A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Child Sexual Abuse: Forensic Medical Assessment of the Traumatic Injuries Over the Victim's Body

Child sexual abuse is a public health problem that affects children worldwide in all ethnic, educational, and socioeconomic groups. These assaults are extremely dangerous not only due to their direct physical traumas received at the time of the abuse, but they also have long-term consequences that can worsen the future quality of the victim's life. A retrospective study of all cases related to child sexual abuse for five years was performed by materials of the Clinic of Forensic Medicine and Deontology, Sofia, Bulgaria. Ninety-five cases involve children from both genders. The traumatic injuries were carefully examined and classified according to their localization over the victim's bodies and based on the time that had passed after the reported assaults. In cases of sexual violence, the most informative and pointing at the exact type of violence are the injuries situated in the anogenital area. Too often, there is a lack of physical findings, depending on the type of sexual violence or associated with the prolonged time that passes after the crime. Children are unaware of what they have to do after suffering such traumas, or they are scared to share their experience with different family members, which can lead to late forensic examination and lack of physical and biological findings, which are the most critical traces in the criminal prosecution of the crimes and this can be a possibility for the perpetrator not to be charged for his unlawful actions.

A Scoping Review of Programs to Prevent Child Sexual Abuse in Mainland China

Child sexual abuse (CSA) is a worldwide public health concern. With the widespread dissemination of prevention approaches to end CSA, numerous CSA prevention programs exist in developed countries, but there is little evidence on how these programs are performing in Mainland China. The aim of this study was to review the existing research focusing on CSA prevention programs in Mainland China. Studies of CSA prevention programs were identified by conducting a comprehensive search of major academic databases for Chinese and English research. Articles were retained if they were original empirical studies that conducted programs to prevent CSA in Mainland China and measured related outcomes. Twelve studies met the inclusion criteria. A child-targeted, universally focused, and school-based educational program was the most common (n = 7), followed by specifically focused programs that covered migrant and left-behind children using group-based intervention strategies (n = 2) and ordinary parents with self-learning strategies (n = 2); one study delivered agency-based face-to-face education to parents with disabled children. However, the shortcomings in research design limited its replication to the broader population. CSA prevention program research in Mainland China is in an early stage due to the limited target populations, lack of large-scale government-led initiatives, and low involvement of multicomponent collaboration. We provide suggestions for conducting future research involving more inclusive programs for other populations, comprehensive programs with multiple targets and stakeholders, large-scale evidence-based research, culturally tailored and contextual adaptation programs.

Abnormal spontaneous activity of regions related to mood regulation mediates the effect of childhood emotional neglect on major depressive disorder

This study investigated the mediating factors between childhood emotional neglect (EN) and major depressive disorder (MDD) and whether combining multi-indicator could help diagnose MDD. Regional homogeneity (ReHo) and clinical features were compared between 33 MDD patients and 36 healthy controls (HC). Mediation analysis was employed to explore whether social support or ReHo mediates the association between EN and MDD. The linear discriminant analysis model was constructed with EN, social support, and ReHo, and applied to distinguish MDD from HC in both primary and replication cohorts. We found that MDD patients experienced severer EN and poorer social support, and exhibited lower ReHo in the left middle occipital gyrus and bilateral postcentral gyrus, and higher ReHo in the right cerebellum crus1. EN could affect MDD directly and indirectly through ReHo in these discrepant brain regions and social support. Combining ReHo values of these four distinct brain regions, EN, and objective support could classify MDD patients from HC, and the 10-fold cross-validation accuracy within-study replication and in the independent cohort was 83.78 % ± 1.49 % and 82.72 % ± 2.22 %, respectively. These findings suggested that childhood EN, social support, and emotional-related regions' ReHo were associated with risks of MDD, providing new insights into the pathological mechanisms underlying MDD.

What do adults who experienced child sexual abuse want to convey about therapy?

BACKGROUND

Child sexual abuse (CSA) studies have significantly advanced the understanding of its prevalence and adverse consequences. Tremendous efforts worldwide have been devoted to CSA interventions. However, surprisingly, there is a lack of research dedicated to learning about experiences with therapy among adults who experienced CSA.

OBJECTIVE

This study was designed to address this gap by exploring the perspectives and experiences with therapy among adults who experienced CSA.

METHODS

Thirty-nine written testimonies comprised the current sample. All of the testimonies were provided to the Israeli Independent Public Inquiry into CSA by adults who experienced CSA and received therapy at one point in their lives. A qualitative inductive thematic analysis guided the exploration of the testimonies.

RESULTS

The testimonies provided an important glance into significant characteristics of therapy, such as the timing and reasons leading to therapy, and perceptions regarding what constitutes appropriate therapy. Although beneficial and rehabilitating therapy experiences were mentioned by some of the participants, the majority of the testimonies focused on experiences related to the obstacles and challenges to accessing and engaging in therapy faced by those who experienced CSA.

CONCLUSIONS

The testimonies not only addressed essential aspects of therapy, but also highlighted the importance of thoroughly comprehending the broad context of a person's life that leads them to seek therapy. The discussion points to grave social and policy lacunas that prevent people who experienced CSA from receiving therapy that is accessible, timely, subsidized, stigma-free and multifaceted.

Psychologist attitudes towards disclosure and believability of childhood sexual abuse: Can biases affect perception, judgement, and action?

BACKGROUND

The perception of CSA disclosure belief is critical to long-term outcomes for CSA survivors. Despite disclosures often occurring in clinical settings CSA survivors do not always report a sense of clinician belief in response to their disclosure. Ascertaining the factors that influence clinician belief is essential to improving outcomes.

OBJECTIVE

This study examined whether language (i.e., word choice to describe abuse) and ongoing relationship status with a perpetrator impact perceptions of CSA belief amongst psychologists.

METHODS

This 2 × 2 within subject's study examined relationship effects (ongoing verses estranged) and language effects (consensual verses abusive), embedded in fictitious vignettes, on believability. Seventy-five participants completed demographic surveys, rated and discussed belief in four vignettes, and completed validated scales capturing clinician trauma history and CSA myth endorsement.

RESULTS

A significant main effect for relationship was found with ongoing victim-perpetrator relationships being less believed than depictions of estranged relationships (F(1,3) = 15.57, p = .001, h2 = 0.174). While no main effect for language was found (F(1,3) = 0.06, p = .801, h2 = 0.001) content analysis of the open-ended items revealed 80 % of psychologists reported being influenced by the language manipulations. Correlations revealed male psychologists were less likely to believe disclosures and more likely to endorse CSA myths than females, and psychologists who had engaged in trauma training appeared to have heightened disclosure belief and lower myth endorsement.

CONCLUSIONS

While psychologists generally report belief in CSA disclosures they appear to evaluate specific disclosure aspects to inform this level of belief. Issues around social desirability, measure sensitivity, and learning effects are discussed alongside the importance of trauma training for psychologists.

International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications

BACKGROUND

Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence.

OBJECTIVE

The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations.

RESULTS

Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children.

DISCUSSION

Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.

"I was alone. No one offered me a real intervention": Israeli child protection services as experienced by adults who underwent child sexual abuse

BACKGROUND

Many children worldwide come into contact with child protection social workers (CPSW) following child sexual abuse (CSA). Surprisingly, little is known concerning how they experience and perceive these encounters.

OBJECTIVE

The current study was designed to examine the way adults who underwent CSA experienced and perceived child protection services (CPS) in Israel as conveyed in their written testimonies.

METHOD

The current sample included 83 written testimonies sent to the Israeli Independent Public Inquiry on CSA, analyzed using inductive thematic analysis.

RESULTS

The participants' testimonies uncovered two main themes: 1) experiences with CPSW interventions, including being disregarded, abandoned and disbelieved; and 2) constructions of the CPSW practice as poor, maladapted and abusive. Some participants described their active efforts to change the system from within.

