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

Determinants of Sexual Abuse Prevention Knowledge among Children’s Schools in West Java Indonesia: A Cross-Sectional Study

Child sexual abuse (CSA) is a severe problem in Indonesia. Adequate knowledge in children about CSA prevention is essential so that children do not become victims. Lack of adequate children’s knowledge of the prevention of CSA may put them at risk for experiencing CSA. This cross-sectional study explores the association factors between knowledge and characteristics regarding the prevention of CSA. The study was conducted in Bandung Regency, West Java, Indonesia. Students from grades two to nine at two elementary schools were eligible for the study. Results showed that as sources of information associated with better knowledge of CSA prevention (p = 0.00), teachers and parents significantly contributed to CSA information. Multivariate analysis showed that teachers (OR: 33.479, 95% (CI: 4.467–250.912)) and parents (OR: 45.336, 95% (CI: 10.886–188.807)) significantly contributed as a source of CSA information among students. The findings are essential important implications for interventions intended at preventing CSA. Sexual education programs should be officially applied at schools for children with the support of their parents and teachers.

Sex and Urban–Rural Differences in the Relationship between Childhood Sexual Abuse and Mental Health among Chinese College Students

This study aimed to reveal sex and urban–rural differences in the association between childhood sexual abuse (CSA) and mental health among Chinese college students. The study used data from the “National College Student Survey on Sexual and Reproductive Health 2019”, a cross-sectional study conducted in all 31 provinces of mainland China. Weighted logistic regression analysis was conducted to determine the association between CSA (noncontact CSA, contact CSA, and penetrative CSA) and mental health (suicide attempts and mental disorders). Among 49,728 students, 39.42% of the male participants and 43.55% of the female participants had ever experienced CSA. According to the OR results of logistic regression analysis, compared to females, males in the contact CSA group (AOR: 3.49, 95% CI: 1.95–6.23) and the penetrative CSA group (AOR: 8.79, 95% CI: 3.15–24.52) had higher odds of suicide attempts. Participants from rural and suburban areas that were categorized in the penetrative CSA group were more likely to report suicide attempts (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban AOR: 4.86, 95% CI: 2.52–9.36) and mental disorders (rural: AOR: 4.01, 95% CI: 1.51–10.62, suburban: AOR: 4.86, 95% CI: 2.52–9.36). In conclusion, the findings revealed a high prevalence of CSA in both sexes and reported that males are more vulnerable to the adverse effects of CSA. In addition, we also found that undergraduates growing up in rural and suburban areas are more vulnerable to the adverse psychological effects of CSA. Policymakers should pay more attention to this vulnerable population and implement effective measures to alleviate mental trauma.

Specific type of childhood trauma and borderline personality disorder in Chinese patients

Background

Childhood maltreatment (CM) is a known risk factor for the development of mental disorders. An extensive body of literature about CM and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries including China.

Aims

To explore the possible relationship between specific types of CM and borderline personality disorder (BPD) in patients with mental disorders in China.

Methods

A survey was conducted in 2006, involving over 3,402 Chinese individuals aged 18-60 years who were randomly selected from the outpatients in the Shanghai Mental Health Center. The patients were screened with the Personality Diagnostic Questionnaire and CM was assessed using the Childhood Trauma Questionnaire. The final sample comprised 178 patients with BPD, 178 patients with other personality disorders (PDs), and 178 patients without PDs.

Results

In Chinese patients, compared to other PDs, patients with BPDs are more likely to have experienced CM. Emotional maltreatment (emotional abuse and neglect) was the strongest predictor of BPD. Female gender and sexual abuse are significant predictors of the self-harm/suicidal risk of BPD patients.

Conclusion

This is a pioneering study conducted on a large set of Chinese clinical samples with paired controls to establish and compare the associations between specific CM and BPD. Further studies in this field are necessary to elucidate the mechanism of how various types of childhood trauma have influenced PDs.

Child protection training for professionals to improve reporting of child abuse and neglect

BACKGROUND

Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed.

OBJECTIVES

To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list.

SELECTION CRITERIA

All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect).

DATA COLLECTION AND ANALYSIS

We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence.

MAIN RESULTS

We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).  We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

Knowledge and Myths About Child Sexual Abuse in Mexican Women

Child sexual abuse (CSA) is a terrible type of maltreatment that occurs in all countries and social statuses, but due to the shame and taboo that it creates, it is still riddled with myths and false beliefs that make it difficult for the population and the authorities to adequately determine its prevalence. The objective of this work was to explore what Mexican women know about CSA. The participants were Mexican women (N = 499) who filled out a questionnaire comprising ten items referring to truths and myths about CSA, indicating their degree of agreement with them on a Likert scale. The results showed that although Mexican women have quite adequate knowledge about CSA, they still hold wrong beliefs about the child's feelings toward the abuser or the child victim becoming an adult abuser. Likewise, differences were found in the myths and truths about CSA held by women under 40 and over 40 years of age.

Reliability of the Sexual Knowledge Picture Instrument: a potential diagnostic instrument for sexual abuse in young children

OBJECTIVE

To determine the intra-rater and inter-rater reliability of the Sexual Knowledge Picture Instrument (SKPI), a potential diagnostic instrument for young suspected victims of sexual abuse containing three scoring forms, that is, verbal responses, non-verbal reactions and red flags.

DESIGN

Video-recorded SKPI interviews with children with and without suspicion of child sexual abuse were observed and scored by two trained, independent raters. The second rater repeated the assessment 6 weeks after initial rating to evaluate for intra-rater reliability.

SUBJECTS

78 children aged 3-9 years old were included in the study. 39 of those included had known suspicion of sexual abuse and the other 39 had no suspicion.

MAIN OUTCOME MEASURES

Intra-rater and inter-rater reliability of the scores per study group and in the total sample were assessed by Cohen's kappa and percentage of agreement (POA).

RESULTS

The median intra-rater Cohen's kappa exceeded 0.90 and the POA exceeded 95 for all three forms in both study groups, except for the red flag form (median Cohen's kappa 0.54 and POA 87 in the suspected group, and 0.84 and 92, respectively, in the total sample). For the verbal scoring form the median inter-rater Cohen's kappa and POA were 1.00 and 100, respectively, in both groups. For the non-verbal form the median inter-rater kappa and POA were 0.37 and 97, respectively, in the suspected group, and 0.47 and 100, respectively, in the control group. For the red flag form, they were 0.37 and 76, respectively, in the suspected group and 0.42 and 77, respectively, in the control group.

CONCLUSION

The reliability of the SKPI verbal form was sufficient, but there is room for improvement in the non-verbal and red flag scoring forms. These forms may be improved by adjusting the manual and improving rater training.

Changes in Risk Perception After Sexual Victimization: Are We Following the Right Track?

