The impact of sexual abuse on female development: lessons from a multigenerational, longitudinal research study

Sex and sensitive period differences in potential effects of maltreatment on axial versus radial diffusivity in the corpus callosum

Corpus callosum (CC) abnormalities have been observed in several psychiatric disorders. Maltreatment has also been associated with marked differences in CC anatomy and microstructure, though rarely controlled for in psychiatric neuroimaging studies. The aim of this study was to identify type and timing of maltreatment associated with alterations in CC microstructure and to ascertain if they differ by sex. T1 and diffusion-weighted MRIs were obtained from 345 (135 M/210 F) healthy 18-25-year-olds. The Maltreatment and Abuse Chronology of Exposure scale provided retrospective data on exposure to ten types of maltreatment across each year of childhood. AI predictive analytics were used to identify the most significant type and time risk factors. The most striking maltreatment-associated alterations in males were in axial diffusivity and were most specifically associated with exposure to emotional abuse or neglect during segment-specific sensitive periods. In contrast, maltreatment was associated with marked alteration in radial diffusivity and fractional anisotropy in females and was most specifically associated with early physical neglect during one common sensitive period involving all segments except the splenium. Overall sex differences, controlling for maltreatment, brain size, and sociodemographic factors were limited to the genu with greater fractional anisotropy in males and radial diffusivity in females. These findings suggest that maltreatment may target myelinization in females and axonal development in males and that these sex differences need to be taken into account in studies seeking to delineate the contribution of CC abnormalities and interhemispheric communication to psychiatric disorders.

Parent-Focused Sexual Abuse Prevention: Results From a Cluster Randomized Trial

This study tested whether a child sexual abuse (CSA) prevention program, Smart Parents-Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. In a cluster randomized trial, six community-based organizations were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). CSA-related awareness and protective behaviors, as well as general parenting behaviors taught by PAT were assessed at baseline, post-PAT, post-SPSHK, and 1-month follow-up. Multilevel analyses revealed significant group by time interactions for both awareness and behaviors (ps < .0001), indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Results indicate adding SPHSK to existing parent training can significantly enhance parents' awareness of and readiness to engage in protective behavioral strategies. Implementing SPHSK as a selective prevention strategy with at-risk parents receiving parent training through child welfare infrastructures is discussed.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

IPV Characteristics, Childhood Violence, and Adversities as Risk Factors for Being Victimized in Multiple IPV Relationships

Empirical knowledge regarding risk factors for intimate partner violence (IPV) from multiple partners (MP) is scarce and sought by clinicians and many women themselves for the prevention of future intimate partner violence relationships (IPVRs). Quantitative data were obtained through a structured interview with a stratified sample of help-seeking women (N = 154) with no (n = 48, 0IPVR), one (n = 55, 1IPVR), or multiple (n = 51, 2IPVR) IPVRs. This study investigated the association between (a) childhood family violence, (b) other childhood adversities, (c) victimization and perpetration of IPV in the last (index) relationship, and (d) controlling sociodemographic and contextual variables, and the following dependent variables: (a) women with 1IPVR and 2IPVR compared with 0IPVR and (b) women with 1IPVR compared with 2IPVR. Multivariate logistic regression analyses indicated that, compared with nonvictimized women, IPV victimized women were nearly three times more likely to report childhood sexual abuse. They also reported a higher frequency of peer victimization and a higher likelihood of having an immigrant partner. In addition, the length of the index relationship was shorter for IPV victimized women. Compared with women with 1IPVR, women with IPV by MP were more likely to report childhood emotional abuse and less education, and they were less likely to be immigrants. The two groups of IPV victimized women were indistinguishable regarding characteristics of victimization and perpetration of IPV. This study indicated that there were other risk factors for IPV by MP than for IPV in general and highlighted the importance of addressing parenting and emotional care in IPV families.

Healing from sexual violence among young women in South Korea

Reports of sexual violence against young women have been increasing. Due to limited support, young women who experience sexual violence have difficulties in healing, resulting in long-term consequences for individuals and society. We used grounded theory combined with a Photovoice approach to explore young women's experience of healing from sexual violence. From interviews and Photovoice activities of 29 participants, we identified a social process of healing that included internalizing anger, cutting off connections, reaching a turning point with support, restoring connections, struggling through individual internal processes, and transforming sexual violence into a stepping stone. The process of healing from sexual violence identified in this study shows commonalities as well as cultural and age-specific aspects from experiences of sexual violence among young women. In addition, this theory presented a new perspective on healing that contrasts with the past belief that disclosure is the key to healing.

Cortisol trajectories measured prospectively across thirty years of female development following exposure to childhood sexual abuse: Moderation by epigenetic age acceleration at midlife

Lasting changes in the hypothalamic-pituitary-adrenal (HPA) axis are a potential indication of the biological embedding of early life adversity, yet, prospective and repeatedly collected data are needed to confirm this relation. Likewise, integrating information from multiple biological systems, such as the HPA axis and the epigenome, has the potential to identify individuals with enhanced embedding of early life adversity. The current study reports results from the Female Growth and Development Study, a 30-year prospective cohort study of childhood sexual abuse (CSA). Females exposed to substantiated CSA and a demographically-similar comparison condition were enrolled and resting state cortisol concentrations were sampled on seven subsequent occasions across childhood, adolescence, and adulthood. Differences in participants' cortisol trajectories were examined in relation to prior CSA exposure and DNA methylation-derived epigenetic age acceleration at midlife. Bilinear spline growth models revealed a trajectory where cortisol secretion increased until approximately age twenty and then declined into mid-life, consistent with normative trends. However, cortisol concentrations peaked at a lower level and transitioned to the decline phase at an earlier age for females in the CSA condition with increased epigenetic age acceleration. Robustness tests across three independent measures of epigenetic age acceleration demonstrated similar results for lower peak cortisol levels and earlier ages at transition. Results suggest that CSA is associated with significant changes in HPA-axis activity over extended periods of time with these changes most pronounced in females with accelerated epigenetic aging in mid-life. Implications for biological embedding models of early life adversity and adulthood health are discussed.

Mental health characteristics and their associations with childhood trauma among subgroups of people living with HIV in China

BACKGROUND

People living with HIV (PLWH) carry a high risk for mental health problems, which has been extensively reported in the literature. However, an understanding of mental health characteristics in different subgroups of PLWH is still limited. In the present study, we conducted a cross-sectional survey to explore mental health characteristics and their associations with childhood trauma in two major subgroups of PLWH in China.

METHODS

A total of 533 PLWH (213 prisoners in the prison system, and 320 outpatients) were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Childhood Trauma Questionnaire (CTQ).

RESULTS

From the total sample, 22.0% PLWH frequently experienced psychotic-like experiences (PLEs), 21.8% had clinically significant anxiety syndrome, 34.0% had clinically significant depressive syndrome, and 63.6% experienced at least one type of traumatic exposure during their childhood, with physical neglect being the most common. Compared to outpatients with HIV, prisoners living with HIV reported more severe mental health problems and a higher frequency of childhood trauma, with childhood trauma in turn predicting higher risk for mental health problems. Similarly, among outpatients living with HIV, both childhood emotional and sexual abuse had predictive effects on all the three mental health problems.