CONCLUSIONS

The participants' testimonies, which reflected the negative manifestations of neoliberal policy in the CPS, will be broached in the discussion section, alongside two other significant concepts: child participation and a context-informed perspective of child risk and protection. The ramifications for policy and practice will be expanded while acknowledging the complex role of social workers in CPS.

Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study

The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.

Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study

BACKGROUND

Child sexual abuse (CSA) is a type of maltreatment considered a global health problem. CSA is a traumatic experience with important consequences for the victim's health. It is essential to report the effectiveness of CSA prevention programs to offer society useful tools to combat this abuse.

OBJECTIVE

We aimed to study the effectiveness of CSA prevention programs on the knowledge acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is related to program-related and methodological variables.

PARTICIPANTS AND SETTINGS

Standardised mean change (with studies that report pre-post program measures) of the effectiveness of CSA prevention programs published between 2014 and 2021 was carried out.

METHODS

The general effectiveness of these programs and whether the results were influenced by program-related variables (the duration, the target population, participants' age, or the type of intervention) or by methodology-related factors (the agent who taught them, the geographical area where they were carried out or the way the programs were evaluated) were analysed. A total of 43 samples analysing knowledge about CSA as a dependent variable were included.

RESULTS

The results reported a combined effect size considered large (dMR = -0.96, 95 % CI [-1.10, -0.82], p < .001). High inter-study heterogeneity was observed in the meta-analysis, although only the geographic area where the studies were conducted appears as a significant moderator.

CONCLUSIONS

In conclusion, the prevention programs included in this analysis significantly improved the participants' knowledge acquisition.

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose?

Child Sexual Abuse (CSA) and the production, use, and distribution of Child Sexual Abuse Material (CSAM) are key threats to children's mental health. From the perspective of indicated prevention, it can be assumed that some persons with a sexual interest in children commit such unreported crimes. Accordingly, the German Network kein Täter werden (meaning do not offend) has implemented a confidential treatment service for persons with a sexual interest in minors who voluntarily seek therapy, might or might not have offended but have not yet been detected or have fulfilled all legal requirements (here referred to as non-forensic individuals). However, this offer has been questioned for investing resources in a group which critics consider as low risk. The following study addresses the question of recidivism risks for CSA or viewing CSAM among non-forensic individuals. We found significantly higher rates of CSA/CSAM in our participants' history compared to a German study on a representative sample of males. Regarding CSAM, the recidivism rate of 39% was found to be 11 times higher than the expected recidivism rate based on previous publications. Regarding CSA, the recidivism rate of 14% was not significantly different from the expected rate reported for subjects with a conviction for a sexual contact offense. Among various risk instruments, only the CPORT with CASIC rating was able to predict CSA (AUC = 0.69, 95% CI = 0.55, 0.82) and CSAM (AUC = 0.63, 95% CI = 0.53, 0.73) among individuals with a history of CSAM, but with poor discrimination. We conclude that a large proportion of our sample poses a substantial risk and therefore treatment resources are well invested. However, further studies are needed to improve risk assessment among non-forensic clients.

Enhancing investigative interview training using a child avatar system: a comparative study of interactive environments

The impact of investigative interviews by police and Child Protective Services (CPS) on abused children can be profound, making effective training vital. Quality in these interviews often falls short and current training programs are insufficient in enabling adherence to best practice. We present a system for simulating an interactive environment with alleged abuse victims using a child avatar. The purpose of the system is to improve the quality of investigative interviewing by providing a realistic and engaging training experience for police and CPS personnel. We conducted a user study to assess the efficacy of four interactive platforms: VR, 2D desktop, audio, and text chat. CPS workers and child welfare students rated the quality of experience (QoE), realism, responsiveness, immersion, and flow. We also evaluated perceived learning impact, engagement in learning, self-efficacy, and alignment with best practice guidelines. Our findings indicate VR as superior in four out of five quality aspects, with 66% participants favoring it for immersive, realistic training. Quality of questions posed is crucial to these interviews. Distinguishing between appropriate and inappropriate questions, we achieved 87% balanced accuracy in providing effective feedback using our question classification model. Furthermore, CPS professionals demonstrated superior interview quality compared to non-professionals, independent of the platform.

Childhood maltreatment and suicide risk: The mediating role of self-compassion, mentalization, depression

BACKGROUND

Childhood maltreatment (CM) is a well-established risk factor for depression and increased suicide risk. This study aimed to investigate the distinctive mechanisms of individual types of CM on young adult suicide risk, by exploring the potential mediating role of mentalization, self-compassion, and depression.

METHODS

A total of 4873 adults completed a survey screening for experiences of CM, self-compassion, mentalization, depression, and suicide risk.

RESULTS

The path analysis revealed significant direct effects of mentalization, self-compassion, and depression on suicide risk. Moreover, mentalization, self-compassion, and depression mediated the relationship between emotional abuse/neglect and suicide risk, whereas physical neglect contributed to suicide risk only through mentalization and depression. Furthermore, sexual abuse had a significant direct effect on suicide risk, whereas physical abuse did not show any direct or indirect effects.

LIMITATIONS

The cross-sectional design of the study limits its ability to establish causality, and the risk of recall bias in reporting physical or sexual abuse cannot be ignored.

CONCLUSIONS

This study represents the first identification of disturbances in self-compassion, mentalization, and depression that mediate the relationship between various types of CM and suicide risk in young adults. Our findings suggest substantive differences in the impact of emotional CM compared to other forms of CM. Enhancing self-compassion and mentalization abilities could be valuable intervention strategies for individuals with a history of emotional CM. Addressing factors that hinder the recall of relevant subjective experiences of physical and sexual abuse is also critical.

The association between child sexual abuse and self-reported sleep in adolescent girls

STUDY OBJECTIVES

Child sexual abuse is associated with negative consequences on both physical and mental health. It has been found to influence child and adolescent sleep, which is an important developmental factor, which also influences mental and physical health. However, the literature examining this topic is plagued by methodological limitations, such as small sample sizes and unvalidated measures.

METHODS

Using the Pittsburgh Sleep Quality Index (PSQI), the present study examined 7 self-reported sleep dimensions, including sleep latency, efficiency, duration, disturbances, subjective sleep quality, daytime dysfunction, and use of sleep medication, in a sample of 707 adolescent girls aged 14-18 years old.

RESULTS

Statistical analyses revealed that child sexual abuse had a significant moderate association with the total PSQI score. Sexually abused adolescent girls, compared with their nonabused counterparts, reported more sleep difficulties. Significant differences also emerged on all sleep dimensions, with abused girls reporting increased difficulties. However, the magnitude of these associations differed from one dimension to another.

CONCLUSIONS

Our findings support the continued study of sleep in adolescent girls who experienced sexual abuse. They also support the use of a fine-grained perspective when assessing various dimensions of sleep health in girls with a history of child sexual abuse for improved tertiary prevention and intervention.

CITATION

Langevin R, Pennestri M-H, Hershon M, Pirro T, Hébert M. The association between child sexual abuse and self-reported sleep in adolescent girls. J Clin Sleep Med. 2023;19(11):1933-1939.

A systematic review of the measurement properties of self-report screening tools to detect risk or exposure to child sexual abuse for children under 12

Child sexual abuse (CSA) is a substantial public health issue that is challenging to measure epidemiologically due to the "pact of silence" among those involved. Validated tools could contribute to early recognition or risk detection for CSA. We aimed to systematically assess self-report tools' measurement properties and methodological quality that detect risk or exposure to CSA for children under twelve. The search strategy, selection criteria, data extraction, data analysis, and synthesis followed the COSMIN methodology for systematic reviews (2018). PROSPERO 2021 registration CRD42021278465. MEDLINE, COCHRANE, EMBASE, CINAHL, SCOPUS, and ERIC were searched until August 2021, with an updated search on September 23, 2021, and unlimited by language. The inclusion criteria were: to assess risk or exposure to CSA under twelve years old by objective items and self-report tools; sexual violence risk or exposure in the domestic context; the application context should include health facilities (such as hospital emergency rooms, outpatient clinics, pediatric wards, psychology centers, social services), education (such as schools) and community; no language or date restriction. The exclusion criteria were: non-self-report tools studies, comprehensive articles, comments, editorials, expert opinions, and studies of projective techniques. The COSMIN risk of bias checklist was used to evaluate the methodological quality of the included studies. Feasibility aspects were assessed. This study had no funding source; 29 studies describing eight tools met eligibility criteria. No single instrument reported all nine measurement properties outlined by the COSMIN methodology. The strength of the evidence was moderate to high for six out of eight instruments. ICAST-C and JVQ were the tools that obtained the highest number of rated measurement properties and strength of evidence.

"Silent screams": Family perceptions in the drawings of incest victim children

PURPOSE

This study aimed to examine the family perceptions in the drawings of children exposed to incest.

DESIGN AND METHODS

This qualitative research involved 25 child survivors of incest, all of whom were examined and subjected to forensic interviews at a facility in northern Türkiye specializing in cases of child sexual abuse. The data were collected using the "Child and Family Descriptive Information Form", the "Abuser Descriptive Information Form", the "Family Drawing Test", and the "Semi-structured Interview Form".

RESULTS

The children's drawings were subjected to a projective analysis, leading to the identification of three key themes: the distress of confronting incest; unbalanced power and role allocation in the family; and dysfunctional family dynamics.". These themes were discerned by examining the connections and coherence between the categories.

CONCLUSION

It is concluded in the study that who are exposed to incest perceived a trauma experience that affected the whole family, perceived unbalanced power and role allocation in the family with authoritarian-aggressive and submissive-oppressed roles, and had negative perceptions of family dynamics such as emotional ties, family integrity, and social interaction.

IMPLICATIONS TO PRACTICE

This study emphasizes the need to restructure the issues of familial trauma, power and role imbalance, and unmet needs within the family while planning for trauma in nursing approaches to children who are victims of incest.

Ecological factors associated with child sexual abuse among 15- to 17-year-old adolescents in mainland China: implications for intervention

Background

Child sexual abuse is a major public health problem with adverse consequences for victims' physical, mental, and reproductive health. This cross-sectional study aimed to determine the prevalence of child sexual abuse and its associated factors among 15- to 17-year-old adolescents in mainland China.

Methods

From September 8, 2019 to January 17, 2020, a total of 48,660 participants were recruited by 58 colleges and universities across the whole country to complete the self-administered, structured, online questionnaire. This analysis was restricted to 3,215 adolescents aged between 15 and 17 years in mainland China. Chi-square tests and multivariate Logistic regression analyses were performed to identify individual, relationship, and community factors associated with child sexual abuse.

Results

The overall prevalence of child sexual abuse was 12.0%. More specifically, 13.0% of girls and 10.6% of boys reported that they were sexually abused prior to 18 years of age. At the individual level, being female, sexual minority identity, younger age, and higher levels of knowledge, skills and self-efficacy regarding condom use were significantly related to increased odds of reporting sexual abuse. At the relationship and community level, adolescents from disrupted families and those entering into a marriage, having casual sexual partners, and having first intercourse at a younger age were more likely to report sexual abuse. On the contrary, those who had never discussed sex-related topics with their family members at home and were offered school-based sexuality education later (vs. earlier) were less likely to report sexual abuse.

Conclusion

Multilevel prevention programs and strategies, including targeting adolescents with high-risk characteristics, educating young children and their parents about child sexual abuse prevention and optimizing the involvement of parents, school, community, society and government in comprehensive sexuality education, should be taken to reduce child sexual abuse among 15- to 17-year-old adolescents.

Sexual violence affects adolescents' health and prosocial behaviour beyond other violence exposure

Background: Sexual violence is a public health issue among adolescents globally but remains understudied in Sub-Saharan Africa.Objective: The present study focused on the association of cumulative exposure to different types of sexual violence with mental and physical health problems and prosocial behaviour.Method: We conducted a survey with a regionally representative sample of both in-school and out-of-school adolescents, aged 13-17 years, living in south-western Nigeria. Self-reported exposure to sexual violence, behavioural problems, physical complaints, and prosocial behaviour were assessed.Results: About three quarters of the participants reported the experience of sexual violence (74.6%). Multiple regression models revealed that the more types of sexual violence an individual reported, the more mental and physical health problems, and the fewer prosocial behaviours they reported when controlling for other forms of violence exposure. Latent class analysis revealed three severity classes of sexual violence. Symptoms of mental and physical health indicators were significantly higher as exposure increased by group whereas prosocial behaviours were non-significantly fewer in the opposite direction.Conclusion: This study revealed a consistent and unique relation between sexual violence exposure and negative health outcomes among adolescents. Further research on sexual violence in Sub-Saharan Africa and its associations is needed.

The Relationship Between Child Sexual Abuse and Sexual Dysfunction in Adults: A Meta-Analysis

Child sexual abuse (CSA) has been recognized as a risk factor for sexual dysfunction and has attracted increasing attention. However, controversies remain regarding related research. The aim is to calculate the pooled effect size estimate for the correlation between CSA and sexual dysfunction in adults by meta-analysis. Five bibliographic databases (PubMed, Cochrane Library, Web of Science, Embase, and PsycINFO) were comprehensively searched to clarify the association between CSA and sexual dysfunction in adults. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Subgroup analysis, publication bias analysis, and sensitivity analysis were conducted. Adults who had a history of CSA experienced a higher proportion of sexual dysfunction than adults with no history of CSA (OR = 1.68, 95% CI [1.49, 1.87]). Subgroup analysis showed that women with a history of CSA reported a higher proportion of sexual dysfunction than men with a history of CSA (men: OR = 1.45, 95% CI [1.05, 1.84]; women: OR = 1.62, 95% CI [1.42, 1.83]). The estimates of the effect sizes differed substantially depending on the CSA and sexual dysfunction instruments that were used in each study and the region of each sample. This meta-analysis provides conclusive evidence of an association between CSA and sexual dysfunction in adults. Currently known interventions for the treatment of sexual dysfunction after CSA have only been evaluated in women, so specific interventions should be designed for men CSA survivors who experience sexual impairment.

Functional neurological disorder is a feminist issue

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

Adapting prevention programs for virtual delivery: A case study in adapting a parent-focused child sexual abuse prevention module

Background

Evolving and emerging contexts require interventions to respond and adapt. The COVID-19 pandemic necessitated a quick adaptation from in-person to virtual delivery. Not only were there few programs able to transition to virtual delivery, there was a lack of parent-focused CSA-prevention programs. The current study describes the responsive adaptation of a parent-focused child sexual abuse (CSA) prevention module (Smart Parents-Safe and Healthy Kids; SPSHK) for virtual delivery.

Design and methods

This two-phase study used mixed-methods to inform and pilot test adaptations to the virtual module. In Phase 1, parenting providers with and without experience delivering SPSHK (N = 110) completed anonymous surveys and a subsample (n = 27) subsequently participated in brief interviews elaborate on challenges and needed adaptations for virtual platforms.

Results

Providers indicated the greatest technological difficulties with parents' access to technology noting the inability to use a screensharing function. Thus, providers recommended no adaptations for the virtual delivery of SPSHK. In Phase 2, the virtual SPSHK module was piloted with nine parents. Results demonstrated virtual SPSHK was acceptable and feasibly implemented. Pre-posttest assessments indicated increases in parents' CSA-related awareness and use of protective behaviors.

Conclusion

The current study suggests the promise of virtual SPSHK implementation and may act as a blueprint for other parent-focused CSA-prevention programs, but also more general parenting programs, considering virtual delivery.

