Young women's social and occupational development and mental health in the aftermath of child sexual abuse

Child Sexual Abuse, Academic Functioning and Educational Outcomes in Emerging Adulthood

In many parts of the world, emerging adults, aged 18 to 25 years old, require education beyond high school to transition to a stable, secure adulthood. Child abuse, trauma, victimization, and adversity have been shown to negatively affect academic functioning and educational attainment during childhood and adolescence. Despite this, many emerging adults who have experienced these adverse events also show remarkable resilience. Understanding both maladaptation and resilience among emerging adults will inform efforts to increase academic success and post-secondary educational attainment. In the current review, we synthesize literature on associations between child sexual abuse and academic functioning and educational outcomes in emerging adults and college students, including possible social, emotional, and cognitive mediators. We find initial evidence that academic functioning and educational outcomes are separable, with more research needed on reasons for leaving college other than low grades, more research on community colleges, trade schools, on-the-job training, military training, and other sites of post-secondary learning, and as well as the antecedents and consequences of academic experiences in emerging adulthood. Overall, we have a limited understanding of the social and emotional functioning important to educational success in college and other post-secondary educational settings.

The Impact of Child Sexual Abuse Discovery on Caregivers and Families: A Qualitative Study

In this qualitative study with nonoffending caregivers of suspected child sexual abuse victims, we aimed to explore the perceived impact of sexual abuse discovery on caregivers and their families, and caregivers' attitudes about mental health services for themselves. We conducted semistructured, in-person interviews with 22 nonoffending caregivers of suspected sexual abuse victims <13 years old seen at a child advocacy center in Philadelphia. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment continued until thematic saturation was reached. We found that caregivers experienced significant emotional and psychological distress, characterized by anger, depressed mood, and guilt, after learning that their child may have been sexually abused. We identified four specific sources of caregiver distress: concerns about their child, negative beliefs about their parenting abilities, family members' actions and behaviors, and memories of their own past maltreatment experiences. Some caregivers described worsening family relationships after discovery of their child's sexual abuse, while others reported increased family cohesion. Finally, we found that most caregivers in this study believed that mental health services for themselves were necessary or beneficial to help them cope with the impact of their child's sexual abuse. These results highlight the need for professionals working with families affected by sexual abuse to assess the emotional and psychological needs of nonoffending caregivers and offer mental health services. Helping caregivers link to mental health services, tailored to their unique needs after sexual abuse discovery, may be an acceptable strategy to improve caregiver and child outcomes after sexual abuse.

Unpacking the Influence of Abuse and Depression on Grades among Urban Ethnic Minority Adolescents and Young Adults

BACKGROUND

Both depression and a history of abuse have known negative consequences on the overall health of adolescents and young adults (AYAs). Research is not clear, however, on the interactive influence of abuse and depression on academic achievement, especially among AYAs of color.

OBJECTIVE(S)

This study aims to assess the interactive influence of abuse and depression on academic grades among African American and Latino AYAs.

METHODS

The study sample was made up of 476 predominantly urban African American and Latino youth ages 14 to 24. Study participants completed a demographic questionnaire (which included self-reported grades) and the Beck Depression Inventory for Primary Care-Fast Screen. Screenings for abuse were done through three structured methods using the Childhood Maltreatment Interview Schedule-Short Form, a short-structured questionnaire, and a face-to-face unstructured interview with a clinical provider.

FINDINGS

Depression had a significant main effect on grades, while abuse did not. Abuse and depression had a significant interactive effect on grades in that non-depressed adolescents who reported abuse had an almost four point higher average grade score than their non-depressed counterparts who did not report abuse.

CONCLUSIONS

Our findings highlight an unexpected effect in AYAs of color with a history of abuse but no history of depression, suggesting that perhaps there is something intrinsic to this group's resilience or their support systems that protects both against depression and supports their academic achievement. In conclusion, abuse alone does not serve as a predictor of grade achievement. Further work should be done to determine influential factors behind this relationship, with recommendations for school-based counselors and medical providers to screen for depression along with abuse in AYAs in order to determine how best to support this population.

Caregivers' abuse stigmatization and their views of mental health treatment following child sexual abuse

Many families do not utilize mental health services after the discovery of child sexual abuse (CSA), even when trauma-focused treatments are offered at low or no cost. Non-offending caregivers frequently serve as gatekeepers to youths' treatment, and their reactions to CSA may figure into decisions about treatment engagement. The current study examined caregivers' abuse stigmatization (i.e., self-blame and shame about their children's CSA) and associations with two factors predictive of treatment engagement (motivation, obstacles). Participants were recruited from a Child Advocacy Center where they received forensic interviews and were offered services following CSA discovery. Participating caregiver-child dyads included 52 non-offending caregivers (83% biological parents) and their children (69% girls; M_age=10.94, SD_age=2.62). Caregiver abuse stigmatization was associated with higher motivation for treatment but also more obstacles to treatment. Further, abuse stigmatization moderated associations between children's PTSD symptoms and perceived obstacles to treatment with medium effect sizes (M f²=0.287). Among caregivers experiencing high abuse stigmatization, greater child PTSD symptoms were associated with more obstacles to treatment. Among caregivers experiencing low stigmatization, child PTSD was either associated with fewer treatment obstacles or was unrelated to treatment obstacles. Results highlight the potential significance of reducing parents' abuse stigmatization for increasing mental health service utilization following CSA discovery, especially for more symptomatic youth.

Impact of functional and structural social relationships on two year depression outcomes: A multivariate analysis

BACKGROUND

High rates of persistent depression highlight the need to identify the risk factors associated with poor depression outcomes and to provide targeted interventions to people at high risk. Although social relationships have been implicated in depression course, interventions targeting social relationships have been disappointing. Possibly, interventions have targeted the wrong elements of relationships. Alternatively, the statistical association between relationships and depression course is not causal, but due to shared variance with other factors. We investigated whether elements of social relationships predict major depressive episode (MDE) when multiple relevant variables are considered.

METHOD

Data is from a longitudinal study of primary care patients with depressive symptoms. 494 participants completed questionnaires at baseline and a depression measure (PHQ-9) two years later. Baseline measures included functional (i.e. quality) and structural (i.e. quantity) social relationships, depression, neuroticism, chronic illness, alcohol abuse, childhood abuse, partner violence and sociodemographic characteristics. Logistic regression with generalised estimating equations was used to estimate the association between social relationships and MDE.

RESULTS

Both functional and structural social relationships predicted MDE in univariate analysis. Only functional social relationships remained significant in multivariate analysis (OR: 0.87; 95%CI: 0.79-0.97; p=0.01). Other unique predictors of MDE were baseline depression severity, neuroticism, childhood sexual abuse and intimate partner violence.

LIMITATIONS

We did not assess how a person's position in their depression trajectory influenced the association between social relationships and depression.

CONCLUSIONS

Interventions targeting relationship quality may be part of a personalised treatment plan for people at high risk due of persistent depression due to poor social relationships.

Caregiver perceptions about mental health services after child sexual abuse

The objective of this study was to describe caregiver perceptions about mental health services (MHS) after child sexual abuse (CSA) and to explore factors that affected whether their children linked to services. We conducted semi-structured, in-person interviews with 22 non-offending caregivers of suspected CSA victims<13 years old seen at a child advocacy center in Philadelphia. Purposive sampling was used to recruit caregivers who had (n=12) and had not (n=10) linked their children to MHS. Guided by the Health Belief Model framework, interviews assessed perceptions about: CSA severity, the child's susceptibility for adverse outcomes, the benefits of MHS, and the facilitators and barriers to MHS. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment ended when thematic saturation was reached. Caregivers expressed strong reactions to CSA and multiple concerns about adverse child outcomes. Most caregivers reported that MHS were generally necessary for children after CSA. Caregivers who had not linked to MHS, however, believed MHS were not necessary for their children, most commonly because they were not exhibiting behavioral symptoms. Caregivers described multiple access barriers to MHS, but caregivers who had not linked reported that they could have overcome these barriers if they believed MHS were necessary for their children. Caregivers who had not linked to services also expressed concerns about MHS being re-traumatizing and stigmatizing. Interventions to increase MHS linkage should focus on improving communication with caregivers about the specific benefits of MHS for their children and proactively addressing caregiver concerns about MHS.

Associations between mental health, substance use, and sexual abuse experiences among Latinas

This study examined self-reported sexually abusive experiences in childhood and adulthood as correlates of current drug use, alcohol abuse, and depression and posttraumatic stress disorder (PTSD) symptoms. Participants were 204 Latina women 18-34 years old. Results indicated significant relationships between history of sexual abuse (regardless of age of occurrence), depression symptoms, PTSD symptoms, alcohol abuse, and drug use. When examined separately, childhood sexual abuse was associated with symptoms of depression, PTSD, and substance use but not alcohol abuse behaviors. Experiencing sexual abuse in adulthood was associated with symptoms of depression, alcohol abuse behaviors, and substance use but not PTSD symptoms. Structural equation modeling showed that substance use partially mediated the relationship between sexual abuse and mental health outcomes. These findings suggest mental health and substance use services should incorporate treatment for trauma, which may be the root of comorbid mental health and substance use issues.

Childhood maltreatment among Hispanic women in the United States: an examination of subgroup differences and impact on psychiatric disorder

Prevalence rates of childhood maltreatment among Hispanic women in the United States are presented separately for nativity status and ethnic origin subgroups, and the associations between different types of maltreatment and the development of anxiety and depressive disorders are examined. Analyses used self-report data from 1,427 Hispanic women who participated in the National Latino and Asian American Survey. Foreign-born Hispanic women compared to U.S.-born Hispanic women reported significantly lower rates of sexual assault and witnessing interpersonal violence, and a significantly higher rate of being beaten. Ethnic subgroups reported similar rates of maltreatment, with the exception of rape. Bivariate analyses were remarkably consistent in that regardless of nativity status or ethnic subgroup, each type of maltreatment experience increased the risk of psychiatric disorder. In multivariate models controlling for all types of victimization and proxies of acculturation, having been beaten and witnessing interpersonal violence remained significant predictors of both disorders, but sexual abuse increased risk of anxiety only. A significant interaction effect of family cultural conflict and witnessing violence on anxiety provided very limited support for the hypothesis that acculturation moderates the influence of maltreatment on mental health outcomes. