (Hedges's g = 1.065 [95% CI: 0.655; 1.474], z = 5.100, p = 0.000) are effective in assessing CWDs' knowledge of CSA.

CONCLUSION

This systematic review and meta-analysis of seven randomized controlled studies and quasi-experimental studies provide robust evidence supporting the effectiveness of school-based interventions in significantly enhancing CSA knowledge among CWDs.

IMPLICATIONS TO PRACTICE

These findings are potentially significant evidence for education professionals, including educators and school health nurses.

The prevalence of child sexual abuse perpetrated by leaders or other adults in religious organizations in Australia

BACKGROUND

Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce.

OBJECTIVE

To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia.

METHODS

The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS).

RESULTS

One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3-0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5-1.2 %), compared to women (0.1 %, 95 % CI, 0-0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3-0.6 %), compared to women (0 %, 95 % CI, 0-0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16-24-year-old men).

CONCLUSIONS

Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.

Effects of Therapy at a Community Based Trauma Therapy Service Treating Child Abuse and Neglect: A Pre-Post Study Using Administrative Data

This repeated-measures study examined the effects of a hybrid of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) with other therapeutic approaches at a community-based clinic in Perth Western Australia among a sample of children and young people overwhelmingly experiencing multiple forms of maltreatment and with complex family situations (i.e., family and domestic violence, parental mental health, parental substance abuse). Drawing on 1713 individual client records from between 2017 and 2020, the researchers identified 113 children and young people with viable pre-post treatment assessments including 78 on the TSCC, 36 on the TSCYC, and 12 on the CBCL. Significant improvements on most clinical scales were identified on the TSCC and TSCYC. Sub-analysis of the TSCC results found no differences across gender, age, care status, therapy funding source, and the presence of sexual abuse in the rate of improvement on trauma symptoms. Overall, the study highlights that integrating different therapy approaches for populations with multiple and complex trauma symptoms accessing community-based services can be useful for supporting the delivery of TF-CBT for difficult to treat populations.

Trust, entrusting and the role of trustworthiness for adult survivors of child sexual abuse

BACKGROUND

Survivors of Child Sexual Abuse (CSA) are reported to have difficulties in trusting. Yet no previous study investigating CSA survivors' subjective experiences of trust exists and there is a paucity of clinical research into constructs and definitions of "trust."

AIMS

To use a phenomenological lens to investigate CSA survivors' descriptions of trust relationships and trustworthy others by privileging their subjective experience. To better understand how trust can be built within therapeutic relationships.

METHODS

A qualitative methodology using Interpretative Phenomenological Analysis was conducted within the survivor-research paradigm. The researcher was a person with lived experience of CSA who co-produced the study with CSA survivor advisors and co-constructed interviews with 17 adult CSA survivors.

RESULTS

Findings present a "Survivor Trust Enactment Model" that delineates the process of building/repairing relational trust and advancing "transactional trust." Trust is portrayed as nuanced and formed across and according to context, including the demarcation of generalised and relational trust. The findings emphasise that trustees' trustworthiness is key to building trust which challenges assumptions that survivors are deficient in trust.

CONCLUSION

The foregrounding of subjective trust experiences challenges diagnostic and clinical views on trust deficiency in adult CSA survivors. The study develops clinical constructs of trust, considers implications for clinical practice, and indicates areas for further research into trust dynamics in therapeutic relationships.

From percentages to narratives: Giving silence a voice in child sexual abuse within the Portuguese Catholic Church, 1950-2022

BACKGROUND

Over the last two decades, several studies have examined the extent and expression of child sexual abuse (CSA) in religious institutions. In 2021, following new Vatican guidelines and under intense public pressure, the Portuguese Episcopal Conference commissioned a study on CSA in Portugal by members of the Portuguese Catholic Church (PCC) and others associated with it (from 1950 to 2022).

OBJECTIVE AND METHODS

The study draws on a web-based survey and a respondent driven sample. The questionnaire included categorical questions about victims, abusers, types of abuse, and open-ended questions. We characterized victims and abusers and developed a social cartography of abuse using Correspondence Analysis. Victims' narratives are also part of the model of analysis.