"Falling Through the Cracks": A Retrospective Exploration of the Barriers to Help-Seeking Among Men Convicted of Sexual Crimes

The prevalence and impact of sexual abuse is of global concern, and the alarming rates of victimization have inspired a focus on its prevention. Whilst research has begun to explore the experiences of non-offending individuals to inform prevention initiatives, there is limited exploration of those who have struggled with their sexual interests and go on to commit sexual crime. Arguably these individuals hold key information about gaps in service provision, which may inform approaches to crime prevention. This study aimed to provide a phenomenological exploration of the pre-offense experiences of convicted individuals' beliefs about help-seeking, their desires for support, and any barriers that might have prevented them from coming forward for help. Semi-structured interviews were conducted with 14 individuals convicted of sexual offenses (n = 13 against children; n = 1 sexually motivated violence), and interpretative phenomenological analysis elicited three superordinate themes: Desperation, Barriers to Help-seeking and A Way Forward. The findings shed light on the distressing experience of living with sexual interests that are so openly rejected by society and the many ways participants attempted to cope with this, including multiple failed attempts to seek help. Implications and limitations are discussed.

Understanding the Dynamics of Unwanted Online Sexual Solicitation Among Youth in Taiwan: Vulnerability and Resilience Factors

The rise in online sexual exposure and solicitation among youth has heightened concerns. Youth, due to their limited socio-cognitive capacity, face greater risks of online sexual victimization compared to adults. Unwanted online sexual solicitation (UOSS) is a concerning aspect of sexual victimization, encompassing requests for unwanted sexual talks, activities, and sharing personal sexual information or images online. This study, based on target congruence theory, examined UOSS risk and protective factors using a national-representative youth sample in Taiwan. In 2020, 19,556 students (Grades 5-12, average age 15, 50% male) participated in the school-based online survey. Hierarchical linear regression was used to determine the significance of UOSS predictors. Findings revealed a 15.4% prevalence of UOSS. Accounting for age and gender, target-vulnerability variables (self-esteem, bullying victimization, psychological distress) and target-gratifiability variables (online self-disclosure, time spent online) significantly linked to UOSS. Youth who were bullied, had greater psychological distress and online self-disclosure, and increased Internet use were prone to UOSS, while self-esteem mitigated risks. Bullying victimization and online self-disclosure were the strongest correlates of UOSS in Taiwan's youth, followed by psychological distress, Internet usage, and self-esteem. In sum, this study enriches the understanding of UOSS among Taiwanese youth and suggests strategies to prevent online sexual victimization. Enhancing self-esteem, promoting social media education including online privacy and self-disclose, tackling bullying, addressing psychological distress, and furnishing relevant services are crucial preventive measures. These findings offer guidance to parents, educators, and health professionals for supervising and steering adolescents' online conduct, presenting an evidence-based framework to avert online sexual victimization.

Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis

BACKGROUND

Previous studies have frequently reported a high prevalence of co-occurring anxiety and depression among people who experienced stressful events in childhood. However, few have noted the symptomatic relationship of this comorbidity among childhood sexual abuse (CSA) survivors. Therefore, this study's objectives were as follows: (1) to examine the relationship across symptoms between anxiety and depression among CSA survivors; (2) to compare differences between male and female network structures among CSA survivors.

METHODS

A total of 63 Universities and Colleges in Jilin Province, China, covered 96,218 participants in this study, a sub-set data of which met the criteria of CSA was analyzed with the network analysis. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), measured CSA. Anxiety was measured by the seven-item Generalized Anxiety Disorder Scale (GAD-7), and depression was measured by the Patient Health Questionnaire (PHQ-9). The sex difference between anxiety and depression among CSA survivors was compared.

RESULTS

3,479 college students reported the experience of CSA (CTQ-SF total scores ≥ 8), with a prevalence of 3.62% (95% CI: 3.50-3.73%). Among CSA survivors, control worry, sad mood, and energy were central and bridge symptoms of the anxiety and depression network. Meanwhile, male CSA survivors appeared to have a stronger correlation between guilt and suicide, but female CSA survivors seemed to have a stronger correlation between control worry and suicide. Moreover, the edge of control worry-relax-afraid was stronger in the male network, while the edge of restless-relax was stronger in the female network.

CONCLUSION

Control worry, sad mood, and energy are crucial to offer targeted treatment and to relieve anxiety and depression symptoms for CSA survivors. Guilt needs more attention for male CSA survivors, while control worry remains more important for female CSA survivors to reduce suicidal ideation and suicide attempts.

Hypothalamic volume in pedophilia with or without child sexual offense

The hypothalamus regulates sexual behavior and is simultaneously associated with aggression and violence. Consequently, this brain region is relevant in research of pedophilia and child sexual offenses (CSO). The distinction between these two phenomena is of great importance and was the object of consideration of this study. We analyzed exclusively men, including 73 pedophilic offenders who committed CSO, an equal number of people with pedophilia but without such offenses, and 133 non-pedophilic, non-offending subjects who formed the control group. All data were collected in a multicenter in vivo study and analyzed using a semi-automated segmentation algorithm for 3-Tesla magnetic resonance images. Men with pedophilia who committed CSO on average had a 47 mm3 smaller hypothalamus per side than people without committed CSO. This effect was driven by both the group of non-offending people with pedophilia and the control group. By contrast, the exploratory comparison of pedophilic persons without CSO with the control group showed no significant difference. The present study demonstrates a deviant hypothalamic structure as a neurobiological correlate of CSO in pedophiles, but not in people with pedophilia who have not committed CSO. Thus, it strengthens the argument to distinguish between sexual offending and paraphilic sexual preferences.

Childhood Sexual Abuse: A Longitudinal Study of Disclosures and Denials

In legal cases regarding child sexual abuse (CSA), children have various options, such as to disclose or deny maltreatment. When interviewed in adulthood, their accounts may be consistent with their childhood responses. Alternatively, denial in childhood could be followed in adulthood by disclosure ("deferred disclosure"), confirming previous suspicions. Or the adults could possibly recant. We conducted a longitudinal study of CSA disclosures and denials (N = 99; Time 1 [T1], 3- to 16-year-olds). T1 CSA disclosures and denials at a forensic unit were compared to the individuals' responses 20 years later (Time 2 [T2]. 22- to 37-years-old). We found that consistent disclosure was associated with being older at T1 and female. Deferred disclosure was significantly associated with greater T2 trauma-related symptoms. Corroboration and higher CSA severity predicted T2 recantation. Consistent denial was related to less severe CSA. Our findings add to knowledge about CSA disclosures, which affect legal pathways available to child victims.

The Role of Technology in the Perpetration of Childhood Sexual Abuse: The Importance of Considering Both In-Person and Online Interactions

Child sexual abuse (CSA) is a pervasive global problem. To date, prevention efforts have largely focused on legislative efforts, parent and child education, and environmental protections. Due to the proliferation of the Internet, and especially since the COVID-19 pandemic, recent prevention efforts have focused on online CSA. However, the extent to which technology is being used in the perpetration of in-person, contact CSA remains unclear. This study examined the role of technology in the perpetration of in-person, contact CSA using a sample of 332 adult CSA survivors who completed an anonymous online survey. Overall, we found that only 8.5% of the sample reported that they met the perpetrator online through social media, chatrooms, and other online applications. When looking at the role of technology in the perpetration of the abuse, 35% reported texting with the perpetrator, 27% reported engaging in online chats, and 33% spoke to the perpetrator on the phone. Few participants reported sending (11%) or receiving (13%) photographs or videos that were sexual in nature. Technology use was reported more frequently in CSA involving adolescents than CSA involving children aged 12 and under. There were no differences in the use of technology based on the age of the person who perpetrated the CSA. These findings will be discussed as they pertain to prevention efforts for CSA.