Sexual abuse is a major public health concern with detrimental effects on both mental and physical health. Several studies have reported that victims of sexual abuse have a decreased ability to recognize risk in potentially threatening situations compared with nonvictims, although others were not able to replicate this finding. In addition, although emotion dysregulation has been linked to risk perception and sexual victimization, results have been contradictory. To strengthen the theoretical framework needed for the development of interventions to reduce women's likelihood of sexual assault, it is crucial to further examine the role of emotion dysregulation in relation to sexual victimization history and risk perception. The aim of the current study was to examine cross-sectional associations between sexual victimization, emotion regulation difficulties, and risk perception. In our sample of 276 female college students, 40% reported lifetime sexual victimization, 14% reported recent sexual victimization, and 12% reported childhood sexual abuse. In contrast to our hypothesis, we did not find risk perception to be related to lifetime sexual victimization, childhood sexual victimization, or recent sexual victimization. In addition, we did not find evidence for the expected relationship between sexual victimization, risk perception, and emotion regulation difficulties. The discussion of the current study specifically highlights the need for a clear conceptualization of risk perception and provides recommendations for future studies. More sophisticated measurement methods could lead to a higher applicability of findings to real-life situations. The potential relationships between victimization, risk perception, and emotion dysregulation need further clarification to reach the ultimate goal of contributing to the prevention of victimization.

Recall of sexual abuse prevention education at school and home: Associations with sexual abuse experience, disclosure, protective parenting, and knowledge

BACKGROUND

Child sexual abuse (CSA) prevention is dominated by a focus on child education. However, evidence that this education reduces CSA risk is limited and mixed.

OBJECTIVE

We investigated whether participants' history of receiving school-based child sexual abuse prevention (CSAPP) was associated with experiencing CSA. Uniquely, we also investigated whether parent-led CSA education (PLSAE) and received protective parenting were associated with CSA. CSA knowledge was also considered.

METHODS

Australian university students (N = 1265, M_age = 22.8, SD = 7.7, Mo_age = 18, Md_age = 20, 75% female) reported their history of CSAPP and PLSAE, experience of CSA, disclosure of CSA, parenting, and CSA knowledge.

RESULTS

CSAPP attendance was reported by 29% of respondents, 72% reported PLSAE, and 24% reported CSA. PLSAE was significantly associated with lower risk of CSA, but was CSAPP attendance was not. PLSAE was significantly associated with higher levels of parental involvement/care and monitoring/supervision. In a multivariate logistic regression model, involvement/care and monitoring/supervision were associated with lower risk of CSA, but PLSAE was not. Neither CSAPP attendance nor PLSAE was associated with CSA disclosure or CSA knowledge.

CONCLUSIONS

These findings add to the small body of literature using reports of real-life experiences. Results call into question the over-reliance of child-education in CSA prevention and highlight the role of protective parenting. Building parenting capacity to include parenting practices is most likely to be effective for CSA prevention, such as monitoring and involvement, and should be included in CSA prevention efforts.

The Adverse Childhood Experiences - International Questionnaire (ACE-IQ) in community samples around the world: A systematic review (part I)

BACKGROUND

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) collects additional data (e.g., witness community violence/terrorism) than the previous version. Despite ACE-IQ is widely used and validated in several languages, no reviews focus on this measure.

OBJECTIVE

The main goals are to: 1) synthesize the ACE-IQ prevalence rates and average means among community samples, both for total ACE and single dimensions (e.g., intrafamily abuse, bullying); 2) discuss these data in light of the characteristics of studies and samples; 3) identify main research lines of the field.

PARTICIPANTS AND SETTING

The search for studies using the ACE-IQ with community participants was conducted on seven academic databases, including retrieval of grey literature. The screening process led to include 63 documents.

METHODS

A systematic review following the PRISMA guidelines was performed.

RESULTS

1) On average, 75% of community respondents experienced ACEs, with a mean of three, primarily emotional abuse and bullying. 2) Males experienced more ACEs, but they were underrepresented, as well as children and adolescents. Most studies were conducted in Asia or Africa, and different geographical areas showed different pathways of prevalence in subdimensions. 3) Most research focused on prevalence and relationships between ACE-IQ scores and respondents' mental and physical health, suicide and parenting, focusing on intrafamily ACEs more than on those outside the household.

CONCLUSIONS

Several issues emerged in terms of lack of reporting prevalence or means, lack of studies in Europe, America and Oceania, and no attention to collective/community/peer violence, plus a lack of consensus toward the dimensions of the ACE-IQ.

Treating Sexual Dysfunctions Among Survivors of Child Sexual Abuse: An Overview of Empirical Research

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.

Adverse childhood experiences in offspring living with parental mental illness: a controlled study from China

BACKGROUND

Adverse childhood experiences (ACEs) affect children's development, and their harm to health is pervasive throughout the life course.

AIMS

To identify ACEs and their risk factors in Chinese household with or without parental mental illness.

METHODS

A controlled study was conducted among 181 young adults with parental mental illness (positive group) and 201 demographically matched individuals without parental mental illness (negative group). Univariate and multivariate analyses were performed to study the correlation between ACEs and their risk factors.

RESULTS

The positive group suffered emotional abuse, domestic violence, bullying, and cumulative ACEs more frequently than the negative group. In the positive group, living in rural areas and having a low household economic status during childhood were identified as risk factors for cumulative ACEs, whereas a higher education level of the mother was a protective factor for cumulative ACEs in univariate analyses. Low household economic status remained an independent risk factor for cumulative ACEs in the positive group in multivariate analyses.

CONCLUSIONS

Children living with parental mental illness are more vulnerable to ACEs, and our findings highlight the importance of socioeconomic factors in increasing the risk of ACEs. To alleviate the deleterious impact of parental mental illness on offspring, multidimensional supports are needed.

Mediators and moderators in the relationship between maternal childhood adversity and children's emotional and behavioural development: a systematic review and meta-analysis

Maternal experiences of childhood adversity can increase the risk of emotional and behavioural problems in their children. This systematic review and meta-analysis provide the first narrative and quantitative synthesis of the mediators and moderators involved in the link between maternal childhood adversity and children's emotional and behavioural development. We searched EMBASE, PsycINFO, Medline, Cochrane Library, grey literature and reference lists. Studies published up to February 2021 were included if they explored mediators or moderators between maternal childhood adversity and their children's emotional and behavioural development. Data were synthesised narratively and quantitatively by meta-analytic approaches. The search yielded 781 articles, with 74 full-text articles reviewed, and 41 studies meeting inclusion criteria. Maternal mental health was a significant individual-level mediator, while child traumatic experiences and insecure maternal-child attachment were consistent family-level mediators. However, the evidence for community-level mediators was limited. A meta-analysis of nine single-mediating analyses from five studies indicated three mediating pathways: maternal depression, negative parenting practices and maternal insecure attachment, with pooled indirect standardised effects of 0.10 [95% CI (0.03-0.17)), 0.01 (95% CI (-0.02 to 0.04)] and 0.07 [95% CI (0.01-0.12)], respectively. Research studies on moderators were few and identified some individual-level factors, such as child sex (e.g. the mediating role of parenting practices being only significant in girls), biological factors (e.g. maternal cortisol level) and genetic factors (e.g. child's serotonin-transporter genotype). In conclusion, maternal depression and maternal insecure attachment are two established mediating pathways that can explain the link between maternal childhood adversity and their children's emotional and behavioural development and offer opportunities for intervention.