CONCLUSIONS

The study suggests that PLWH have higher risk of anxiety, depression and PLEs, and childhood trauma could serve as predicting factors for such risks. In addition, childhood trauma may play distinct roles in predicting the risk for the mental health problems, depending on different subgroup of PLWH.

The Centrality of Child Maltreatment to Criminology

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US

BACKGROUND

Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population.

OBJECTIVE

To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual, heterosexual-identified with same-sex attraction and/or behavior, heterosexual-identified without same-sex attraction and/or behavior, and unsure).

PARTICIPANTS AND SETTING

Data were collected using structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 US adults.

METHODS

We used descriptive statistics and logistic regression modeling to analyze data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).

RESULTS

Childhood sexual abuse was most prevalent among sexual minorities, especially bisexual females. Nearly one-third of bisexual females (30.6%) reported experiencing two or more types of CSA, p < .001. Among all participants, exposure to one or more types of CSA was associated with greater odds of lifetime suicide attempts, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol, tobacco or other drug use disorder, and mental health disorders, after adjusting for other childhood adversity/maltreatment and general life stressors.

CONCLUSIONS

Sexual minority females and males in the US are more likely than their heterosexual counterparts to report CSA. Higher risk of suicide attempts and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in adulthood was directly associated with CSA, particularly among bisexual females. Health professionals working with individuals who have experienced CSA should assess these risks and intervene as needed.

Prevalence of adverse childhood experiences and their co-occurrence in a large population of adolescents: a Young HUNT 3 study

PURPOSE

Studies of adverse childhood experiences (ACEs) undertaken at the time of adolescence in the general population are not common. The aim of this study was to determine the prevalence and co-occurrence of the individual ACEs and sub-types of ACEs in a large population of adolescents.

METHODS

Data were used from the Young Nord-Trøndelag Health (Young HUNT 3) study, a population-based study of young adolescents. ACEs were operational defined as sexual, physical and/or emotional abuse; physical and/or emotional neglect; and/or household dysfunction. Co-occurrence was measured as the accumulation of ACEs and as an overlap analysis.

RESULTS

Of the 8199 evaluable adolescents, 65.8% had experienced at least one ACE and 28% of those had experienced more than one ACE. Household dysfunction was the most prevalent ACE subtype. The biggest overlaps among the three ACE sub-types were seen in those reporting neglect or abuse.

CONCLUSION

There was a high degree of overlap between the three ACE sub-types and the individual ACEs, indicating that ACEs should be assessed together as a whole rather than separately. This study provides an opportunity to assess ACEs and their co-occurrences in relation to outcomes later in life.

An observational study of Internet behaviours for adolescent females following sexual abuse

Child sexual abuse (CSA) is associated with revictimization and sexual risk-taking behaviours. The Internet has increased the opportunities for teens to access sexually explicit imagery and has provided new avenues for victimization and exploitation. Online URL activity and offline psychosocial factors were assessed for 460 females aged 12-16 (CSA = 156; comparisons = 304) with sexual behaviours and Internet-initiated victimization assessed 2 years later. Females who experienced CSA did not use more pornography than comparisons but were at increased odds of being cyberbullied (odds ratio = 2.84, 95% confidence interval = 1.67-4.81). These females were also more likely to be represented in a high-risk latent profile characterized by heightened URL activity coupled with problematic psychosocial factors, which showed increased odds of being cyberbullied, receiving online sexual solicitations and heightened sexual activity. While Internet activity alone may not confer risk, results indicate a subset of teens who have experienced CSA for whom both online and offline factors contribute to problematic outcomes.

Intergenerational Continuity in Child Maltreatment: Explicating Underlying Mechanisms

The current study examined direct and indirect effects of a mother's history of childhood physical and sexual abuse on her child's officially reported victimization. This prospective, longitudinal study followed a community-based sample of 499 mothers and their children. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, and 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target child between birth and age 3.5. Whereas both types of maternal maltreatment history doubled the child's risk of child protective services investigation, mothers' sexual abuse history conferred significantly greater risk. Pathways to child victimization varied by type of maternal maltreatment history. Mothers who had been physically abused later demonstrated interpersonal aggressive response biases, which mediated the path to child victimization. In contrast, the association between maternal history of sexual abuse and child victimization was mediated by mothers' substance use problems. Study implications center on targeting child maltreatment prevention efforts according to the mother's history and current problems.

Association between childhood trauma, intimate partner violence, and perceived parental competence among women abusing amphetamine-type stimulant

INTRODUCTION

This cross-sectional study examines the correlation between childhood trauma, intimate partner violence (IPV), and parenting self-efficacy among women who reported using amphetamine-type stimulants (ATS) in an institutional drug rehabilitation center.

METHODS

A total of 106 participants were recruited by purposive sampling, of which 88 were mothers. Questionnaires were used to collect sociodemographic data and study variables.

RESULTS

Most of these women had experienced emotional abuse, sexual abuse, and physical neglect in their childhood. IPV assessments revealed that 70.5% (n = 74) and 30.5% (n = 32) had experienced physical and sexual violence, respectively. In terms of parenting competency, they scored 79.5% for self-efficacy and 54.4% for parenting satisfaction. Childhood emotional abuse significantly increases the odds of individuals experiencing sexual violence by 20.9%.

DISCUSSION

We found that childhood trauma and IPV did not have a significant relationship with parenting efficacy. Conversely, childhood emotional abuse and physical abuse were negatively correlated to parenting satisfaction. It is imperative that any form of childhood abuse be recognized and stopped early to reduce the harm it brings to women later in life.

Relational and Sexual Experiences of Betrayal From the Point of View of Sexually Victimized Young Women

Worldwide, it is estimated that one in five women have reported being sexually victimized before the age of 18. Girls are particularly at risk of sexual abuse at the end of adolescence and are more vulnerable to revictimization during this period. However, there is a paucity of findings related to the relational and sexual impacts of child sexual abuse among young women. The traumagenic dynamics model, proposed by Finkelhor and Browne, postulates that the consequences of sexual abuse can be analyzed in light of four distinct dynamics: traumatic sexualization, betrayal, powerlessness, and stigmatization. Among the four postulated dynamics, betrayal appears to be a key element to gain insight on the relational challenges experienced by victims, as betrayal situations can recur in romantic relationships. The present study aimed to describe, from the point of view of young women victims of child sexual abuse, the issues related to betrayals in their relational and sexual experiences. Semi-structured interviews were conducted with 19 young women aged 18 to 25 years old who had reported sexual victimization. Two main conceptual categories emerged from the narratives of the participants: (a) relational situations that echo the betrayal dynamic and (b) strategies to cope with relational situations involving betrayal: protection, reparation, and the use of both strategies, which leads to ambivalence. Findings highlight the importance of addressing the traumagenic dynamic of betrayal in interventions with sexually abuse youths, given their likelihood to experience betrayal in the context of romantic relationships and their increased risk of revictimization.