Associations between exposure to sexual abuse, substance use, adverse health outcomes, and use of youth health services among Norwegian adolescents

BACKGROUND

A strong association between sexual abuse and adverse health outcomes has been reported among adolescents. The present study aimed to provide more information about adverse health outcomes associated with sexual abuse and substance use, and to examine the use of youth health services among Norwegian adolescents.

METHODS

National representative cross-sectional study among 16-19-year-old Norwegian adolescents (n = 9784). Multivariable regression analyses, adjusted for socioeconomic status and age, were used to examine the association between exposure to sexual abuse, substance use and health risk factors, and the use of youth health services.

RESULTS

Adolescents exposed to sexual abuse had higher odds of depressive symptoms (males: OR:3.8; 95% CI:2.5-5.8, females: 2.9;2.4-3.5), daily headache (males: 5.3;2.8-10.1, females:1.9; 1.5-2.4), high medication use (males: 3.2;1.7-6.0, females: 2.0;1.6-2.6), self-harm (males: 3.8;2.4-6.0, females:3.2; 2.6-3.9), suicidal thoughts (males: 3.3; 2.2-5.0, females:3.0; 2.5-3.6) and suicide attempts (males: 9.5;5.6-16.0, females:3.6;2.7-4.9). Furthermore, exposure to sexual abuse was associated with higher odds of using school health services (males: 3.9;2.6-5.9, females: 1.6;1.3-1.9) and health services for youth (males: 4.8;3.1-7.6, females: 2.1;1.7-2.5). In general, substance use was associated with increased odds of adverse health related outcomes and use of youth health services, but the strength of the relationships varied according to sex. Finally, results indicated a significant interaction between sexual abuse and smoking that was associated with increased odds of having suicidal thoughts for males (2.6;1.1-6.5) but a decreased odds of having suicidal thoughts and have conducted suicide attempts once or more for females (0.6;0.4-1.0 and 0.5;0.3-0.9, respectively).

CONCLUSIONS

The present study confirmed a strong relationship between exposure to sexual abuse and health risks, especially among males. Moreover, males exposed to sexual abuse were much more likely to use youth health services compared to sexually abused females. Substance use was also associated with adverse health outcomes and use of youth health services, and interactions between sexual abuse and smoking seemed to influence risk of suicidal thoughts and attempts differently according to sex. Results from this study increase knowledge about possible health related effects of sexual abuse which should be used to identify victims and provide targeted treatment by youth health services.

Mimicry Deception Theory applied to sexual abuse of children

Sexual abuse of children remains a widespread problem with well-documented, adverse consequences. Often, abuse ending is contingent on a disclosure made by the victim, but victims delay disclosure if they tell someone at all. The factors associated with (non)disclosure are complex and interrelated. In this paper, we propose a new theoretical framework (Mimicry Deception Theory; MDT) to explore various aspects of the grooming process, using a qualitative content analysis of US court appeal cases (N = 25). Specifically, we focus on how MDT components contribute to the likelihood of a CSA disclosure. MDT is made up of five components: Victim Selection, Community Integration, Complexity of Deception, Resource Extraction, and Detectability. These five components allow us to look at several characteristics of abuse in tandem and examine how they interact to impact various outcomes, such as (non)disclosure. We provide a detailed codebook for this framework, that can be used to systematically extract relevant information from large amounts of data. Through the application of this framework, we were able to identify several factors that may play a role in delayed or non-disclosure. Further, we found repeat offenders were likely to use the exact same methods of access, grooming, and remaining undetected across victims. Implications for prevention, as well as clinical interventions with perpetrators as well as victims are discussed.

A Meta-Analysis of the Effects of Childhood Maltreatment on Elderly Depression

Background: The present study aimed to synthesize the effects of five types of child maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect) on late-life depression.Method: Four English-language databases (Web of Science, PsycINFO and PsycARTICLES, PubMed, and Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang Database, and Weipu Database) were systematically reviewed, and data related to the association between child maltreatment and late-life depression were extracted. Ten studies involving 30,308 older adults were included, and the effect sizes were pooled using random-effect models.Findings: Except for sexual abuse, four types of child maltreatment were found to be positively associated with late-life depression. Physical abuse, emotional abuse and physical neglect were associated with elderly depression (PA: OR = 1.73, 95% CI = 1.55-1.95, p < .001; EA: OR = 1.92, 95% CI = 1.73-2.12, p < .001; PN: OR = 2.05, 95% CI = 1.15-3.67, p < .01) at a small level, and emotional neglect was associated with elderly depression (OR = 3.25, 95% CI = 1.43-7.39, p < .001) at an approximately moderate level. Gender moderated the relationship between physical neglect, emotional neglect, and late-life depression.Conclusion: Our findings highlight the significance of child maltreatment in the development of late-life depression, and underscore the need for future research and practice to explore potential ways to address late-life depression among older adults who suffered child maltreatment.

The Potential for Anti-Stigma Interventions to Change Public Attitudes Toward Minor-Attracted Persons: A Replication and Extension of Jara and Jeglic's Study

From a public health perspective, ensuring access to, and uptake of, support services for people concerned about their sexual thoughts and behavior is essential to the prevention of child sexual abuse. However, public and fiscal support for these services can be adversely affected by negative preconceptions regarding minor-attracted persons (MAPs); negative stigma may also limit MAPs' engagement with such services. Using a randomized-control design, the present study replicated and extended a recent US study to test effects of different modes of educational messaging to reduce negative attitudes toward MAPs in Australia. Participants were recruited nationally via a Qualtrics XM online survey platform. The final sample (n = 178) were aged 18-84 (M = 47.57 years, SD = 17.34; 49% male). Participants completed the Attitudes Toward Minor Attracted Persons (ATMAP) scale prior to being randomly assigned to one of four conditions (written text [facts only]; written text [myth and facts]; info-video [myths and facts]; and control). Following intervention (or control) the ATMAP was readministered; those in experimental groups also completed a comprehension test. Mixed between-within subjects analysis of covariance revealed significant reductions in pre-post scores on the ATMAP scale, but no significant differences were found across intervention types, or the control. Scores indicated that older participants were less negative in their attitudes compared to younger participants, both before and after intervention. Findings suggest that educating the public may improve attitudes toward MAPs, but more knowledge is required on how to best disseminate messages to maximize impact.

Child Sexual Abuse Studies in Arab Societies: A Systematic Review and Directions for Future Research

Although child sexual abuse (CSA) is acknowledged as a worldwide social phenomenon, less is known about CSA within Arab societies. The current systematic literature review was designed to highlight the empirical knowledge on CSA in Arab societies. Guided by PRISMA principles, key databases were searched, with no time limit, for studies meeting the inclusion criteria. Fifty-seven studies were identified. The majority focused on the prevalence of CSA in various Arab societies around the world, with a wide range of rates reported. It is important to stress two main barriers addressed by the included studies. The first relates to the issue of taboo and the forbidden discussion of sexual content. The second is ethical, in which the researchers expressed their fear of creating emotional distress for their participants. A small group of studies examined parents' perceptions of CSA and the need for parents' involvement in the protection of their children. Another small group of studies focused on professionals' perceptions and experiences in contending with CSA, as well as their distress, conflict, and urgent need for support and guidance. The conclusions from the systematic literature review emphasized the enormous challenge of conducting studies on CSA in Arab societies and the urgent need to advance this research while also including children and adult survivors, whose perceptions and experiences are currently understudied. Moreover, the discussion stresses the need to adopt an intersectionality paradigm in future studies to advance the improvement of CSA policy and practice.

Lived experiences of resilience for women who have experienced childhood sexual abuse: A systematic review of qualitative studies

BACKGROUND

Child sexual abuse (CSA) can have detrimental, long-lasting consequences but effects are diverse, and resilience, or attainment of better-than-expected outcomes, is possible.

OBJECTIVE

This systematic review synthesises qualitative research findings about lived experiences of resilience processes used by women who had been subjected to CSA.