The Survivor Moms' Companion Trauma-Specific Perinatal Psychoeducation Intervention in a Community Outreach Program: An Open Pilot

INTRODUCTION

Posttraumatic stress disorder (PTSD) confers significant risk during the childbearing year, including for maternal substance use, inadequate prenatal care, preterm birth, and impaired maternal-infant bonding. Although several treatments are available for PTSD, few are specific to the perinatal period. The purpose of this pilot study was to evaluate outcomes of a PTSD- and pregnancy-specific psychoeducational intervention, the Survivor Moms' Companion (SMC).

METHODS

The SMC includes psychoeducation with tutor support to address maternal posttraumatic stress, affect regulation, and interpersonal sensitivity. This open pilot was conducted in a large city in a mid-Atlantic state within an organization that provides perinatal services via community health workers (CHWs). The majority of participants were aged 20 to 25 years and African American and had low levels of income and educational attainment. The SMC learning modules were supplied to participants by specially trained CHWs who provided weekly face-to-face support during 30-to-60-minute tutoring sessions. Pretest-to-posttest analyses using multiple imputation methodology and paired-samples t tests examined PTSD symptom counts and scores related to theorized mechanisms of affect dysregulation and interpersonal sensitivity. Nonparametric statistical tests examined clinically meaningful changes.

RESULTS

Of 56 women who completed pretests, 38 (67.9%) completed the core dose of a minimum of 4 of 10 learning modules. Examination of intention-to-treat (n = 56) pretest-to-posttest scores revealed statistically significant improvements in PTSD symptoms (P < .001), affect regulation (depression [P < .001] and anger expression [P < .05]), and interpersonal sensitivity (P < .001). Per-protocol analyses (n = 38) revealed significant changes from clinical to nonclinical range scores for PTSD (P < .01) and depression (P < .05).

DISCUSSION

These findings suggest that a psychoeducational intervention with tutor support can be influential in fostering positive mental health changes in a high-risk perinatal population. CHWs with intervention-specific training can be effective at implementing a trauma-specific intervention.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey

OBJECTIVES

Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood.

DESIGN

Cross-sectional population-based study carried out from November 2011 to March 2012.

SETTING

Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample.

PARTICIPANTS

A total of 3378 adults (aged 19 years and above) were included.

PRIMARY AND SECONDARY OUTCOMES MEASURES

The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models.

RESULTS

Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship.

CONCLUSIONS

Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong

There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.

The role of multiple attachments in intergenerational transmission of child sexual abuse among male victims

BACKGROUND

According to Finkelhor (1984), difficulties child sexual abusers have in establishing adaptive adult relationships are a consequence of attachment problems with parents. Research shows that insecure attachment is associated with both the experience of child sexual abuse (CSA) as a victim and perpetration of CSA as an adult. Attachment may thus be a key factor in intergenerational transmission (IT) of CSA.

OBJECTIVE

The study aims to examine the direct, interactive, and mediated effects linking attachment in different relationships (mother, father, romantic partner) to IT of CSA among male victims.

PARTICIPANTS AND SETTING

Thirty-two abusing and 27 non-abusing male CSA survivors were recruited, respectively, in a prison and via networks of former foster children or CSA victims.

METHOD

All participants completed the Attachment Multiple Model Interview to assess attachment along four dimensions (security, deactivation, hyperactivation, and disorganization) in the relationship with mother, father, and partner.

RESULTS

Partial least square modeling suggests that the partner carries forward (mediates) the increased risk of committing sexual abuse associated with insecure/disorganized attachment with the father. A significant partner-mother interaction also suggests that the deleterious effects of attachment to the mother in terms of committing CSA are countered by more secure/organized attachment to the partner.

CONCLUSIONS

Findings highlight the pivotal role of the romantic partner in IT of CSA. Beyond early intervention, therapy in adulthood aimed at fostering adaptive ways of finding emotional security in the relationship with an adult could thus be encouraged.

Childhood maltreatment class and sexually violent behavior among university men in Vietnam

Background

Sexual violence against women remains a global public health problem, with Southeast Asia having among the highest rates of violence victimization globally. Exposure to violence in adolescence--a highly prevalent experience in Vietnam--is associated with later perpetration of violence against others. However, childhood maltreatment as a latent construct is understudied, with most analyses focusing on theoretical categories, potentially missing key patterns of victimization, particularly poly-victimization. Poor understanding of these experience limits researchers' ability to predict and intervene upon cyclical perpetration of violence. This study aims to identify latent classes of childhood maltreatment, and to test associations between class membership and sexually violent behavior during the first 12 months of university in a sample of Vietnamese men.

Methods and findings

Heterosexual and bisexual men aged 18-24 matriculating into two universities in Hanoi were recruited for the randomized controlled trial of GlobalConsent, a six-module online sexual-violence prevention program. Participants (N = 793) completed a baseline survey, were randomized 1:1 to GlobalConsent or attention control, and were invited to complete post-test surveys at six-months post-baseline and 12-months post-baseline. Validated scales were employed to assess childhood maltreatment and past-six-month sexually violent behavior at each post-test. Latent class analysis identified four classes of childhood maltreatment: Limited-to-no, physical, physical and emotional, and poly-victimization. Associations between childhood maltreatment class and sexually violent behavior demonstrate a threshold effect, wherein poly-victimized men were significantly more likely than men in other classes to have engaged in sexually violent behavior during the 12-month follow-up period.

Conclusions

There is a vital need for screening and intervention with men who have experienced childhood maltreatment in Vietnam to prevent future violence perpetration. Education is needed to break the cycle of violence intergenerationally and in romantic relationships by changing harmful norms around men's sexual privilege and the normalization of childhood maltreatment.

Prevalence of adverse childhood experiences among Vietnamese high school students

BACKGROUND

Adverse childhood experiences (ACE) are linked to a range of negative health outcomes. However, the majority of research has been conducted in high-income-countries and little is known about ACE prevalence in low-and-middle-income-countries (LMIC), where the majority of the world's youth reside.

OBJECTIVE

Assess ACE prevalence and demographic correlates in two provinces of the Southeast Asian LMIC Vietnam.

METHODS

Prevalence of ACE were assessed among 644 Vietnamese high-school students, using the WHO Adverse Childhood Experiences-International Questionnaire.

RESULTS

About 74% of participants reported experiencing at least one ACE, with 27% reporting experiencing three or more ACE. Prevalence of sexual abuse was above 10% for both males and females. Sex differences were non-significant, suggesting child protective services should give consideration to both males and females. Factor analysis identified two patterns of ACE: Violence and Aggression in Family and Community, and Family Member Dysfunction. Three ACE (sexual abuse, emotional neglect, physical neglect) did not load on either factor. Thus, at least in our sample, sexual abuse was independent of other ACE, which indicates that it can occur in any context, among children in otherwise well-functioning families, an important consideration for child protective services. The lack of significant sex differences in sexual abuse means that Vietnamese boys need equal consideration for protection and support as girls.

CONCLUSIONS

Results indicate that ACE are a prevalent public health problem in Vietnam. Future research evaluating potential ACE risk factors such as authoritarian parenting may be useful to identify possible targets for prevention programs in Vietnam.