Puerto Ricans and Mexican immigrants differ in their psychological responses to patterns of lifetime adversity

BACKGROUND

Puerto Ricans and Mexican immigrants are often exposed to multiple types of adversity across their lifetime (e.g., maltreatment, household dysfunction, discrimination) and this exposure can increase the risk for adult mental health problems.

PURPOSE

The objective of this study was to (a) identify subgroups of individuals exposed to unique combinations of childhood adversity and lifetime discrimination among Puerto Ricans and Mexican immigrants, and (b) compare the prevalence of mental health problems across different risk profiles.

METHOD

We used existing data from the HCHS/SOL Sociocultural Ancillary Study. Participants included Puerto Rican (N = 402) and Mexican adults (N = 1351) born outside but living in the continental U.S.

FINDINGS

Through latent profile analysis, we selected a three-profile solution for Puerto Ricans: (a) Low Exposure (low on all adversity items; 58% of sample), (b) Adverse Childhood Experiences (ACEs) Only (high on ACEs items, average or lower than average on discrimination items; 32%), and (c) Dual Exposure (high on all adversity items; 10%). For Mexicans, we selected a four-profile solution: (a) Low Exposure (52%), (b) ACEs Only (24%), (c) Maltreatment and Discrimination (15%), and (d) Dual Exposure (9%). For Mexicans, we found that the Dual Exposure and the Maltreatment and Discrimination profiles had the highest levels of mental health problems. For Puerto Ricans, the Dual Exposure and ACEs Only profiles had the highest levels of mental health problems, suggesting that Puerto Ricans may be more vulnerable to the effects of childhood adversities as compared to Mexican immigrants. Results from our study indicate that different patterns of adversity exposure are linked to different levels of mental health outcomes, and therefore, may require different intervention dosage. Understanding which groups of individuals are at highest and lowest risk for mental health problems is critical for developing effective, tailored interventions to prevent the negative effects of childhood adversity and discrimination for Latinxs.

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR) = 2.68, P < 0.01), risky behaviours such as binge drinking (OR = 2.15, P < 0.05) and self-harming (OR = 2.86, P < 0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR = 1.88, P < 0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR = 2.21, P < 0.05) and loss of friends/family contact (OR = 2.73, P < 0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care.

Experience with outreach services of a multidisciplinary team for child abuse identification

BACKGROUND/PURPOSE

Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement.

METHODS

We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined.

RESULTS

Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables.

CONCLUSION

Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.

Advancing Our Understanding of the Risk Factors Associated with Crossover Youth in the Child Welfare and Juvenile Justice Systems: A Trauma-Informed Research Agenda

Previous research has provided robust evidence demonstrating that a notable proportion of youth become involved in both the child welfare (CW) system and the juvenile justice (JJ) system, a population often referred to as crossover youth. Prior work has identified a number of risk factors associated with crossing over between these systems. However, there are limitations to the extant literature, key among which is a lack of systematic attention to the influence of trauma exposure and posttraumatic sequelae on the crossover trajectory. In contrast, viewing this research through a trauma-informed lens promises to enhance our ability to integrate findings across studies and to derive theoretically derived hypotheses about underlying mechanisms which will better inform future research and the development of effective prevention and intervention efforts. Accordingly, the purpose of this article is to present a trauma-informed research agenda that would strengthen future research in the field. After providing a brief critique of the existing studies that has documented known risk factors associated with the crossover population, we outline ways in which future research could apply relevant theoretical trauma-informed approaches, including developmental traumatology, to further advance our knowledge of risk factors and mechanisms associated with the crossover trajectory. We conclude by discussing policy and system-wide implications related to the proposed research agenda.

Maternal Adverse Childhood Experiences, Paternal Involvement, and Infant Health

OBJECTIVES

To assess the interplay between maternal exposure to adverse childhood experiences (ACEs) and father's acknowledgment of paternity (AOP; a proxy for paternal involvement) in the risk of low birth weight (<2500 grams) and preterm birth (<37 weeks) among offspring.

STUDY DESIGN

Data come from the 2018 North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (n = 1896). Logistic regression models were used to assess low birth weight and preterm birth outcomes. Moderation analyses are conducted to assess the interaction between maternal ACEs and father's AOP.

RESULTS

Moderation analyses demonstrated a positive interaction between an accumulating number of maternal ACEs and being unmarried without AOP for low birth weight and preterm birth. Upon comparing newborns of unmarried women without AOP, those whose mothers were exposed to 4 or more ACEs had a 3.74 times greater probability of low birth weight (0.050 vs 0.187) and a 1.74 times greater probability of preterm birth (0.085 vs 0.148) than those whose mothers reported no ACE exposure.

CONCLUSIONS

Exposure to accumulating ACEs substantially increases the risk of deleterious infant health outcomes, but only for newborns of unmarried women without AOP. Future research should assess the efficacy of interventions that can mitigate the impact of maternal ACEs in the absence of father's AOP.

Identifying the Contributions of Maternal Factors and Early Childhood Externalizing Behavior on Adolescent Delinquency

We examined whether childhood externalizing group subtypes were uniquely related to maternal depression and victimization and whether these subtypes differentially predicted adolescent delinquency. Data were drawn from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN) consortium (N = 1091; 51.3% female, 52.2% African American). Latent class analysis indicated three groups at age 4 (titled "well-adjusted," "hyperactive/oppositional," and "aggressive/rule-breaking"). Caregiver victimization and depression significantly predicted group membership such that aggressive/rule-breaking group had higher levels of maternal depression and victimization although the well-adjusted group had higher levels of maternal victimization relative to the hyperactive/oppositional group. Further, membership in higher externalizing groups at age four is associated with greater risk of adolescent delinquency at age 16. These findings underscore the need to address maternal risk factors in the treatment of childhood disruptive behavior and provide evidence of the continuity of disruptive behaviors from early childhood to adolescence.

Hypothalamic-pituitary-adrenal axis attenuation and obesity risk in sexually abused females

BACKGROUND

Childhood sexual abuse (CSA) confers elevated risks for obesity in females. Mechanisms that explain this link remain unclear. This study tracked serum basal cortisol levels with body mass index (BMI) from childhood into adulthood to test whether hypothalamic-pituitary-adrenal (HPA) axis attenuation accounts for elevated obesity risks for sexually abused females.

METHODS

Data drew from six timepoints of a longitudinal study of the impact of CSA on development. Participants were females aged 6-16 years at time of study enrollment with substantiated CSA and demographically matched non-abused peers. Analyses included only participants who did not have obesity at study enrollment. Main outcomes were BMI growth trajectories across ages 6-27 (n = 150; 66 abused, 84 comparisons) and early adulthood obesity status (ages 20-27; n = 133; 62 abused, 71 comparison). HPA axis functioning indicators were intercept and linear slope parameters extracted from multilevel growth trajectories of serum basal cortisol levels across development. Racial-ethnic minority status, parity, steroid medication use, depression history and disordered eating history were covaried.