METHODS

A comprehensive search was undertaken of major and minor article databases (e.g., PsychInfo, Medline, CINAHL, Web of Science, Scopus) and Google Scholar, with hand searching of reference lists and forward searching of retrieved articles. Eight studies met the inclusion criteria (peer-reviewed qualitative or mixed methods studies written in English about experiences of resilience by women who had experienced CSA). Data extraction, quality appraisal, and thematic analysis were performed.

RESULTS

Thematic analysis generated several process-related resilience themes: distancing oneself from sexual abuse; building healthy interpersonal, community, and cultural connections; drawing on spiritual belief systems; reframing the sexual abuse; placing blame with the perpetrator; reclaiming self-worth; taking control of one's life; and pursuing meaningful goals. For some, it involved forgiveness of self and others, reclaiming one's sexuality, and/or fighting against diverse forms of oppression. There was much evidence that resilience was a dynamic, personal and social-ecological phenomenon.

CONCLUSION

Counsellors and other professionals can use these findings to help women affected by CSA explore, develop, and strengthen factors that support resilience. Future research could explore the experiences of resilience for women with different cultural backgrounds, socioeconomic status, religious and/or spiritual affiliations.

Child sexual abuse unmasked due to vaginal foreign body: case review

Vaginal foreign body (VFB) can be a routine presentation to a pediatric unit, especially with associated vaginal discharge. Although it can be rare, this case series highlights that child sexual abuse (CSA) should not be ignored as a possibility when such a presentation is investigated. In the first case, an 11-year-old school girl presented with vaginal discharge and urinary symptoms, which was revealed to be due to a vesico-vaginal fistula secondary to an intra-vaginal foreign body, which was a plastic cap. Further investigation revealed that she had undergone vaginal penetration since the age of 6 years by two older male relatives. However, she was unaware how a plastic object came in to being inside her vagina. In the second case, a polythene bag was retrieved from the vagina of a 15 and a half year-old, pubertal female with an intellectually disability who presented with a 3-4-month history of vaginal discharge. Further investigation revealed that she had been vaginally penetrated on multiple occasions by her elder brother, who used polythene bags instead of condoms. Such a bag had been retained in her vagina leading to the vaginal discharge. VFB with or without genito-urinary symptoms is a red flag to identify sexual abuse among children, especially with intellectual disabilities. Although literature reports a wide variety of vaginal foreign bodies, there had been no reports of polythene bags used in place of condoms which were retrieved from a vagina of a CSA victim.

"I was the only one talking about the abuse": Experiences and perceptions of survivors who underwent child sexual abuse as boys

OBJECTIVE

Empirical literature on child sexual abuse (CSA) has traditionally focused on the CSA of girls. Much less is known about the CSA of boys, specifically about the survivors' experiences. The current study was designed to examine the experiences and perceptions of male adult survivors who underwent CSA as boys.

METHOD

Fifty-one written narratives were collected from survivors who experienced CSA as boys as part of the Israeli Independent Public Inquiry into CSA. A qualitative inductive thematic analysis guided the data analysis.

RESULTS

The findings highlighted CSA survivors' experiences of not understanding and confusion about the abuse while highlighting the context in which the abuse took place. The findings also emphasized the exploitation of power and the survivors' difficulty identifying being sexually abused during physical fights or public events. Moreover, the survivors referred to their surroundings' failure to notice the abuse and their struggle to establish their identity and overcome the abuse consequences, their loneliness and pain.

CONCLUSION

The present findings advance the literature on the CSA of boys by examining narratives written by male CSA survivors. They highlight the potentially destructive role of the heteronormative and conventional masculinity discourse for male CSA survivors, which often enabled the continuation of abuse and challenges that survivors continued to face throughout their lives. The findings also stress society's crucial role in CSA prevention and treatment and the need for public education to challenge societal perceptions regarding the CSA of boys.

Treating post-traumatic stress disorder in survivors of community and domestic violence using narrative exposure therapy: a case series in two public health centers in Rio de Janeiro/Brazil

Prevalence of violence in Brazil is high, which contributes to an increasing number of trauma-related disorders, especially post-traumatic stress disorder (PTSD). This study aims to present a case series of PTSD patients treated with narrative exposure therapy (NET) in two public health centers in Rio de Janeiro (Brazil). Health professionals were trained in a two-week workshop to deliver NET. Exposure to violence and other potentially traumatic events, as well as PTSD were assessed by interviewers before treatment and six months later in follow-up interviews conducted by blind assessors. Multiple traumatic events, including different types of childhood and sexual abuse, intimate partner violence and community violence were reported. Five patients were exposed to community violence, and one to domestic violence, during or after NET treatment. Treatment delivery was integrated into the routine of health centers. Eight patients completed NET and presented a substantial reduction in PTSD severity at six-month follow-up. NET is a feasible and effective treatment for PTSD patients exposed to ongoing violence, and can be integrated into established public health services.

Understanding the dark side of personality in sex offenders considering the level of sexual violence

This study examined the relationship between the actual level of physical violence in sexual offenses and dark triad, empathic and impulsive personality traits of their perpetrators. Sixty-four male perpetrators of sexual offenses without any serious mental illness were included. A 5-point Likert-type coding system based on Violence Profile for Current Offense was applied to assess the severity of physical violence of each sexual offense. Personality traits of dark triad (psychopathy, Machiavellianism, narcissism), trait empathy and impulsiveness were also evaluated. Multivariate analyses indicated that non-stranger victim, secondary psychopathy, narcissism and empathy could significantly predict greater involvement of physical violence in a sexual offense. In addition, empathy was negatively correlated with all dark triad traits. Sexual violence should be conceptualized in the form of a continuum, and, considering such an approach, offenders with high secondary psychopathy and narcissism may show preference for sexual assaults that are more violent in nature.

A cross-sectional study of non-suicidal self-injury in a Chinese adolescent inpatient cohort

Background

Non-suicidal self-injury (NSSI) is a significant predictor of completed suicide and is increasingly recognized as a serious public health concern. Multiple factors, including social, familial, mental, and genetic factors could influence the occurrence of this behavior. Identifying the early risk factors is important for screening and preventing this behavior.

Methods

Here, we recruited a total of 742 adolescent inpatient participants from a mental health center and conducted a series of diagnostic interviews and questionnaires to assess NSSI behavior and other events. Bivariate analysis was used to detect differences between groups in NSSI and non-NSSI. Then, binary logistic regression was fitted to identify predictors of NSSI as a function of these questionnaire scores.

Results

Of the 742 adolescents examined, a total of 382 (51.5%) participants engaged in NSSI. Bivariate analysis showed that age, gender, depression, anxiety, insomnia, and childhood trauma was significantly associated with NSSI. Logistic regression results suggested that females had 2.43 higher odds of engaging in NSSI when compared to their male counterparts (OR = 3.43, 95%CI = 2.09-5.74, p = 1.70 × 10^-6). Depression was a primary risk predictor for NSSI with each additional increase in symptoms of depression increasing the odds of engaging in NSSI by 18% (OR = 1.18, 95%CI = 1.12-1.25, p = 2.25 × 10^-8).

Conclusion

More than half of the adolescent inpatients with psychiatric disorders have NSSI experience. Depression and gender were the risk factors for NSSI. Age at a specific range had a high prevalence of NSSI.