Anxiety and depression related to childhood maltreatment in teenagers: Comparing multiple individual risk model, cumulative risk model and latent profile analysis

BACKGROUND

Few studies have employed person-centered approaches (i.e. latent profile analysis in this study) to investigate the specific patterns of childhood maltreatment in a large sample of Chinese adolescents, and little is known about the predictive validity of latent profile analysis on internalizing problems, compared with multiple individual risk model and cumulative risk model.

OBJECTIVE

The purpose of this study was to investigate whether differential patterns of maltreatment existed by employing latent profile analysis with a sample of 9071 Chinese adolescents, and further examined the predictive validity of latent profile analysis on internalizing problems, relative to the cumulative risk and multiple individual risk model.

PARTICIPANTS

Using a stratified sampling approach, 10,515 participants (Mean age = 14.24; SD = 1.73) were chosen from three different types of middle schools in Chongqing city, China. 9071 valid responses (males = 4775; females = 4296) were obtained for final analysis.

METHODS

Participants reported their childhood maltreatment experience, anxiety and depression symptoms. Latent profile analysis was used to obtain possible patterns of maltreatment with Mplus version 7. 4. Bolck-Croon-Hagenaars (BCH) method was used to test the association between maltreatment patterns and anxiety and depression symptoms. Relative weight analysis and analysis of variance (ANOVA) were used to test the predictive validity of latent profile analysis, multiple individual risk and cumulative risk model.

RESULTS

Using latent profile analysis, two patterns of childhood maltreatment were uncovered ("No Maltreatment" and "Multiple Maltreatment"). Further analysis showed that multiple individual risk model accounted for the largest variance in anxiety (R² = 26.7%) and depression (R² = 33%), followed by the latent profile analysis (R² = 14.7% for anxiety and 18.6% for depression) and the cumulative risk model (R² = 12.9% for anxiety and 15.2% for depression).

CONCLUSIONS

Our findings suggested that the multiple individual risk model is the optimal model for identifying adolescents at the risk of developing anxiety and depression symptoms, and the results suggested emotional abuse and emotional neglect are risk factors for higher levels of anxiety and depression among adolescents.

Case Report: A Functional Approach to Deal With Sexual Harassment Within Families

Abuse is followed by multiple short- and long-term psychological consequences. Researchers suggest a significant need to design a culturally relevant and competent treatment plan specifically for the Asian context. This research presents an account of therapeutic strategies that were employed to manage the complaints of sexual harassment and associated psychological challenges. This case report dealt with a 16-year-old girl who was self-referred to the psychologist with complaints of getting sexually harassed by her brother-in-law, difficulty in managing academic challenges, communication gap with parents, and difficulty in handling her anger for the past 7 years. The assessment modalities used with the client were Behavioral Observation, Clinical Interview, Baseline Charts, School Children Problem Scale to rule out emotional-behavioral problems, the Adult-Child Interaction Test, and Downward Arrow Technique for cognitive assessment. The management plan was based on trauma-focused cognitive behavioral therapy (TF-CBT) and constituted of goals, such as having self-protection awareness from harassment, reducing the fear and unexplained emotions of grief, increasing self-esteem, designing a proper schedule for studies, and developing good communication ability. Post-assessment showed that anger reduced to 40%, communication gap with parents reduced to 50%, fear of harassment reduced to 40%, and self-image improved up to 40%. Sessions were based on 9 in-person meetings.

My Work Is Meaningless: The Consequences of Perceived Occupational Stigma for Employees in High-Prestige Occupations

Occupational stigma is pervasive, but there is a lack of understanding about how it impacts the behaviors of employees in relatively high-prestige occupations. We draw on the job characteristics model and social information processing theory to establish hypotheses about the effects of occupational stigma on the withdrawal behavior of employees in a relatively high-prestige occupation (preschool teacher). We suggest that perceptions of skill variety and task significance among high-prestige employees may be negatively influenced due to occupational stigma perception. In addition, occupational stigma conveys information to employees that the work they do is not appreciated by beneficiaries. For those reasons, making it difficult for them to perceive the meaningfulness of their work. This lack of meaningful experience is in turn positively associated with employees’ withdrawal behavior. Furthermore, we propose that these indirect effects are moderated by perceived job embeddedness of employees. Based on data collected at two time points from 466 preschool teachers in China, we find that occupational stigma is positively related to employees’ withdrawal behavior through meaningfulness. In addition, the negative relationship between perceived occupational stigma and experienced meaningfulness is stronger for employees with high job embeddedness than for employees with low job embeddedness.

Early Adversity and Changes in Cortisol and Negative Affect in Response to Interpersonal Threats in the Laboratory

Adverse childhood experiences, such as abuse and neglect, are associated with poor health outcomes. This association may be partially explained by differences in stress physiology. Though most early adverse experiences occur within the context of interpersonal relationships, stress exposures manipulated in the laboratory rarely involve interpersonal interactions beyond the mere presence of others. This study examines whether adverse childhood experiences are associated with differences in affective and cortisol reactivity to two stressors which may more closely resemble the powerlessness and the lack of control characteristic of many adverse childhood experiences: a dominant (vs. submissive) interaction partner and lower (vs. higher) social status. We also manipulate social-evaluative threat as a test of whether these interpersonal stressors are more germane to stress reactivity associated with early adversity than the performance anxiety evoked by more traditional laboratory stressors, such as the Trier Social Stress Test. The results partially support the hypothesis that participants with greater early adversity may be more reactive to interpersonal stressors reminiscent of early adverse experience. Given the interpersonal nature of most adverse childhood experiences, conceptualizing and measuring associations with stress physiology in an interpersonal context may more closely capture the psychological and biological embedding of these early experiences.

Relation of Non-Suicidal Self-Harm to Emotion Regulation and Alexithymia in Sexually Abused Children and Adolescents

Child sexual abuse is a global issue affecting children. It burdens the entire society physically and mentally. It can cause eating disorders and non-suicidal self-injury in abused people (NSSI). Emotion regulation (ER) is an important etiological link between purging, NSSI, and abusive experiences. We interviewed 80 people, ranged in age from 13 to 20, of whom 62.5% had CSA, versus 30 healthy controls. The Toronto Alexithymia Scale, an eating disorders clinical interview, the Difficulties in Emotion Regulation Scale (DERS) to assess emotion dysregulation, the Self-punishment Scale to assess NSSI, the Mini-Kid for children under the age of 18, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) for those aged 18 and older were given to victims. CSA was found in 62.5% of the participants. Emotional dysregulation was strongly linked to CSA. Descriptive and identifying difficulties in feelings and externally oriented thinking (p0.001, p0.03, p0.001) were found to be associated with the development of alexithymia. CSA participants had higher NSSI than controls, with 28% having severe self-punishment symptoms (P0.001). Finally, CSA is common in kids and teens. It has negative effects on future generations' mental and physical health. All of these conditions can lead to alexithymia.

The association between child maltreatment and sleep disturbances among preschoolers

BACKGROUND

Child maltreatment (CM) can result in lifelong detrimental consequences, but its association with sleep disturbances in young children remains unclear.

OBJECTIVE

This study aimed to investigate the association of CM with sleep disturbances and short sleep duration among Chinese preschoolers.

PARTICIPANTS AND SETTING

Data were from a representative sample of 17,023 children (6.17 ± 0.29 years old, 51.96% boys) at their graduation year of preschool in September 2019, as a subset of the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study.