RESULTS

While controlling for covariates, multilevel modeling indicated that high initial serum basal cortisol levels in childhood and attenuated cortisol growth rate over time (i.e., HPA axis attenuation) were associated with accelerated BMI accumulation (p < .01). Attenuated cortisol growth rate mediated the effect of CSA on accelerated BMI accumulation and on elevated adulthood obesity rates (p < .05).

CONCLUSION

This work establishes a mechanistic association between HPA axis attenuation and obesity, suggesting that trauma treatments for abuse survivors should include interventions that reduce health consequences associated with dysregulated stress physiology.

Fuel to the fire? Newspaper reporting of sexual offending across the US, UK, Norway, and New Zealand

Research suggests that the news media plays an important role in shaping public opinion about sex crimes and the people who commit them, thereby influencing the development of laws and policies. The media has potential to fuel non-evidence-based policies that are ineffective and counterproductive. Alternatively, the media offers a powerful vehicle for educating the public and promoting evidence-based practices and policies. The current study aimed to examine newspaper reports of sexual crimes across four countries with different criminal justice responses to sexual offending. Constructed week sampling was used to generate samples of newspaper articles over a six-month period in 2015. Episodic articles were coded to examine how people accused/charged with sexual offenses were portrayed, the extent to which articles aligned with stereotypes, and the extent to which rehabilitation was mentioned as a solution (n = 240). Episodic and thematic articles were combined to code for systemic/environmental solutions to sexual crimes (n = 290). Overall, Norwegian articles demonstrated more neutral and less informative portrayals of individuals who have sexually offended, compared to US, UK, and New Zealand. At the same time, Norwegian articles were less likely to discuss solutions to sexual offending. Rehabilitation was rarely discussed as a solution. However, environmental/systemic solutions were discussed in approximately one third of articles. Implications for framing sexual abuse as a public health problem rather than a criminal justice problem are discussed.

Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China

BACKGROUND

Little is known on the co-occurrence and heterogeneity of child sexual abuse (CSA) or health risk behavior (HRB) prevalence nor the associations among the victims.

OBJECTIVES

To detect the prevalence and subgroups of adolescents reporting CSAs or HRBs, and to examine the association between the subgroups.

METHODS

Participants were secondary school students in a national survey in China (N = 8746). Self-reported CSA and HRB experiences were collected through a computer assisted questionnaire. Prevalence and confidence intervals were calculated. Multigroup latent class analysis (LCA) was used to examine latent subgroups of CSA and HRB. Dual latent class regression analysis was used to examine the association between CSA and HRB classes.

RESULTS

A total of 8746 students participated in our study. The prevalence of having ever experienced any of the reported seven CSA items was 12.9%. The preferred LCA model consisted of a three-class CSA latent variable, i.e. "Low CSAs"(95.7% of the total respondents), "Verbal or exhibitionism CSAs"(3.3%), and "high multiple CSAs" (1.1%); and a three-class HRB latent variable, i.e. "Low HRBs"(70.5%), "externalizing HRBs" (20.7%), and "internalizing HRBs" (8.7%). Students in the "Verbal or exhibitionism CSAs" or "high multiple CSAs" classes had higher probabilities of being in "externalizing HRBs" or "internalizing HRBs" classes. The probabilities were higher in "high multiple CSAs" class(male externalizing OR 4.05, 95%CI 1.71-9.57; internalizing OR 11.77, 95%CI 4.76-29.13; female externalizing OR 4.97, 95%CI 1.99-12.44; internalizing OR 9.87, 95%CI 3.71-26.25) than those in "Verbal or exhibitionism CSA"(male externalizing OR 2.51, 95%CI 1.50-4.20; internalizing OR 3.08, 95%CI 1.48-6.40; female externalizing OR 2.53, 95%CI 1.63-3.95; internalizing OR 6.05, 95%CI 3.73-9.80).

CONCLUSIONS

Prevalence of CSA items varies. Non-contact CSAs are the most common forms of child sexual abuse among Chinese school students. There are different latent class co-occurrence patterns of CSA items or HRB items among the respondents. CSA experiences are in association with HRB experiences and the associations between latent classes are dose-responded. Multi-victimization has more significantly negative effects. The results could help identify high-risk subgroups and promote more nuanced interventions addressing adverse experiences and risk behaviors among at-risk adolescents.

Childhood Maltreatment Experiences, Attachment, Sexual Offending: Testing a Theory

The aim of this study was to empirically examine the theoretical model proposed by Grady, Levenson, and Bolder used to explain the relationships between experiencing trauma, attachment styles, and risk factors associated with sexual offending. The specific risk factors tested were emotional, behavioral, and cognitive regulation deficits. The research questions were as follows: (1) What specific childhood traumatic experiences (physical and sexual abuse and/or other domestic trauma events) are associated with anxious-ambivalent and anxious-avoidant attachments? (2) Are anxious-ambivalent and anxious-avoidant attachment styles differentially linked to dysregulation outcomes (emotional, behavioral and cognitive shift, and inhibitions)? (3) Do insecure attachment styles explain why childhood trauma is associated with dysregulation? and (4) Do these early life experiences contribute to sexual offending behavior? The sample included 200 male youth adjudicated for either a sexual or nonsexual crime and living in the community or a residential facility. The average age of the youth was 17.17 years (SD = 1.81 years). Structural equation modeling was used to determine the direct and indirect relationships between abuse and traumatic experiences, anxious-avoidant and ambivalent-anxious attachment styles, and regulation deficits. Authors found a direct relationship between physical abuse and both of the attachment styles, separately. Both anxious-ambivalent and anxious-avoidant attachment styles related similarly to regulation deficits. Separately, anxious-ambivalent and anxious-avoidant attachment styles served as mediators between physical abuse and regulation deficits. Sexual abuse predicted the later commission of sexual crimes with no influence from attachment style. Finally, domestic trauma independently predicted regulation deficits in the model that included anxious-ambivalent attachment but had no effect on deficits in the model that included anxious-avoidant attachment. Implications for treatment include the need to consider using attachment-based interventions and prevention strategies, and a trauma-informed approach when working with justice involved youth. Suggestions for future research are also discussed.

Talking About Feelings: Mother-Child Emotion Dialogues Among Sexually Abused Children

Mother-child dialogues about children's emotional experiences are associated with children's adaptive coping with stressful situations and mental health. Despite these findings, dialogues have not been examined yet in the context of child sexual abuse. This gap is surprising given that mother-child dialogues may particularly promote children's recovery from traumatic events. The current exploratory study examined the quality of mother-child emotion dialogues, as well as the quality of child and maternal contributions to dialogues, among dyads with sexually abused children (n = 30; 60% female; M age = 8.03), as compared with dyads with nonabused children (n = 30; 60% female; M age = 8.20). Quality of dialogues was assessed using the Autobiographical Emotional Events Dialogue. Mothers reported on their own childhood maltreatment history and psychopathological symptoms. Results showed that dyads with abused children were more likely to engage in overwhelming/excessive dialogues and dialogues lacking content, as compared with dyads with nonabused children. After controlling for differences in background characteristics, mothers of abused children showed lower sensitive guidance. Although mothers of abused children had more experiences of childhood maltreatment and higher levels of psychopathology, they did not add to explain group differences in maternal sensitive guidance. Our findings suggest that the ability to discuss emotional experiences may be impaired among mother-child dyads with sexually abused children. This may be an important target in the treatment of sexually abused children and their families.