Impacts of Victim Resistance and Type of Assault on Legal Decision-Making in Child Sexual Assault

Prior studies have examined the effects of victim resistance and type of assault (attempted or completed) on perceptions of adult rape cases. However, research has not yet tested whether these findings extend to verdicts rendered in child rape cases, nor has research focused on how perceptions of victim and defendant characteristics in child rape cases may contribute to legal decision-making. In the present study, a 2 (attempted or completed sexual assault) x 3 (victim resistance: verbal-only, verbal with outside interruption, or physical) x 2 (participant sex) between-participant design was used to assess legal decision-making involving a hypothetical criminal case of child rape, with a six-year-old female victim and a 30-year-old male perpetrator. Three-hundred and thirty-five participants read a criminal trial summary and answered questions about the trial, the victim, and the defendant. Results revealed that: (a) when a victim physically resisted, compared to verbally resisted, more guilty judgments were rendered, (b) when the victim physically resisted, higher ratings for aggregated factors for Victim Credibility and Negative Perceptions of the Defendant were given, leading to more guilty verdicts, and (c) female participants were more likely than male participants to render a guilty verdict. No differences in verdict rendered between the verbal with interruption (e.g., knocking on door) and verbal-only conditions were found, nor did type of assault lead to differences in verdict rendered. Implications for child sexual assault cases and the courtroom, as well as implications for practitioners, are provided.

Determining the Prevalence of Child Maltreatment Among Young Adults in Saudi Arabia Using ISPCAN Child Abuse Screening Tool

Background Child maltreatment is an important public health issue, thus determining its prevalence is critical to recognize the extent of the problem and mandate efforts to combat child abuse. We aimed to investigate child maltreatment prevalence among special populations of young adults in Riyadh, Saudi Arabia. Methods We used the retrospective version of the International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (ICAST-R). The survey included Saudi students of both genders aged between 18 to 24 years old and attending King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). The questionnaire was provided electronically using Survey Monkey (Momentive Global Inc., San Mateo, CA, USA). Results A total of 713 students completed all sections of the questionnaire. The prevalence of any type of child maltreatment was estimated to be 42%. Physical abuse was the most prevalent (51.1%), followed by emotional abuse (49.9%), lack of protection and safety (38%), and sexual abuse (29.6%). The most common form of physical abuse was being hit or punched at 77.5% followed by 'beaten very hard with an object' at 58.8% while touching was the most common form of sexual abuse at 68.7%, and only 13.7% encountered penetrating form of sexual abuse. In comparison to female victims, male victims were more likely to be physically abused (odds ratio (OR)=1.5; confidence interval (CI)=1.1-2.0). Participants who lived with a single parent were more likely to be victims of a lack of protection and safety than those who lived with both parents (OR=1.9; CI=1.0-3.7). Most participants reported the abuse to occur after the age of nine years, and the perpetrator was the parents in 17.5% of cases.  Conclusion Our findings demonstrated a high prevalence of child maltreatment among the young adult population in Saudi Arabia. It is vital to obtain more information on the prevalence and risk factors of child maltreatment in various populations and regions of Saudi Arabia to raise awareness and improve services for the victims of abuse.

Knowledge, Skills, and Self-Disclosure Following a Sexual Abuse Prevention Program Among Iranian Preschoolers: A Cluster Quasi-Experimental Controlled Study

Standard empirical studies are needed despite three decades of research on child sexual abuse prevention programs (CSAPPs). This study aimed to investigate the effects of CSAPP on the child's sexual safety. A multicenter, random cluster, quasi-experimental controlled survey was conducted in a 1:1 ratio in Tehran, Iran, from May to December 2019 in seventy 5- to 6-years-old children from 10 kindergartens. In groups of 7 to 8, the intervention group participated in four sessions of 45 minutes of face-to-face sexual self-care training, 3 to 4 days apart. The control groups received one session on accident safety. Knowledge, self-protective skills, fear, and self-disclosure were assessed respectively by the "Personal Safety Questionnaire (PSQ)," "What If Situation Test (WIST)," "Fear Assessment Thermometer Scale (FATS)," and researcher-made questions before and 8 weeks after the intervention. At the baseline, children obtained 70% of knowledge and 45% of protective skills scores. After the intervention, knowledge, protective skills, and detection of "appropriate requests" were significantly promoted (p < .001). Detecting "inappropriate requests" did not differ; however, all quadruple skills (Say, Do, Tell, and Report) improved significantly. "Girl sex" and "parents' education" were related factors promoting children's protective skills. Sexual abuse self-disclosure was 4.2% (n = 3), and one child reported child sexual abuse (CSA) only after the intervention. Despite the lack of formal education, children's basic knowledge reflects the importance of parents in preventing CSA. However, the CSAPP significantly improved children's skills and revealed one CSA case. CSAPP should not focus solely on risky scenarios because if children cannot distinguish between safe and unsafe situations, they will experience unnecessary anxiety. Even after recognizing the dangerous conditions, CSA prevention will practically fail without appropriate reactions such as escaping and reporting. CSAPP should emphasize individual rights such as body ownership and assertiveness skills and explain the "danger of known people" with detailed scenarios, especially in collectivistic and traditional societies.

Association between trauma exposure and glucocorticosteroid concentration in hair during pregnancy

BACKGROUND

Traumatic events, including child abuse and intimate partner violence, are highly prevalent among women of child-bearing age. These traumatic experiences may impact maternal and offspring physical and mental health. A proposed mechanism for these effects is maternal hypothalamic-pituitary-adrenal (HPA) axis dysregulation which can be measured using hair corticosteroid levels.

AIMS

This study aims to examine the association of child abuse and intimate partner violence exposure with HPA axis functioning, as measured by hair corticosteroid levels in a cohort of pregnant women.

METHODS

We included data from 1822 pregnant women (mean gestational age 17 weeks) attending a prenatal clinic in Lima, Peru. We extracted cortisol and cortisone concentrations from hair samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Each participant provided 6-cm hair samples: 3 cm hair segment closest to the scalp reflecting HCC in early pregnancy (first three months), and 3-6 cm from the scalp reflecting HCC in pre-pregnancy (three months prior to conception). Multivariable linear regression procedures were used to assess the association between maternal trauma exposure and hair corticosteroid levels.

RESULTS

Overall, women who experienced child abuse on average had higher levels of cortisol (p < 0.01) and cortisone (p < 0.0001) after adjustment for age, race, adult access to basic foods and hair treatments. For the hair segment reflecting early pregnancy, presence of child abuse was associated with a 0.120 log unit increase in cortisol and a 0.260 log unit increase in cortisone (p < 0.001). For the hair segment reflecting pre-pregnancy, a history of child abuse was associated with a 0.100 log unit increase in cortisol and a 0.180 log unit increase in cortisone (p < 0.01). Results also suggested an impact of intimate partner violence on HPA regulation; however, associations were not statistically significant after controlling for child abuse.

CONCLUSIONS

These results underscore the long-lasting impacts of exposure to adversity and trauma during early life. Our study findings will have implications for research investigating HPA axis function and long-term effects of violence on corticosteroid regulation.

Youth Sport Coaches' Perceptions of Sexually Inappropriate Behaviors and Intimate Coach-Athlete Relationships

Although sexual harassment and abuse in youth sport have received increasing research attention worldwide, less is known about youth coaches' perceptions of sexually inappropriate behaviors and intimate relationships with athletes. The purpose of this exploratory study was to examine youth sport coaches' perceptions of behaviors that can lead to potential sexual harassment and abuse, as well as to understand how coaches perceive coach-athlete sexual relationships. A cross-sectional survey was completed by 200 male coaches from various U.S. youth sport programs. Overall, a majority of coaches indicated behaviors associated with sexist comments and verbal/physical advances as sexually inappropriate. There was, however, a lack of consensus regarding what constitutes sexually inappropriate behaviors when the behavior was instruction-related/contextually dependent. Results were mixed regarding the perceptions of coach-athlete sexual relationships, with a notable number of coaches agreeing that sexual intimacies with young athletes (17 years or younger) are not always harmful and should not be prohibited. Based on a regression analysis, white coaches were more likely to exhibit negative perceptions about coach-athlete sexual relationships compared to ethnically diverse coaches. Overall, these findings warrant the development or reevaluation of policies and interventions aimed at preventing sexual harassment and abuse in the youth sport environment. Continued research is needed to better understand youth sport coaches as the perpetrators of sexual harassment and abuse.