METHODS

Parents reported children's CM of different types and the Children's Sleep Habits Questionnaire (CSHQ). Logistic regression was used to evaluate the risk of sleep disturbances and short sleep duration linked to CM.

RESULTS

Of the children, 12,583(73.92%) demonstrated sleep disturbances (CSHQ total score > 41) and 3017(17.72%) demonstrated short sleep duration (<9 h/night). After adjusting covariates, physical abuse (aOR = 1.16, 95%CI = 1.05-1.28) and emotional abuse (aOR = 1.50, 95% CI = 1.39-1.62) were associated with global sleep disturbances. Physical abuse (aOR = 1.16, 95% CI = 1.06-1.28), physical neglect (aOR = 1.29, 95%CI = 1.12-1.49), and emotional abuse (aOR = 1.19, 95% CI = 1.09-1.30) were associated with short sleep duration. Sexual abuse was not significantly associated with global sleep disturbances or short sleep duration. A cumulative association was noted that more CM types were associated with increased global sleep disturbances and short sleep duration.

CONCLUSIONS

CM is associated with sleep disturbances and short sleep duration in young children. This highlights the efforts to prevent and reduce CM in favor of optimal sleep and whole health in young children.

Reduced structural connectivity of the amygdala is associated with childhood trauma in adult patients with alcohol use disorder

Childhood trauma (CT) is frequent in patients with alcohol use disorder (AUD) and may impact on adult drinking behaviour and treatment outcome. This study aimed to investigate the structural correlates of CT in AUD, focusing on the amygdala, which plays a crucial role in the neurobiology of trauma. We hypothesized reduced amygdala volume and reduced structural connectivity as quantified by fractional anisotropy (FA) and by number of streamlines in those AUD patients with a history of moderate to severe CT (AUD‐CT). T1‐weighted MP2RAGE and diffusion‐weighted imaging (DWI) 3‐Tesla MRI‐scans were acquired in 41 recently abstinent patients with AUD. We compared bilateral amygdala volume and structural connectivity (FA and number of streamlines) of pathways emanating from the amygdala between AUD‐CT (n = 20) and AUD without CT (AUD‐NT, n = 21) using a mixed model multivariate analysis of variance (MANCOVA) controlling for age and gender. AUD‐CT displayed reduced FA and reduced number of streamlines of amygdalar tracts. There were no differences regarding amygdala volume. The severity of physical abuse, a subscale of the childhood trauma questionnaire, was negatively correlated with FA and with number of streamlines. AUD‐CT and AUD‐NT differ regarding structural connectivity of pathways projecting to and from the amygdala, but not regarding amygdala volume. Those alterations of structural connectivity in AUD‐CT may represent a distinguishable neurobiological subtype of AUD, which might be associated with the complex clinical picture and poorer outcome that patients with CT and AUD often present.

A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

The Residuum of Childhood Physical and Sexual Abuse: Coming to Terms in Couple Relationships

Childhood exposure to physical violence and sexual abuse is a public health concern and is empirically connected to poor outcomes in adulthood. The present study was designed to assess dyadic associations between exposure to childhood physical violence and sexual abuse, and resolution, or a sense that one has "come to terms" with events in one's family of origin. The study was also aimed at assessing whether attachment behaviors mediated associations between abuse, violence, and resolution. The study was carried out using data from a community sample of 3,836 heterosexual couples who completed the Relationship Evaluation Questionnaire inventory. Actor-Partner Interdependence Modeling was employed within a structural equation model to examine associations. Results suggested inverse, direct actor associations for both men and women between physical violence and sexual abuse, and coming to terms. The results also showed inverse, direct partner associations for both men and women between sexual abuse and coming to terms. Furthermore, findings indicated the presence of inverse, indirect actor and partner effects for men and women between physical violence and coming to terms. Examination of these specific indirect partner and actor effects from physical violence to coming to terms implies partial mediation carried through one's own rating of attachment behaviors. Finally, actor (but not partner) associations were noted between attachment behaviors and coming to terms. In aggregate, the findings support the potential benefit of enhancing investment in attachment behaviors as a resource to aid in the resolution process of exposure to physical violence and sexual abuse in childhood.

Childhood Abuse Classes for Incarcerated Men and Women: Are There Unique Gender Patterns in Abuse Classes?

Childhood adversity is predictive of poorer health and behavioral health outcomes in adulthood. Males and females are known to experience different types of childhood adversity, with females experiencing more sexual and emotional harm in childhood. Latent class analysis (LCA) has been used to identify patterns among types of childhood adversity. These studies have constructed class structures using single gender or blended gender samples. Class structures based on blended gender samples, however, may misrepresent the nuances of gender-specific adversity histories through averaging, potentially distorting the relative need for gender-specific types of intervention. This study investigated whether latent class structures of childhood abuse are equivalent for incarcerated males and females. Our sample included 4,204 residents (3,986 males, 218 females) drawn from a single prison system. Residents completed an hour-long audio computer-assisted self-interview that included questions on 10 types of childhood abuse, depression, and anxiety symptoms, the Beck Hopelessness Scale (BHS), Buss-Perry Aggression Questionnaire, and Criminal Sentiments Scale-Modified (CSS-M). Overall, female residents were both more likely to experience childhood abuse and have more extensive victimization experiences. Small subgroups of males, however, had even more extensive victimization experiences. Abuse patterns for males and females, while optimally clustering in four classes, are rather unique, especially for higher abuse classes, in terms of distribution of membership and types of abuse. These differences may matter in terms of identifying the relative need for therapeutic intervention among incarcerated males and females and targeting those interventions in ways that reflect the gradient and density of therapeutic need. The next step is to test whether using blended or gendered latent class structures matters in terms of predicting outcomes, such as prison-based behavioral health problems, suicidality, and victimization.

Prevalence, correlates, and the mitigation of ICD-11 CPTSD among homeless adults: The role of self-compassion

BACKGROUND

In 2018, Complex Post-Traumatic Stress Disorder (CPTSD) was accepted into the International Classification of Diseases, edition 11 (ICD-11) to capture symptoms associated with exposure to chronic, inescapable trauma. Thereafter, the disorder's links with interpersonal trauma have been established.

OBJECTIVE

Within a sample of homeless adults in Ireland, the (1) prevalence of ICD-11 disorders specifically associated with stress; Post Traumatic Stress Disorder (PTSD) and CPTSD, (2) nature of interpersonal trauma exposure, self-identified index events, and their association with the diagnostic criteria of CPTSD, and (3) relationship between cumulative interpersonal trauma exposure and CPTSD via self-compassion were examined.

PARTICIPANTS AND SETTING

Adults using homeless services (N = 56) completed self-report measures of socio-demographics, trauma-history, PSTD, CPTSD, and self-compassion.

METHODS

The data were analysed using chi-squared and mediation analyses (via PROCESS).

RESULTS

CPTSD was highly prevalent (33.9%) among the sample, but PTSD was not (3.6%). Emotional neglect was the most prevalent interpersonal trauma and the most common index event. Only lifetime sexual abuse (from someone other than a parent or guardian) was associated with CPTSD diagnostic status (χ² = 3.94, (1), p = .047). When adjusted for gender, relationship status, and living situation, self-compassion mediated the relationship between cumulative interpersonal trauma exposure and CPTSD severity (B = 1.30, SE = 0.50, 95% CI = [0.43-2.35]).