RESULTS

We validated 512 of CSA by members of the PCC. Boys were more frequently abused (57.2 % vs. 42.2 %); male abusers predominate (96.7 %); most victims were abused more than once (57 %); the average age of victims when the first abuse occurred was 11.2 years. More invasive forms of abuse predominate (80 % manipulation of sexual organs or penetration; only 20 % had no body touching). There are patterns of abuse, and space plays a pivotal role in understanding the forms that CSA takes within Catholic environments. The richness of individual narratives was an unexpected outcome that enables us to better understand the organisational and symbolical power structures in which abuse takes place.

CONCLUSION

Given the characteristics of our sample, these cases are the tip of the iceberg, with CSA within the PCC likely involved thousands of children. Further research should strive to consider victims' narratives.

Schools' readiness for child sexual abuse prevention education: Preliminary scale development using a Delphi method

BACKGROUND

This study employed a Delphi method with a panel of experts to collaboratively design a new instrument to assess schools' readiness for school-based child sexual abuse prevention education.

METHODS

An initial item pool was generated based on a review of existing empirical research and theoretical models. We invited researchers and stakeholders in the field of child sexual abuse prevention as experts to participate in a two-round online Delphi study in which they rated item importance and clarity, contributed their views on superfluous and/or missing items, gave rephrasing suggestions, and re-appraised revised items. Following the Delphi study, the instrument was pilot tested with a convenience sample of school staff.

RESULTS

The initial item pool comprised 81 items in five construct sub-scales congruent with Wiener's Organizational Readiness for Change theory: contextual factors, informational assessment, change valence, change commitment, and change efficacy. In the Delphi study, 24 experts participated in round 1, and 13 participated in round 2. Based on Delphi study responses, the instrument was reduced to 56 items in the five construct subscales: contextual factors (28 items), informational assessment (13 items), change valence (6 items), change commitment (3 items), and change efficacy (6 items). The Schools' Readiness for Child Sexual Abuse Prevention Education (SR-CSAPE) was successfully pilot tested with school staff (n = 19) and minor changes to demographic items were incorporated.

CONCLUSIONS

Informed by experts, the Schools' Readiness for Child Sexual Abuse Prevention Education (SR-CSAPE) is a newly-developed 56-item scale that identifies key organizational dimensions to schools' preparedness for CSA prevention education. Psychometric properties of the scale must be determined in future research.

Review of Policies and Practices to Prevent Technology-Facilitated Child Sexual Abuse Within Youth-Serving Organizations in the United States

Technology-facilitated child sexual abuse (TF-CSA), or child sexual abuse that occurs online or through electronic communication, is a preventable public health problem that can be addressed within youth-serving organizations (YSOs). This study is a review of a purposive sample of organizational policies and practices designed to prevent TF-CSA collected from 13 national and local YSOs in the United States. Documents were coded to identify practices to prevent TF-CSA related to YSO activities or YSO staff, volunteers, or participants. Qualitative analysis indicated that YSOs included seven common practices to prevent TF-CSA in their documents. These practices included transparent electronic communication between youth and YSO staff; codes of conduct and online behavior agreements related to youth; monitoring the YSO's online presence; parental controls for youth online activity; safety behaviors for online activity for staff, parents, and youth; parent and youth trainings for youth online engagement and prevention of TF-CSA; and practices to address staff policy violations. Most prevention practices documented by YSOs identified in this study are consistent with emerging literature on TF-CSA prevention. Key gaps include protections for youth from groups inequitably burdened by TF-CSA and evaluation of the implementation and effectiveness of practices in preventing TF-CSA across settings and populations.

Reoffending after convictions related to child sexual exploitation material: Data from the German Federal Central Criminal Register

BACKGROUND

As digitalization has made it easier to produce, copy, and distribute child sexual exploitation material (CSEM), the possession and distribution of child sexual abuse images has become more widespread. Thus, the need to assess the risk of subsequent sex offenses - above all, sexual abuse of children by individuals who have been convicted of CSEM offenses - becomes more and more important.

OBJECTIVE

The main objective of this paper is to contribute to the understanding of the respective size of two groups of offenders: first, offenders who commit CSEM offenses without ever crossing the line to sexual abuse of children, and second, so-called crossover offenders, that is, individuals who commit CSEM offenses and engage in child sexual abuse. Identification of differences between these two groups facilitates analyzing the risk that someone convicted of a CSEM offense might in the future sexually assault children.