Appraisal of published guidelines in European countries addressing the clinical care of childhood sexual abuse: protocol for a systematic review

INTRODUCTION

Childhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators of CSA, and able to provide appropriate medical management. The WHO issued global guidelines for the clinical care of children with CSA, based on rigorous review of the evidence base. The current systematic review identifies existing CSA guidelines issued by government agencies and academic societies in the European Region and assesses their quality and clarity to illuminate strengths and identify opportunities for improvement.

METHODS AND ANALYSIS

This 10-database systematic review will be conducted according to the Centre for Reviews and Dissemination guidelines and will be reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Guidance for HCPs regarding CSA, written by a national governmental agency or academic society of HCPs within 34 COST Action 19106 Network Countries (CANC) and published in peer-reviewed or grey literature between January 2012 and November 2022, is eligible for inclusion. Two independent researchers will search the international literature, screen, review and extract data. Included guidelines will be assessed for completeness and clarity, compared with the WHO 2017/2019 guidelines on CSA, and evaluated for consistency between the CANC guidelines. The Appraisal of Guidelines for Research and Evaluation II tool and Grading of Recommendations Assessment, Development and Evaluation methodology will be used to evaluate CANC guidelines. Descriptive statistics will summarise content similarities and differences between the WHO guidelines and national guidelines; data will be summarised using counts, frequencies, proportions and per cent agreement between country-specific guidelines and the WHO 2017/2019 guidelines.

ETHICS AND DISSEMINATION

There are no individuals or protected health information involved and no safety issues identified. Results will be published in a peer-reviewed medical journal.

PROSPERO REGISTRATION NUMBER

CRD42022320747.

The prevalence of child maltreatment in Australia: findings from a national survey

OBJECTIVES

To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence.

DESIGN, SETTING

Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study).

PARTICIPANTS

People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more).

MAIN OUTCOME MEASURES

Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016.

RESULTS

Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7-33.3%), sexual abuse by 28.5% (95% CI, 27.3-29.8%), emotional abuse by 30.9% (95% CI, 29.7-32.2%), neglect by 8.9% (95% CI, 8.1-9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3-40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16-24 years was lower than for those aged 25-34 years, and that of sexual abuse was lower than for those aged 35-44 years, suggesting recent declines in the prevalence of these maltreatment types.

CONCLUSIONS

Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities.

Sexual Victimization of Children and Adolescents: A Qualitative Study with Brazilian Undergraduates on Disclosure, Detection, Outcomes, and Consequences

This qualitative study aimed to discover whether experiences of sexual violence suffered by a sample of adolescents and young-adults at a Brazilian public health had been disclosed or detected, why or why not, and what happened after disclosure or detection. Seventy-one (8.3%) students were victims of sexual violence, and 52 (73.2%) were females. The researchers interviewed 22 participants to obtain an oral history of these abuse experiences. The 22 interviewees had experienced 29 episodes of violence. Acquaintances had perpetrated 26 of these attacks, and of these 26 only four (15.4%) occurrences were never disclosed. Twenty-two experiences were disclosed or detected, of which four (18.2%) were promptly revealed (days after the event), resulting in a discontinuation of the violence. Unfortunately, molestation continued without intervention in nine (41.0%) of the revealed situations, despite disclosure or detection. The authors find that children or adolescents disclosing their experiences of sexual violence cannot end the attacks. This study identifies an urgent need to educate society about how to respond appropriately to revelations of sexual violence. Children or adolescents must be oriented to disclose their abuse and seek help from as many people as necessary until they are heard, believed and the violence is ended.

Disentangling the Associations Between Attention Deficit Hyperactivity Disorder and Child Sexual Abuse: A Systematic Review

BACKGROUND

An association between child sexual abuse (CSA) and attention deficit hyperactivity disorder (ADHD) has been documented. However, the temporal relationship between these problems and the roles of trauma-related symptoms or other forms of maltreatment remain unclear. This review aims to synthesize available research on CSA and ADHD, assess the methodological quality of the available research, and recommend future areas of inquiry.

METHODS

Studies were searched in five databases including Medline and PsycINFO. Following a title and abstract screening, 151 full texts were reviewed and 28 were included. Inclusion criteria were sexual abuse occurred before 18 years old, published quantitative studies documenting at least a bivariate association between CSA and ADHD, and published in the past 5 years for dissertations/theses, in French or English. The methodological quality of studies was systematically assessed.

RESULTS

Most studies identified a significant association between CSA and ADHD; most studies conceptualized CSA as a precursor of ADHD, but only one study had a longitudinal design. The quality of the studies varied greatly with main limitations being the lack of (i) longitudinal designs, (ii) rigorous multimethod/ multiinformant assessments of CSA and ADHD, and (iii) control for two major confounders: trauma-related symptoms and other forms of child maltreatment.

DISCUSSION

Given the lack of longitudinal studies, the directionality of the association remains unclear. The confounding role of other maltreatment forms and trauma-related symptoms also remains mostly unaddressed. Rigorous studies are needed to untangle the association between CSA and ADHD.

The lifetime prevalence of child sexual abuse assessed in young adults in Lithuania

OBJECTIVE

We examined the prevalence of different types of childhood sexual abuse (CSA) in Lithuania focusing on how these experiences were related to victim's age and relationship to the perpetrator.

METHODS

The participants came from a representative household survey of youth aged 18-29 and the sample consisted of 2000 participants (47.7 % women) with a mean age of 23.9 years (SD = 3.6). The ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R, Dunne et al., 2009) for young adults was used to investigate childhood exposure to CSA. Both current sociodemographic information and information on circumstances during childhood (e.g., number of siblings, family members with whom the participant lived between 7 and 12 year of age) were collected.

RESULTS

The prevalence of any CSA experience before the age of 18 was 15.9 %, with higher rates for women (13.5 % and 18.5 % for men and women, respectively). Being spoken to in a sexual way or sexual things being written about the person was the most prevalent form of CSA. In contrast, number of victims that reported sexual intercourse was much lower. The most common type of perpetrator was another young person. Intrafamilial CSA was rare with higher risk in step-relationships.

CONCLUSIONS

Our study provides representative prevalence estimates of the CSA in a region for which such estimates were not previously available. These Lithuanian estimates correspond well with previous literature. Importantly, the findings point to peers being an important perpetrator group in CSA cases. This and other findings can inform the planning of relevant policy measures and actions to both prevent CSA and investigate cases effectively.

Child Sexual Abuse in the Roman Catholic Church in France: Prevalence and Comparison With Other Social Spheres

This study aims to estimate and compare Roman Catholic Church-related child sexual abuse (CSA) prevalence and characteristics to CSA in other social spheres in France since 1950. Using a cross-sectional representative web-based survey of 28,026 adults in 2021, the weighted prevalence of CSA was estimated according to six social spheres of perpetration: family, Church, school, sports club, artistic activities, and summer camps. Altogether, 14.60%, 95% confidence interval [CI: 13.41; 15.80] of female respondents and 6.38% [5.73; 7.03] of male respondents had experienced CSA. Family was the most common social sphere of perpetration (3.55% [3.18; 3.92]), followed by the Church (0.81% [0.62; 0.99] of respondents exposed) and public schools (0.32% [0.23; 0.40] of respondents exposed). Altogether, we estimate 213,000, 95% CI [147,000; 278,000] people were victims of Church CSA since 1950 in France. Church CSA was more common among men than women (1.28% [0.93; 1.64] vs. 0.34% [0.20; 0.48]) while the opposite was true for other social spheres. CSA was overwhelmingly perpetrated by men ranging from 93.37% in the Church to 97.65% in schools. Many victims spoke with someone about these abuses: 41.81% of the Catholic Church compared to 41.25% of school CSA victims and 51.68% of family CSA victims. Results suggest structural factors including gender norms, but also the spiritual authority of the priest and the culture of secrecy contribute to clerical CSA.