Repeat attenders are disproportionately vulnerable: An exploration of revictimisation at Saint Mary's Sexual Assault Referral Centre

BACKGROUND

Being a victim of sexual assault is linked to many psychological and physical health problems. Experiencing one episode of assault is a risk factor for revictimisation. Saint Mary's Sexual Assault Referral Centre (SARC) provides aftercare for clients in Greater Manchester and Cheshire who have suffered sexual assault and rape, with physical, psychological and sexual health services.

AIMS

This work's primary aim was to establish the prevalence of re-attendance of adults for a forensic medical examination to Saint Mary's SARC. The secondary aim was to identify the characteristics and vulnerabilities of clients who re-attended Saint Mary's SARC during a twelve-month period.

METHODS

Retrospective analysis of 42 sets of forensic medical notes for repeat attenders in 2017 was performed. A control sample of 42 single attenders from 2017 was randomly selected for comparison.

RESULTS

A total of 740 adult clients attended Saint Mary's for a forensic medical examination in 2017, 5.7% of whom had previously attended. Amongst these clients, significantly higher numbers experienced unemployment (p < 0.001), recent mental health complaints (p < 0.001), previous self-harm (p < 0.001), and previous suicide attempts (p = 0.001). There was a significantly larger number of repeat attenders who scored below the threshold that indicates likelihood of having a learning disability (p = 0.008). All clients who disclosed a history of alcohol abuse were repeat attenders. Repeat attenders were more likely to receive safeguarding than single attenders (p < 0.001).

CONCLUSIONS

Prevalence of repeat attenders at Saint Mary's SARC is lower than reported in many other studies. However consistent with the wider literature, this demographic showed higher level of vulnerability, and higher likelihood of receiving safeguarding. SARC staff and services should be prepared to attend to the additional needs of this group. Powered.

Intimate Partner Violence Victimization and Perpetration in a Turkish Female Sample: Rejection Sensitivity and Hostility

Intimate partner violence (IPV) against women is one of the most alarming social problems all over the world. Recently, IPV research focuses on the bidirectional nature of the phenomenon, which underlines that both women and men can equally be victims and perpetrators of IPV, especially in community samples. The cycle of violence theory asserts that child abuse and neglect (CAN) is a vulnerability factor for being both a victim and perpetrator of IPV while developmental mechanisms perspective assesses mediators explaining this association. The purpose of the current study was to investigate whether CAN and each type of CAN (emotional maltreatment, physical abuse and neglect, and sexual abuse) would be associated with victimization of and perpetration by women via the multiple mediator roles of rejection sensitivity and hostility after controlling for co-occurring CAN types. The sample (N = 288) included Turkish women who were currently married or in a romantic relationship or in one of these statutes in the past year. Participants were recruited via online survey to fill out the related questionnaires. The results of Bootstrap analyses showed that the total CAN scores were associated with being a victim and perpetrator of IPV in the past year. Rejection sensitivity mediated the association between CAN and being a victim of IPV while hostility was a mediator between CAN and perpetration of IPV. Childhood emotional maltreatment (CEM) was the only trauma type which predicted victimization by rejection sensitivity and perpetration by hostility above and beyond the effects of co-occurring trauma types. The present study findings contributed to the growing literature that women exposed to childhood traumas can also be perpetrators of violence that was a demonstrated risk factor for the repeated victimization. Results implied that developmental and process variables should be taken into account rather than a strict gendered analysis of IPV in research and clinical practice.

Health Access of Women in Provincial Correctional Institutions

Historically, there has been a disparity between men and women rates of incarceration, even though there has been a significant increase in the number of women imprisoned over the past 20 years, globally. Women have unique health care needs that are often not adequately addressed within the correctional institutions in which they are held. The focus of this study was to explore women's experiences when accessing health services within Canadian provincial correctional institutions. Narrative inquiry was used to investigate the life stories of five women who accessed health care in provincial correctional institutions. A total of two storylines and five sub-storylines resulted from the analysis of interviews conducted with the participants. The findings suggest that during incarceration, participants experienced compromising conditions that contributed to the worsening of their health, and faced difficulties accessing their prescribed treatments and medications. Consequently, this contributed to the worsening of their physical and mental wellbeing.

The impact of child abuse on the neurobiology of self-processing in depressed adolescents

Child abuse is linked to lifetime psychopathology including abnormal self-processing. Given self-processing maturation in adolescence, we tested duration, presence, and abuse accumulation's impact upon self-processing neurobiology among depressed youth with (N = 54) and without an abuse history (N = 40). Youth evaluated positive and negative self-descriptors across four points of view in the scanner. Regression analyses showed that longer abuse duration (in days) was associated with lower activity in inferior temporal (e.g. insula, fusiform & parahippocampus), striatal, cerebellar and midbrain structures when processing negative self-descriptors with the least activity in youth exposed to 6+ abuse years. Abuse presence vs. absence was linked to higher neural activity. However, youth exposed to a single abuse instance to 3 years of abuse might drive that relative neural hyperactivity. Results support: 1) the toxic stress model of blunted overall neuro-reactivity underpinning emotion, sensorimotor gating, and social cognition during negative stimuli as an adaptation to pervasively toxic environments and 2) the differential impact of acute versus chronic stress upon neurophysiological indices. Finally, child abuse duration might impact these ancillary and higher socioemotional processes differently among depressed youth primarily for negative but not positive self-processing.

Intimate Partner Violence Among Patients With Dissociative Disorders

Childhood trauma is common among survivors and perpetrators of intimate partner violence (IPV). Although symptoms of posttraumatic stress disorder (PTSD) and dissociative disorders (DDs) are predictors of IPV victimization and perpetration, few studies explore IPV among those with DDs. The present study examined IPV and symptoms as predictors among participants in the Treatment of Patients With Dissociative Disorders (TOP DD) Network study, an educational intervention for individuals with DDs and their clinicians. Both clinicians and patients reported on patients' history of physical, emotional, and sexual IPV as both victims and perpetrators. Patients self-reported dissociative, posttraumatic (PTSD), and emotion dysregulation symptoms, as well as IPV-specific dissociative symptoms. According to patients and clinicians, patients were frequently victims of IPV, most commonly emotional IPV. Dissociative symptoms predicted IPV exposure, whereas dissociative and emotion dysregulation symptoms predicted IPV-specific dissociative symptoms.

A Comprehensive Pediatric Acute Sexual Assault Protocol: From Emergency Department to Outpatient Follow-up

OBJECTIVE

Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault.

METHODS

A retrospective medical record review was conducted of patients younger than 18 years presenting to the emergency department from January 1, 2010, to December 31, 2013, with a discharge diagnosis suggestive of sexual assault/abuse. We examined differences in demographics, assault characteristics, and medical/legal needs of patients who were evaluated in follow-up versus patients who were not.