CONCLUSION

Findings support the relevance of CPTSD to understanding psychopathology in homeless adults and the potential role of self-compassion in interventions. Further, they open debate on the nature of events that are considered traumatic - subjectively and in psychiatric canon.

Prevalence of childhood exposure to intimate partner violence in low-income and lower-middle-income countries: a systematic review

OBJECTIVE

To determine the proportion of children in low-income and lower-middle-income countries exposed to intimate partner violence (IPV).

DESIGN

Systematic review.

DATA SOURCES

PubMed, CINAHL, ERIC, PsycINFO, Web of Science, WHO Global Index Medicus, and Violence and Abuse Abstracts, hand searching of specialised journals from inception until 19 May 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary quantitative studies that included a measure of self-reported exposure to IPV prior to age 18 and were conducted in low-income and lower-middle-income countries.

DATA EXTRACTION AND SYNTHESIS

Data were screened, extracted and appraised by two independent reviewers. The prevalence estimates were pooled using a random-effects model. Outcomes included lifetime and past-year prevalence of childhood exposure to IPV. Meta-regression was used to explore heterogeneity. Publication bias was assessed using a funnel plot and Egger's regression test. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

RESULTS

Sixty-two studies with a total of 231 512 participants were included. Eighty-five lifetime prevalence estimates and 6 estimates of past-year prevalence were available for synthesis. The average lifetime prevalence of childhood exposure to IPV was 29% (95% CI 26% to 31%). The average past-year prevalence in children was 35% (95% CI 21% to 48%). The lifetime prevalence disaggregated by WHO regions ranged from 21% to 34%. There were no statistical differences in prevalence estimates between samples of men and women.

CONCLUSION

Almost one-third of children in low-income and lower-middle-income countries have been exposed to IPV in their lifetime. There was large heterogeneity between estimates that was not explained by available study and sample characteristics. Our findings indicate that children's exposure to IPV in low-income and lower-middle-income countries is common and widespread; prevention of this major public health exposure should be a priority.

PROSPERO REGISTRATION NUMBER

CRD42019119698.

Health care providers' responses to sexually abused children and adolescents: a systematic review

Background

Sexual abuse of children and adolescents is a significant health concern worldwide. Appropriate and timely health services for victims can prevent severe and long-term consequences. This study identified and categorized diagnostic and treatment services needed for sexually abused children and adolescents.

Methods

Several databases, including MEDLINE, Web of Science, Scopus, Science Direct, ProQuest, and Google Scholar, were searched to retrieve studies on the topic and clinical guidelines in English covering the literature from 2010 to 2020 using search terms. Primary studies and guidelines were reviewed to identify treatment strategies and medical interventions related to sexually abused children and adolescents.

Results

Twenty-one studies and guidelines were selected and analyzed narratively. The quality of evidence was relatively good. We identified that effective health care systems for sexually abused children include the following: interview and obtain medical history, physical and anogenital examination, collecting forensic and DNA evidence, documenting all the findings, prevention and termination of pregnancy, diagnostic tests, prophylaxis for HIV and other STIs, vaccinations, and psychological intervention.

Conclusions

This review provides up-to-date evidence about adequate health care services for children and adolescent victims of sexual abuse. We conclude that recent studies have focused more on prophylaxis against HIV and other STIs, studies on vaccinating against HPV for victims are still limited, and future research in this area is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07814-9.

Empowerment or Threat: Perceptions of Childhood Sexual Abuse in the #MeToo Era

The rise of the #MeToo movement has shed light on the prominence of sexual violence, and its victims who often remain silent. Despite increasing awareness, victims or survivors of sexual violence who disclose may be faced with negative reactions such as disbelief or blame. Such reactions extend to child victims of sexual abuse. This study aimed to shed light on gender differences in responses to sexual violence against a backdrop of #MeToo. Through an online survey (N = 253) on Amazon's Mechanical Turk, we assessed participants' exposure to and perception of the #MeToo movement. In addition, we measured proximity to a victim or perpetrator of sexual violence. The effect of these variables on participants' response to a disclosure of childhood sexual abuse was examined. Results indicated that men are more likely to perceive the movement as threatening than women. Furthermore, a discrepancy in proximity to sexual violence emerged, with women more likely to know a victim and men more likely to know a perpetrator. In response to a disclosure of childhood sexual abuse, men were more likely to respond in a skeptical manner than women. Positive perceptions of the #MeToo movement translated into more supportive responses to a disclosure. Proximity to a victim of sexual violence did not impact how people responded to a disclosure, but proximity to a perpetrator was associated with a more negative response. Although the aim of this movement is to give a voice to victims of sexual violence, it may trigger a defensive response from men, which makes them more skeptical toward disclosures of victimization.

Childhood maltreatment and disordered gambling in adulthood: disentangling causal and familial influences

BACKGROUND

Despite abundant research on the potential causal influence of childhood maltreatment (CM) on psychological maladaptation in adulthood, almost none has implemented the discordant twin design as a means of examining the role of such experiences in later disordered gambling (DG) while accounting for genetic and family environmental confounds. The present study implemented such an approach to disentangle the potential causal and familial factors that may account for the association between CM and DG.

METHODS

Participants were 3750 twins from the Australian Twin Registry [Mage = 37.60 (s.d. = 2.31); 58% female]. CM and DG were assessed separately via two semi-structured telephone interviews. Random-intercept generalized linear mixed models were fit to the data; zygosity, sex, educational attainment, childhood psychiatric disorder, adult antisocial behavior, and alcohol use disorder (AUD) were included as covariates.

RESULTS

Neither quasi-causal nor familial effects of CM predicted DG after adjusting for covariates. Educational attainment appeared to reduce the risk of DG while AUD appeared to increase risk; evidence also emerged for familial effects of antisocial behavior on DG. Post-hoc analyses revealed a familial effect of CM on antisocial behavior, indicating that the association between CM and DG identified in unadjusted models and in prior studies may be accounted for by genetic and shared family environmental effects of antisociality.

CONCLUSIONS

These findings add to the meager literature showing that CM does not exert a causal effect on DG, and present novel evidence that familial effects of antisocial behavior may account for the association between CM and DG identified in extant non-twin research.

Past is present: Pathways between childhood sexual abuse and relationship satisfaction

Research on childhood sexual abuse (CSA) has consistently demonstrated the damaging effects of these experiences, not only on survivors' development, but also on the nature and quality of their adult relationships, particularly romantic ones. Yet, research to date has not demonstrated a strong direct effect of CSA on relationship satisfaction. This study examined the pathways from CSA to relationship satisfaction via sexual shame and romantic partner attachment. Data collected through surveys from 732 adults were analyzed using a serial mediation model. As expected, the direct association between CSA and relationship satisfaction was statistically significant but rather weak. Results demonstrated that sexual shame, combined with either romantic partner attachment avoidance or romantic partner attachment anxiety, reduces relationship satisfaction. Specifically, three possible pathways mediated by sexual shame were identified. Implications of the findings are discussed and recommendations for clinical interventions with CSA survivors that address sexual shame and romantic partner attachment are provided.

The Prevalence of Technology-Facilitated Sexual Violence: A Meta-Analysis and Systematic Review

The primary aim of this systematic review and meta-analysis was to examine the prevalence of technology-facilitated sexual violence (TFSV) within the adolescent and adult population regarding victimization and perpetration. In addition to the primary aim, associated health outcomes with TFSV were discussed through a qualitative lens. Specific forms of TFSV that were examined include distribution of, production of, and threats to distribute sexual material involving another individual without that person's consent via images or videos; 425 articles from MEDLINE, PsycArticles, PsycINFO, Criminal Justice Abstracts, ProQuest Dissertations & Theses, and Google Scholar were screened. Nineteen articles (comprising 20 independent samples) reporting prevalence rates of TFSV on 32,247 participants were included in this random-effects meta-analysis. Pooled prevalence of victimization results revealed that 8.8% of people have had their image or video-based sexts shared without consent, 7.2% have been threatened with sext distribution, and 17.6% have had their image taken without permission. Regarding perpetration, 12% have shared sexts beyond the intended recipient, 2.7% have threatened to share sexts, and 8.9% have nonconsensually taken an image. Moderator variables included publication year, mean participant age, proportion of female participants, and study setting, with meta-regression analyses revealing no significant predictors. Finally, a qualitative analysis of nine articles (n = 3,990) was conducted to assess mental health associations with TFSV victimization, revealing significant mental health impacts, including anxiety, depression, and poor coping, for victims.

Multisystemic therapy for child abuse and neglect: Parental stress and parental mental health as predictors of change in child neglect

BACKGROUND

Despite high prevalence, child neglect has long been passed over in research. Serious long-term consequences call for effective intervention programs. However, as a result of the lack of research, there is a lack of effective interventions. In order to develop such intervention programs and to maximize the effectiveness of existing programs, it is necessary to examine what factors are related to the reduction of neglect and, subsequently, what change mechanisms their effectiveness is based on.

OBJECTIVE

In this intervention study we investigated whether changes in parental mental health and parental stress after Multisystemic Therapy for Child Abuse and Neglect (MST-CAN), an effective evidence-based intervention program for child neglect, are related to changes in child neglect.

PARTICIPANTS AND SETTING

Study participants were 144 parent-child dyads participating in the MST-CAN program.

METHODS

We analyzed changes from pre- to post-treatment in child neglect, parental mental health, and parental stress, and conducted a multiple regression analysis to examine whether changes in parental mental health and parental stress predict changes in child neglect.

RESULT

Our results showed that child neglect, as well as parental stress, significantly decreased and parental mental health significantly improved during the program. While improvements in parental mental health were not related to the reduction of child neglect, a decrease in parental stress significantly predicted the reduction of child neglect.

CONCLUSION

These findings suggest that parental stress might be a promising target for evidence-based intervention programs to reduce the occurrence of child neglect. Implications and suggestions for further research are discussed.

Peritraumatic Pain in Child Sexual Abuse: Children's Descriptions of Pain as Conveyed in Their Testimonies Following Child Sexual Abuse

The literature on child sexual abuse (CSA) has contributed significantly to the understanding of its characteristics, epidemiology, and consequences. Considerably less attention has been dedicated, however, to the subjective experiences of the abused children, and more specifically to their experiences of pain. The current study explored the way children perceive and describe pain during and shortly following incidents of sexual abuse. The sample was comprised of 35 transcripts of forensic interviews following alleged CSA. Thematic analysis of the children's narratives identified three themes: (a) pain during the abusive incidents, described using words indicating its intensity and quality; (b) pain shortly after the abusive incidents, including weeks later, and (c) pain as embedded within the complex dynamic with perpetrator. The children struggled to localize the pain, mainly using words such as "inside" and "deep." Moreover, they testified that in the course of the abusive incidents, they were often silenced when trying to communicate their pain to the perpetrators. The children's narratives provided us with a unique opportunity to learn about the pain not only during the abusive incidents but also following it. Additionally, children described suffering from pain in areas that were not directly injured during the CSA incidents, mainly referring to the head, abdomen and legs. The discussion addresses the potential intervening factors in peritraumatic CSA pain, as well as its potential links with chronic post-traumatic physical and mental morbidity. This study illuminates the necessity to address the complicated links between short- and long-term physical, emotional, cognitive, and interpersonal manifestations of CSA.

Cutaneous Mimics of Child Abuse & Neglect: Part II

Given that some cutaneous mimics of child abuse result from rare disease, they may be more prone to misdiagnosis. For possible child abuse cases in which diagnosis remains uncertain at time of initial dermatologic evaluation, it is important that dermatologists are prepared to distinguish true dermatologic conditions in cases of ambiguous skin findings. Additionally, this review will aid clinicians in recognizing the possibility of concurrent true dermatologic disease and skin findings related to abuse with the acknowledgement that they are not mutually exclusive. Proper recognition of mimics of abuse may prevent unnecessary stress and child protective service investigation.

The mediating effect of attachment insecurity on circadian consequences of childhood trauma

Circadian preferences have been associated with mental health as well as social and physical health in recent years. However, factors associated with circadian preferences have not been fully elucidated. The main aim of this study is to investigate the associations of childhood trauma and attachment styles with circadian preferences. A total of 673 participants were evaluated using the Morningness-Eveningness Questionnaire (MEQ), the Childhood Trauma Questionnaire 28 (CTQ-28), and the Experiences in Close Relationships-Revised (ECR-R) questionnaire. The results indicated that 14.9% (n = 100) of the participants were morning type, 20.6% (n = 139) were evening type, and 64.5% (n = 434) were intermediate type. Both childhood trauma and attachment-related anxiety/avoidance scores were associated with being evening type (p < .01). Moreover, attachment-related anxiety and avoidance fully mediated the association between childhood trauma and circadian preferences. The present study showed that attachment styles might be associated with circadian preferences. Further studies are needed to replicate these results and to infer explanatory mechanisms for these cross-sectional associations.

Sexual Dysfunction Among Childhood Sexual Abuse Survivors: The "Functional" Dysfunction?

Various studies have established the association between child sexual abuse and sexual dysfunction. Although sexual dysfunction can be a distressing and undesirable condition for survivors of child sexual abuse, the current article suggests viewing sexual dysfunction not solely as a negative outcome but as a condition with a potent psychological function in regulating various psychological and relational needs among survivors. The main question addressed in the current paper is: What are the functional aspects of sexual dysfunction among child sexual abuse survivors? Four main protective purposes for sexual dysfunction among survivors of child sexual abuse are proposed: avoiding re-traumatization, regulating closeness within the relationship, gaining a sense of power and control and avoiding vulnerability, and restoring a positive sense of self. Although healthy sexual functioning is a desirable long-term goal for survivors, therapists need to view sexual dysfunction within the context of trauma, and to understand the protective functions of dysfunctions, before attempting to restore sexual function.

From Policy to Practice: Measures Against Sexual Abuse by Swedish Sports Federations

The sport movement must protect children and young athletes from all forms of abuse. However, research points to a disconnect between policy and implementation of policy against sexual abuse. No studies have investigated measures against sexual abuse in Swedish sport. The purpose of this study was to explore measures against sexual abuse in the 10 largest sports federations (SFs) for child and youth sport in Sweden. The study draws on interviews with representatives (n = 18) of the SFs and on a review of SFs' website content regarding sexual abuse and safe sport. Results show that the SFs have taken few or no measures against sexual abuse. Measures for safe sports vary in existence, development, and organization between the SFs, and many SFs are in the early stages of safe sport measures and practice. Although the SF representatives emphasize that sexual abuse is unacceptable, a conflict between making it visible or invisible emerges and creates a gap between policy and practice. Reproducing a culture of silence around sexual abuse in sports seems advantageously for SFs. Social and organizational factors that can debilitate safe sport measures and facilitate sexual abuse in sport are discussed.

Different Contexts of Sexual Abuse With a Special Focus on the Context of Christian Institutions: Results From the General Population in Germany

Recent revelations of the extent of sexual abuse in the Roman Catholic Church in Germany and the United States have once more triggered the debate about sexual abuse. Those inquiries identify cases that are known to authorities or have been recorded in these institutions. However, to assess the full magnitude of the problem, data beyond recorded or known cases are needed, as it can be assumed that a vast number of cases are not reported and are hence not included in such file reviews. Therefore, representative surveys are needed. The aim of the present study was to examine the prevalence of sexual abuse by priests and in different contexts in the German population based on a representative sample. A total of 2,510 participants (54.3% female, M = 48 years) were retrospectively asked about different experiences, offenders, contexts, and so on, of child sexual abuse using questions that were used to assess child sexual abuse in prior surveys and the Childhood Trauma Questionnaire (CTQ). In sum, 0.21% (n = 7) of the participants reported child sexual abuse by a priest or pastor. 0.16% reported child sexual abuse in an institution of the Roman Catholic Church. Results also indicated that victims of sexual abuse by priests and pastors reported rather severe types of sexual abuse based on the CTQ in comparison with other contexts, such as schools. Extrapolating the data for the population, it can be assumed that the estimated number of victims is much higher than those identified by research based on recorded cases.

Lifetime Victimization and Poly-Victimization in a Sample of Adults With Intellectual Disabilities

People with intellectual disabilities appear to be more vulnerable to victimization. However, few studies have assessed victimization in these groups and those that do exist are highly heterogeneous and tend to focus only on specific forms of violence. This study attempts to shed light on the phenomenon of victimization among adults with intellectual disabilities by assessing victimization and poly-victimization throughout their life course. The sample consisted of 260 adults (154 men and 106 women) with an intellectual disability diagnosis, recruited from the Catalan Federation for People with Intellectual Disabilities (DINCAT) in Spain. They ranged in age from 20 to 71 years (M = 41.69, SD = 12.05). Victimization experiences were assessed by means of an adaptation of the retrospective version of the Juvenile Victimization Questionnaire (JVQ). The results showed that 96.9% of the participants had suffered some kind of victimization throughout their lives. With respect to the types of victimization, the most frequent were common victimization (87.7%), witnessing and indirect victimization (67.3%), victimization by caregivers (59.2%), sexual victimization (35%), and electronic victimization (23.5%). Women and early adults tended to experience higher rates of victimization. The poly-victimized group experienced 13 or more incidents of victimization throughout their lives. This study highlights the elevated rates of lifetime victimization among people with intellectual disabilities. It adds to previous evidence that special protection programs are required to address this issue and emphasizes the need for prevention and intervention measures in this particularly vulnerable group.

Do Trajectories of Sensation Seeking Vary by Sex and Child Maltreatment Subtypes?

Child maltreatment and elevated sensation seeking are associated with a wide range of negative outcomes. Longitudinal data from a study of Puerto Ricans living in two sociocultural contexts were used to determine whether child maltreatment subtypes, sex, or sociocultural context relate to trajectories of sensation seeking. Participants were 2,489 individuals from the Boricua Youth Study (48.5% girls) living in New York and in Puerto Rico (PR; 5-15 years old at Wave 1). Subtypes of child maltreatment were measured using child report on the Parent-Child Conflict Tactics Scale and the Sexual Victimization Scale at Wave 1. The association between child maltreatment subtypes, sex, sociocultural context, and previously established sensation-seeking trajectories across three waves of data collection was probed using multinomial logistic regression. Girls, but not boys, who experienced neglect (adjusted odds ratio; AOR; 95% confidence interval [95% CI] = 5.33 [1.35, 21.03]), or physical abuse (AOR [95% CI] = 3.66 [1.07, 12.54]), were more likely to have an elevated sensation-seeking trajectory than a normative trajectory. For boys, none of the maltreatment subtypes were linked to the elevated sensation-seeking class. Girls exposed to verbal abuse (AOR [95% CI] = 0.33 [0.15, 0.75]) and boys exposed to physical abuse (AOR [95% CI] = 0.39 [0.16, 0.97]) were less likely to belong to the low sensation-seeking class. No significant interactions between sociocultural context (i.e., PR vs. New York) and maltreatment subtype on the development of sensation seeking were found. This research suggests sensation-seeking levels vary by experiences of childhood maltreatment, and that sex moderates the relationship between child maltreatment experiences and sensation seeking, with an association between some maltreatment subtypes and elevated sensation-seeking trajectories found in girls, but not boys. These results underline the importance of considering sex when examining how child maltreatment relates to outcomes.

The impact of COVID-19 and associated measures on health, police, and non-government organisation service utilisation related to violence against women and children

BACKGROUND

Globally, concerns have been raised that the priority implementation of public health measures in response to COVID-19 may have unintended negative impacts on a variety of other health and wellbeing factors, including violence. This study examined the impact of COVID-19 response measures on changes in violence against women and children (VAWC) service utilisation across European countries.

METHODS

A rapid assessment design was used to compile data including a survey distributed across WHO Europe Healthy Cities Networks and Violence Injury Prevention Focal Points in WHO European Region member states, and a scoping review of media reports, journal articles, and reports. Searches were conducted in English and Russian and covered the period between 1 January 2020 and 17 September 2020. Data extracted included: country; violence type; service sector; and change in service utilisation during COVID-19. All data pertained to the period during which COVID-19 related public health measures were implemented compared to a period before restrictions were in place.

RESULTS

Overall, findings suggested that there was a median reported increase in VAWC service utilisation of approximately 20% during the COVID-19 pandemic. Crucially, however, change in service utilisation differed across sectors. After categorising each estimate as reflecting an increase or decrease in VAWC service utilisation, there was a significant association between sector and change in service utilisation; the majority of NGO estimates (95.1%) showed an increase in utilisation, compared to 58.2% of law enforcement estimates and 42.9% of health and social care estimates.

CONCLUSIONS

The variation across sectors in changes in VAWC service utilisation has important implications for policymakers in the event of ongoing and future restrictions related to COVID-19, and more generally during other times of prolonged presence in the home. The increased global attention on VAWC during the pandemic should be used to drive forward the agenda on prevention, increase access to services, and implement better data collection mechanisms to ensure the momentum and increased focus on VAWC during the pandemic is not wasted.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

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.