METHOD

We used data from the German Federal Central Criminal Register (Bundeszentralregister), a data set that includes information about all persons convicted of any criminal offense, including "child pornography" offenses, by a court in Germany.

RESULTS

For persons convicted of CSEM offenses only, with no additional concurring sex offenses, the rate of subsequent convictions for child sexual abuse is very low (1.1 % after a six-year follow-up period, adult offenders). This risk is even lower if offenders are older than 30 years of age, and it is slightly higher for offenders with previous offense-specific convictions (i.e., previous sex offenses).

CONCLUSIONS

The mere existence of a conviction for a CSEM offense is not an indication that the convicted person poses a significant risk of committing child sexual abuse. To pinpoint such a risk more accurately, the following factors should be examined: the existence of offense-specific prior records, the presence of crossover-offending in the form of concurring offenses, and the age of the offender.

The safeguarding capability of adults in Catholic Church ministries: A global perspective

BACKGROUND

In the wake of historical sexual abuse across the Catholic Church globally, the Church continues to develop policies and processes to prevent and respond to child sexual abuse, including supporting the skills, knowledge, and confidence of members of the Church.

OBJECTIVE

We investigated the safeguarding capabilities of a range of people with different roles within Catholic Church ministries in various countries.

PARTICIPANTS AND SETTING

Our 184 participants included lay people, religious men and women, school staff, safeguarding officers and tertiary students associated with the Catholic Church. Data were collected across seven different countries.

METHODS

We measured the awareness, confidence, attitudes, and knowledge of participants and examined differences between participants in different roles within the Church and different countries through General Linear Models.

RESULTS

We found varying levels of awareness, confidence, attitudes, and knowledge regarding sexual abuse prevention and safeguarding. We pinpointed the significant differences in three of these domains (confidence, attitudes, and knowledge) both between people with different roles in the church worldwide, but also between the countries from which participants came from.

CONCLUSIONS

We found that people in various countries and roles within the Church are at different stages of their safeguarding journey. Some are still understanding their roles (attitudes), some are still learning about how it is operationalised (awareness), and others are acquiring skills that will prepare them for enacting safeguarding policies and practices (confidence).

First, do no harm: Critically revisiting contemporary approaches to child sexual abuse prevention

Crime prevention is typically presented in a tripartite model that includes primary, secondary, and tertiary domains. Almost every criminal justice intervention constitutes tertiary prevention and occurs reactively, in the aftermath of an offence. Child sexual abuse is no exception, and prevention science has long recommended we focus our intervention efforts further upstream. Such an approach would include earlier detection and disclosure (secondary prevention), or-even better-reducing the risks of early exposure to the environmental forces which facilitate sexual abuse in the first place (primary prevention). What is missing from the field, however, is a coherent framework through which to critique the unintended consequences of our well-intentioned responses to child sexual abuse. Such consequences include secondary trauma for victim survivors and vicarious trauma for families and practitioners. In this article, we reflect on prevention from a critical perspective that centres the principle of "first, do no harm." In doing so, we introduce the notion of 'quaternary prevention' for child sexual abuse. Public health has long recognised the risks of medicalisation, overdiagnosis, and unnecessary intervention. We encourage our field to engage within a framework of quaternary prevention to consider the iatrogenic effects of many contemporary practices and to take seriously the "do no harm" principle to improve practice across all levels of prevention.

Characteristics and Treatment of Cyberviolence Trauma in Children and Adolescents

Cyberviolence is a new form of violence encompassing any online activity that results in harm to the psychological, emotional, financial, or physical well-being of an individual or group. These adverse activities often lead to serious offline and long-lasting negative impact, especially on children and adolescents whose development has not matured sufficiently. Therefore, it is more important for mental health professionals to be well informed about the rapidly evolving forms of cyberviolence and its risks and to respond appropriately. This article provides an overview of the concept and unique features of cyberviolence trauma in minors in South Korea while also examining ongoing efforts to explore and implement effective treatment programs. Cyberbullying and digital sexual abuse, the most common forms of cyberviolence experienced by minors in South Korea, are explored in detail. Additionally, this review proposes directions for future research and the efforts that clinicians should focus on.

The Impact of Training on Nurses' Attitudes Toward Reporting Child Sexual Abuse: a Pilot Study

The purpose of this project is to assess, for practicing pediatric nurses in the U.S., what is the impact of the Stewards of Children Child Sexual Abuse (CSA) program on their attitudes about reporting suspected CSA. A sample size of 32 nurses completed an online 2-hour continuing education course by Stewards of Children, with a pre/post-test survey. A modified 14-item version of the Teachers Reporting Attitudes Scale for Child Sexual Abuse (TRAS-CSA) was used to measure the nurses' attitudes before and after educational training. The surveys were analyzed to assess changes in attitudes using two-tailed sign tests. Nurses' commitment to reporting CSA is high, even before training. Nurses' confidence in the system of reporting and in the response of authorities related to CSA increased after taking the Stewards of Children online course. While these results are limited in strength by low sample sizes and some null changes, they indicate that trainings like the Stewards of Children course can positively impact nurses' attitudes towards reporting CSA, particularly with regards to confidence in reporting, and therefore warrant further investigation into CSA training for nurses and its effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-023-00581-7.

Executive functioning in child victims of sexual abuse: A multi-informant comparative study

BACKGROUND

Research examining the association between child sexual abuse and executive functions is limited. Yet, exposure to traumatic situations at a young age has been associated with changes in the prefrontal cortex, which hosts executive functions (Wesarg et al., 2020). These functions are crucial for social adaptation, as they make it possible to inhibit maladaptive behavior and respond flexibly to the demands of the environment. As middle childhood is a sensitive period for the development of self-regulatory abilities, exploring executive functioning in school-age children could provide potential intervention targets (Dajani & Uddin, 2015).

OBJECTIVE

Using multiple informants, this study compared executive functioning of sexually abused children to that of non-sexually victimized children and examined whether the differences were moderated by sex.

METHODS

The sample consisted of 225, 6-to-12 years old children with a history of child sexual abuse (CSA) and 97 children without a history of CSA. Children completed two executive functioning tasks measuring cognitive flexibility and inhibition. Parents and teachers completed questionnaires evaluating children's executive functioning.

RESULTS

In comparison to non-abused children, children with a history of CSA displayed greater executive functioning difficulties as assessed by both informant-reported questionnaires and self-completed tasks. Significant interaction effects were found, such as CSA predicting lower inhibition and executive functions at school in boys but not in girls.

CONCLUSION

This study is a first step in understanding the association between CSA and executive functioning and offers a clearer picture of the differential impact of sexual trauma according to children's sex.

Sexual abuse and post-traumatic stress disorder in childhood, adolescence and young adulthood: a systematic review and meta-analysis

Child sexual abuse (CSA) has been associated with mental health disorders throughout life during childhood, adolescence and adulthood; one of the most prevalent mental health conditions after CSA is post-traumatic stress disorder (PTSD). The present systematic review and meta-analysis aims to examine the association between CSA and PTSD in children and adolescents, evaluating also the role of potential effect modifiers, such as gender and geographic region. Participants were sexually abused (vs. CSA-free) children, adolescents and young adults, up to 21 years of age, with or without a PTSD diagnosis. Settings of eligible studies spanned school, college, university, community, hospital and non-hospital mental health facilities. Eligible studies were sought in PUBMED, ΕΜΒΑSE, PSYCINFO and GOOGLE SCHOLAR databases; end-of-search was set at August 31, 2020. Random-effects (DerSimonian-Laird) models were used for the pooling of studies. Results were reported as pooled odds ratios (OR) and 95% confidence intervals (95% CIs). Twenty-eight studies were identified, including a total cohort of 28,693 subjects. CSA was strongly associated with PTSD, at a similar extent in boys (pooled OR = 2.86, 95% CI 2.09-3.91) and girls (pooled OR = 2.38, 95% CI 1.76-3.23); meta-regression with gender confirmed the non-significant effect of gender. The association was present in all examined geographic regions. CSA is strongly associated with PTSD in childhood, adolescence and young adulthood, irrespectively of gender. Future studies should opt for thorough assessment of confounders and examine regions with paucity of studies, such as East Asia and Latin America.

Prevention of child sexual abuse in the United States: Scoping review of United States legislative policies

BACKGROUND

States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA.

OBJECTIVE

Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies.

METHODS

The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed.

RESULTS

2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics.

CONCLUSIONS

Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended.

Organized sexualized and ritual violence: Results from two representative German samples

BACKGROUND

Organized sexualized and ritual abuse (ORA), a contentious issue since the 1980s, remains a polarizing topic. Although there is much debate about the existence of this phenomenon, a differentiated perspective is lacking, and no representative study has yet addressed the frequency.

OBJECTIVE

This paper aims to investigate the frequency of ORA in Germany using two representative datasets.

PARTICIPANTS AND SETTING

Data were collected from representative samples of the German population (N = 2522, N = 2515). Participants aged 16 to 96 years (50 and 53 % female) were recruited. They were selected by a random route procedure and asked to fill out a paper-pencil-questionnaire.

METHODS

The four aspects of ORA (severe sexual violence, perpetrator networks, commercial exploitation, ideology) were assessed based on the definition provided by an expert group. Additionally, in the second survey, a direct yes/no question about the experience of ORA as well as details on perpetrators and offense characteristics were surveyed.

RESULTS

Frequency of ORA was low. The direct question on ORA was affirmed by 0.5 % (n = 13), while according to the criteria of the definition, only 0.2 % or less of individuals experienced organized sexualized abuse, and <0.1 % experienced ritual abuse.

CONCLUSION

Although ORA is discussed thoroughly, frequencies in the German population are low. This may be due to inconsistent terminology and operationalization of definitions with lack of precision. However, an intersection of conspiracy beliefs and the topic of ritual violence sheds another light on this issue that should receive more attention.

The Need for a Prevention Program for Child Sexual Abuse in Brazil: A Report of Shortfall Care to Pedophilia and its Critical Consequences

From a case report of a person with pedophilic disorder, this paper focuses on the issue of pedophilia, child sexual abuse, and the need for specific prevention and treatment strategies in Brazil. It seems inevitable to increase awareness for this topic within the mental health care system to protect children and reduce the risk for sexual offense in individuals at-risk. This is a case report of an individual, known by medical-psychiatric and forensic facilities for a past history of patricide, who revealed his pedophilic fantasies and behavior belatedly. To assess a pedophilic disorder and screen for other paraphilic contents, a screening questionnaire and clinical interview were used during the patient hospitalization in 2020 for a proper evaluation of sexual history and past offending behaviors. A review of the literature on pedophilia prevention programs was also carried out. WW is a middle-aged man admitted to a psychiatric unit for a severe episode of major depressive disorder and at risk of suicide. During recovery, he reported pedophilic fantasies and behaviors in his life. Sexual fantasies involving children and actual sexual offenses have remained unknown to mental health professionals and unreported to legal authorities. WW's case alarmingly emphasizes the need for the training of health care professionals and for preventive strategies in Brazil for those who are at risk of engaging in offending sexual behaviors in a combined and intensive effort to protect children from sexual offense.

Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae

Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.

Child Sexual Abuse within the Catholic Church in Spain: A Descriptive Analysis of its Characteristics and Long-Term Impact

Sexual abuse within the Catholic Church is a serious social issue and a significant public health problem that has caused extensive harm worldwide. In 2022, an independent commission was established in Spain to investigate sexual abuse within the Church. The commission gathered data from 334 victims (82.3% men, 17.7% women), who were predominantly aged between 55 and 74 years old (62.5%). A majority of victims (71.0%) endured sexual abuse involving physical contact, while 21% reported instances of oral, anal, or vaginal penetration. Over half of the victims (57.5%) reported emotional and behavioral issues, as well as functional problems, problems in relationships, sexuality, and cognition, and attributed these difficulties to the abuse. The majority of participants (79.0%) had disclosed the abuse before the study, with the Church taking action in 45.8% of cases. Approximately 8.4% of victims reported the perpetrator was relocated, while 16.2% described institutional efforts to conceal the abuse. In conclusion, victims of sexual abuse within the Catholic Church in Spain faced consequences that had a significant impact on their lives, exacerbated by lack of societal recognition and a prevalent dynamic of cover-up and concealment by the Church.