RESULTS

Of 182 patients, 60.4% completed follow-up appointments with the child protection center. Younger patients had follow-up rates higher than older patients (70.2% vs 50%; odds ratio [OR], 0.42). For patients where child protective services or law enforcement were called, follow-up rates were 74.2% and 64.7%, respectively (OR, 2.5; OR, 3.1). All patients with anogenital injuries on initial examination were seen in follow-up. The majority of patients who followed-up were accompanied by a caregiver/relative (95%).

CONCLUSIONS

(1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.

Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed.

At risk and in love: A mixed methodexamination of the link between childhood maltreatment and youth relationships

INTRODUCTION

Research indicates that sexual and romantic relationships play an important role in youth well-being and development. This strengths-based perspective sits in tension with the documented risks that youth with histories of maltreatment face in sexual/romantic relationships. We conducted a U.S.-based mixed-method study to examine the connection between childhood maltreatment and youth relationships.

METHOD

We collected retrospective ratings of relationship quality and open-ended comments about those relationships using an online sexual life history calendar. Quantitative analyses drew on data from 98 participants (51 cisgender women, 47 cisgender men) between the ages of 18-25 (M_age = 22.51). Qualitative analyses compared demographically matched subsamples of 19 participants who reported multiple forms of child maltreatment and 20 who reported none.

RESULTS

Quantitative analyses indicated that ratings of relationship stability, intimacy, and pleasure were unrelated to prior abuse or neglect. Qualitative analyses showed the relationships of those with multiple maltreatment histories, compared to those without any maltreatment, to be more often intertwined with and complicated by other hardships (e.g., homelessness).

CONCLUSIONS

Quantitatively, childhood maltreatment appeared unrelated to youth sexual/romantic relationship quality, though we regard those findings with due caution. Complementing this was qualitative evidence of differences between participants based on trauma histories, with those who had experienced childhood maltreatment referring more often to surrounding circumstances and hardships in descriptions of their youth sexual/romantic relationships. These mixed method findings reinforce the importance of youth sexuality research, policy, and practice that takes the broader conditions of young people's lives into consideration.

Profiles of Childhood Maltreatment: Associations with Sexual Risk Behavior during Adolescence in a Sample of Racial/Ethnic Minority Girls

This study examines associations between childhood maltreatment and developmental trajectories of sexual risk behaviors (SRBs) in a sample of 882 sexually active adolescent girls, predominantly Hispanic or Black, assessed every 6 months between 13 and 23 years. Latent profile analyses revealed four distinct maltreatment profiles: Low Maltreatment (76%), Moderate Emotional Neglect Only (15%), Severe Physical/Emotional Abuse (3%), and Severe Sexual Abuse (6%). Multilevel growth analyses showed the Moderate Emotional Neglect Only and Severe Sexual Abuse profiles exhibited more SRBs starting in late adolescence, and the Severe Sexual Abuse profile also exhibited a faster increase than the Low Maltreatment profile. Understanding heterogeneity within maltreated populations may have important implications for healthy sexual development.

The Young Adolescent Project: A longitudinal study of the effects of maltreatment on adolescent development

The Young Adolescent Project (YAP) is an ongoing longitudinal study investigating the effects of abuse and neglect on adolescent development. It is a multidisciplinary study guided by a developmental, ecological perspective, and designed to consider the physical, social, and psychological effects of childhood maltreatment through the transition from childhood to adolescence. Four waves of data collection have been completed, ranging from early (Mean age = 10.95) to late adolescence (Mean age = 18.24). Members of the maltreated group (n = 303) were selected from new cases that had been opened by the Department of Child and Family Services, whereas the comparison group (n = 151) were not involved with child welfare but lived in the same neighborhoods as the maltreated group. The study assessed a wide variety of domains including physical development (e.g., height, weight, body mass, pubertal development); physiological reactivity (e.g., cortisol); cognitive abilities; mental health (e.g., symptoms of depression, anxiety, trauma, and aggression); risk behavior (e.g., sexual activity, delinquency, or substance use); social development (e.g., self-esteem, competence, and social support); family environment; and exposure to community violence. Overall, our findings demonstrated the pervasive and persistent adverse effects of child maltreatment both within and across domains, but they also identified maltreated youth with positive functioning. Our hope is that this work will help move us toward identifying targets for intervention to cultivate resilience and positive adaptation after early maltreatment experiences.

What Do Survivors of Child Sexual Abuse Believe Will Facilitate Early Disclosure of Sexual Abuse?

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18-57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.

Victimization profiles in girls involved in the juvenile justice system: A latent class analysis

BACKGROUND

Previous research has demonstrated that youth involved in the juvenile justice system endorse diverse patterns of victimization. However, previous research investigating victimization profiles among youth involved in the juvenile justice system has primarily consisted of boys.

OBJECTIVE

This study investigated victimization profiles and correlates of victimization exposure, including posttraumatic stress symptoms and risk behaviors, in a sample of girls involved in the juvenile justice system.

PARTICIPANTS AND SETTING

Participants were 245 girls involved in the juvenile justice system (Mage = 15.57, SD = 1.13) participating in a dating violence prevention program. The sample was racially diverse, and 48 % self-identified as Hispanic/Latina.

METHOD

Prior to participating in the intervention, participants completed self-report measures of adversity and victimization exposure, posttraumatic stress symptoms, and risk behaviors.

RESULTS

Results of latent class analysis identified three distinct victimization profiles. The first class (n = 106) was characterized by low levels of victimization. The second class (n = 98) experienced predominantly emotional victimization (i.e., emotional dominant). The third class (n = 41) was characterized by exposure to polyvictimization (i.e., polyvictimization predominant). Girls categorized into the polyvictimization dominant class evidenced the greatest levels of posttraumatic stress symptoms, substance use, suicidal behaviors, and sexual risk behaviors.

CONCLUSIONS

Girls involved in the juvenile justice system report distinct patterns of victimization, which are differentially associated with posttraumatic stress symptoms and risk behaviors. The present study underscores the importance of implementing trauma-informed assessment and intervention practices within juvenile justice systems.

Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality

BACKGROUND

Individuals with histories of sexual abuse may be more likely to experience sexual-related problems including hypersexuality, but gender-related differences remain unclear.

AIM

This online study examined sexual abuse history and hypersexuality by gender among 16,823 Hungarian adults, adjusting for age, sexual orientation, relationship status, education, employment status, and residence.

METHODS

An online questionnaire on one of the largest Hungarian news portals advertised this study examining sexual activities in January 2017. 3 categorizations of age-related sexual abuse were examined: child sexual abuse (CSA) occurring at age 13 and earlier (compared to no abuse), adolescent/adult sexual abuse (AASA; compared to no abuse), and CSA and AASA (CSA/AASA; compared to one age-related category of abuse or the other).

OUTCOMES

The outcome variable, hypersexuality, was examined as a continuous variable due to the low prevalence of clinical hypersexuality in this sample. 3 multivariate linear regression analyses adjusting for covariates aimed to predict hypersexuality from each category of abuse, along with gender and its interaction with each category.

RESULTS

In all models, younger age, non-heterosexual sexual orientation, male gender, single relationship status, less than full-time work, and living in a capital city were associated with hypersexuality, and education was not a significant predictor. CSA, AASA, and CSA/AASA predicted hypersexuality in both men and women. There was a significant interaction between CSA/AASA and gender, such that the relationship between CSA/AASA and hypersexuality was stronger in men than in women.

CLINICAL TRANSLATION

Sexual abuse at each developmental time-point may influence hypersexuality among men and women, although the cumulative impact of CSA and AASA on hypersexuality may be particularly relevant among men.

STRENGTHS & LIMITATIONS

This is one of the largest studies to examine gender-related differences in the relationship between sexual abuse and hypersexuality. Nevertheless, our study is cross-sectional, and longitudinal work is needed to determine how sexual abuse affects children, adolescents, and adults throughout their lives.

CONCLUSION

Developmental impacts of sexual abuse may be considered in a gender-informed fashion in order to develop and optimize effective prevention and treatment strategies for hypersexuality. Slavin MN, Blycker GR, Potenza MN, et al. Gender-Related Differences in Associations Between Sexual Abuse and Hypersexuality. J Sex Med 2020;17:2029-2038.

Child maltreatment and mental health problems in 30-year-old adults: A birth cohort study

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer with limited data at 30-year follow-up. This was a prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment was associated with adverse psychological outcomes in early adulthood when participants were 30 years old. We used data from 2861 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exposure to suspected child maltreatment was measured by linkage with state child protection data. The primary outcomes were DSM-IV diagnoses derived from the Composite International Diagnostic Interview-Auto version (CIDI). There were child abuse notifications on 171 participants, of which 103 were substantiated. The most common notifications were for physical abuse (n=96) followed by emotional abuse and neglect (n=80 each). There were 63 notifications of sexual abuse. Of those completing the CIDI at follow-up, 257 participants (9%) reported a depressive disorder, 703 (25%) an anxiety disorder and 138 (5%) PTSD. After adjustment for potential confounders, there were variations in the long-term effects of different types of abuse with physical abuse having a stronger association with depression, and sexual abuse with PTSD. Both emotional abuse and neglect were associated to varying degrees with depression, anxiety and PTSD. Substantiated abuse or multiple forms of abuse had generally the worst outcomes.

Long-term Cognitive, Psychological, and Health Outcomes Associated With Child Abuse and Neglect

Potential long-lasting adverse effects of child maltreatment have been widely reported, although little is known about the distinctive long-term impact of differing types of maltreatment. Our objective for this special article is to integrate findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We compare and contrast the associations of specific types of maltreatment with long-term cognitive, psychological, addiction, sexual health, and physical health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of age. Overall, psychological maltreatment (emotional abuse and/or neglect) was associated with the greatest number of adverse outcomes in almost all areas of assessment. Sexual abuse was associated with early sexual debut and youth pregnancy, attention problems, posttraumatic stress disorder symptoms, and depression, although associations were not specific for sexual abuse. Physical abuse was associated with externalizing behavior problems, delinquency, and drug abuse. Neglect, but not emotional abuse, was associated with having multiple sexual partners, cannabis abuse and/or dependence, and experiencing visual hallucinations. Emotional abuse, but not neglect, revealed increased odds for psychosis, injecting-drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting asthma symptoms. Significant cognitive delays and educational failure were seen for both abuse and neglect during adolescence and adulthood. In conclusion, child maltreatment, particularly emotional abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future.

Intergenerational transmission of childhood trauma? Testing cellular aging in mothers exposed to sexual abuse and their children

BACKGROUND

Exposure to maltreatment in childhood can lead to increased risk for poor health outcomes in adulthood. Child maltreatment and later poor health may be linked by premature biological aging. We tested whether childhood sexual abuse (CSA) was associated with telomere length (TL) in adult females. We further tested the hypothesis of intergenerational transmission of CSA-related effects by measuring TL in both CSA-exposed and non-exposed mothers and their children.

METHODS

Participants were a subset of females and their children in a prospective-longitudinal cohort study of sexually abused females and a demographically comparable control group from the same Washington, D.C. area. TL was measured using qPCR in both leukocyte and buccal samples from females (N = 108, mean age 36.3 years) and buccal samples from their children (N = 124, mean age 10.5 years). Multilevel models were used to test associations between CSA-exposure and TL measured in leukocytes and buccal tissue in females and to test the intergenerational effect of maternal-CSA exposure on age-adjusted TL in their children.

RESULTS

CSA-exposure was not associated with TL in adult females. Maternal TL and biological sex were significant predictors of child TL such that longer maternal TL predicted longer TL in children, and female children had longer TL than male children. However, maternal-CSA exposure did not predict TL in children.

DISCUSSION

CSA-exposure was not associated with TL in this cohort of middle-aged females, nor was there evidence for an intergenerational effect of maternal-CSA exposure on child TL. This finding is in line with some previous results on CSA and adult TL. Previous significant results associating child maltreatment with shorter TL may be capturing a population of individuals exposed to either multiple types of maltreatment compared to controls with no childhood adversity, or maltreatment in childhood with concurrent TL measurements.

Epidemiological Profile of the Victims of Sexual Violence Treated at a Referral Center in Southern Brazil

OBJECTIVE

 To characterize the sociodemographic profile of women victims of sexual violence treated at a university hospital in southern Brazil.

METHOD

 The present cross-sectional study included all female victims of sexual violence who attended the sexual violence unit at the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) from April 18, 2000 to December 31, 2017. Data were extracted from the electronic record of the patients and stored in a standardized questionnaire database with epidemiological aspects of the victim, the perpetrators and the type of aggression. Statistical analysis was performed using the chi-squared test for trend and descriptive statistics with 95% confidence interval (CI).

RESULTS

 During the length of the study, 711 women victims of sexual violence were treated. The mean age of the patients was 24.4 (±10) years old (range from 11 to 69 years old) and most of the victims were white (77.4%), single (75.9%) and sought care at the unit within 72 hours after the occurrence (80.7%). In most cases, violence was exerted by a single perpetrator (87.1%), who was unknown in 67.2% of cases. Victims < 19 years old showed a higher risk of not using contraception (relative risk [RR] = 2.7; 95% CI = 1.9-3.6).

CONCLUSION

 Most victims of sexual violence were treated within 72 hours of the occurrence. The majority of these victims were white and young, and those < 19 years old had a higher risk of not using contraception and to know the sexual perpetrator.

Cognitive behavior therapy for internalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis

Cognitive behavioral therapy (CBT) has received considerable empirical support for internalizing disorders including anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and adolescents. However, there is less knowledge regarding how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis was conducted of CBT for internalizing disorders in children and adolescents in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until October 2019. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined. The effects of CBT in routine clinical care were benchmarked by comparing with efficacy studies for the same disorders. Fifty-eight studies were included, comprising 4618 participants. Large effect sizes for outcome were detected at post-treatment (g = 1.28-2.54), and follow-up (g = 1.72-3.36). Remission rates across diagnoses ranged from 50.7% - 77.4% post-treatment, to 53.5% -83.3% at follow-up. Attrition rate across the disorders was 12.2%. Quality of the included studies was fair, and heterogeneity was high. Similarities between the effectiveness and efficacy studies were greater than the differences in outcome. CBT delivered in routine clinical care is efficacious in reducing internalizing disorders and symptoms. The outcomes are comparable with results obtained in efficacy studies. PROSPERO registration: ID CRD42019128709.

Can Physical and/or Sexual Abuse Play a Role in the Female Choice of a Partner? A Cross-Sectional, Correlational Pilot Study

The present study aims to evaluate the relationship in women between a history of physical/sexual abuse and the preferences regarding the choice of a partner for a short/long-term relationship in terms of male facial dimorphism, and to assess their sexual functioning. We enrolled 48 abused women and 60 non-abused women. Facial preferences were evaluated with the Morphing test. Sexual functioning was measured with the Female Sexual Function Index (FSFI). Regarding the choice for a short-term partner, abused and non-abused women did not show any differences, and both groups chose a less masculine male face. On the other hand, regarding the choice for a long-term partner, abused women showed a preference for an average male face, whilst non-abused women preferred a less masculine face. The sexual functioning of abused women was found significantly dysfunctional in all domains of the FSFI. These data, generated from a small but highly selected cohort, demonstrated that physical/sexual abuse may be associated with a more rational and conscious choice of a male partner for a long-term relationship, but not with an instinctive one, as the choice of an occasional partner. In addition, the sexual functioning of abused women appears to be compromised by the traumatic experience.

A survey of evidence-based practice, training, supervision and clinician confidence relating to post-traumatic stress disorder (PTSD) therapies in UK child and adolescent mental health professionals

Background: Post-Traumatic Stress Disorder (PTSD) in children and adolescents has received increasing recognition in recent decades. Despite development of treatments and improved dissemination efforts, research has identified a number of barriers to implementing these approaches. Objective: This study sought to understand what interventions mental health professionals working with children and adolescents utilised to treat PTSD, their training and supervision, their confidence in assessing and treating PTSD, and how these factors relate to clinicians characteristics (e.g. age, gender, professional background). Method: The study comprised an internet-delivered survey of clinicians working in child and adolescent mental health services in the UK (N = 716). Results: Many clinicians (>40%) had not received training in working with PTSD, with considerable variation between professional background. Lack of training and supervision was associated with reduced clinician confidence in treating children with PTSD (possible range 0-10; training M = 7.54, SD = 1.65, no training M = 5.49, SD = 2.29; supervision M = 7.53, SD = 1.63, no supervision M = 5.98, SD = 2.35). Evidence-based therapies for PTSD such as Trauma-Focused Cognitive-Behavioural Therapy and Eye Movement Desensitisation and Reprocessing were only endorsed modestly by clinicians (58.4% and 37.5%, respectively). Regression analyses identified that lack of training and supervision were significant barriers to the use of evidence-based interventions. Other predictors of clinician confidence and use of evidence-based interventions included profession and years of experience. Participants almost universally wanted more training in working with PTSD. Conclusions: Evidence-based treatments are not currently universally delivered by mental health professionals in the UK, with certain professions particularly lacking training and confidence with this condition. Training around trauma and PTSD may be an ongoing need to boost and maintain confidence in working with PTSD in youth.

Longitudinal Relationships between Perceived Social Support and Symptom Outcomes: Findings from a sample of Adult Survivors of Childhood Sexual Abuse

INTRODUCTION

Cross-sectional studies have consistently reported an inverse association between perceived social support and the severity of mental health symptoms among adult survivors of childhood sexual abuse (CSA). However, there is a lack of longitudinal studies investigating the bidirectional association between social support and the severity of symptoms among adult CSA-survivors, as well as the role of relational problems in predicting perceived social support and symptom levels over time. The present study addressed these questions in a sample of primarily female CSA-survivors.

METHODS

In a three-wave, four-year longitudinal study of 506 CSA-survivors (94.9% women, 5.1% men) recruited from support centers for sexual abuse survivors in Norway, we used cross-lagged panel structural equation modeling to examine the directionality of the longitudinal associations between perceived social support and symptoms of posttraumatic stress, anxiety, depression and insomnia.

RESULTS

Cross-lagged panel analyses revealed significant weak reciprocal associations between perceived social support and depression, posttraumatic stress symptoms and anxiety symptoms, but not with insomnia symptoms. The observed effects were partly overlapping and partly inconsistent across the different symptom domains. Relational problems predicted social support cross-sectionally and longitudinally, whereas only cross-sectional associations were found between the relational problems variable and mental health symptoms. Theoretical and clinical implications of the findings are discussed, alongside methodological limitations of the study.

A Qualitative Metasynthesis of Mothers' Adverse Childhood Experiences and Parenting Practices

INTRODUCTION

Despite the known prevalence and detrimental health outcomes associated with adverse childhood experiences (ACEs), extant literature has rarely focused on the impact of ACEs on mothers' parenting practices. The purpose of this metasynthesis was to synthesize qualitative studies to understand how mothers with a history of ACEs parent their children.

METHOD

A systematic search was conducted across five databases with 11 studies meeting eligibilty criteria. Relevant data were extracted and analyzed with qualitative description.

RESULTS

Six subthemes and three themes emerged from the data. Themes included breaking the cycle, parent and child well-being, and supporting mothers. All mothers described strategies to protect their children, with some describing hypervigilant parenting practices. Mothers discussed worries about appropriate discipline and a pervasive fear of community-based services for fear of removal of the child. Across studies, mothers described their current support system and offered several suggestions for formal support services.

DISCUSSION

This metasynthesis provides the synthesized perspectives of traumatized mothers' parenting practices, which may inform future interventions.

Cohort profile: Norwegian youth study on child maltreatment (the UEVO study)

PURPOSE

Exposure to childhood maltreatment is not uncommon, and is linked to both short-term and long-term health problems. Population-based surveys for adolescent samples provide excellent opportunities for addressing the substantial burden of early-life adversities, because collecting information close in time to exposure may increase accuracy of assessment. Still few large studies have been conducted, following individuals through adolescence. Therefore, the UEVO cohort was created with the aim of investigating prevalence of child maltreatment throughout childhood and adolescence, and its effects on health and functioning in a long-term perspective in a representative sample of Norwegian adolescents.

PARTICIPANTS

The baseline for the cohort includes a representative sample of 9240 Norwegian adolescents (response rate 86.6%) aged 12-16 years, surveyed in January and February 2019. The cohort to be followed over time comprises the 5502 adolescents who agreed to be recontacted for subsequent data collection waves.

FINDINGS TO DATE

The overall prevalence figures from the first wave of measurement have been published in a comprehensive national report on child maltreatment in Norway.

FUTURE PLANS

A second study wave will commence in 2021, including about half of the original cohort (longitudinal), as well as a new sample starting at age 12. For participants above age 16, original survey data will be connected to national registries (pending indvidual consent), enabling the study of real-life functioning within the areas of healthcare utilisation, school drop-out, work-force participation and prescription of medication.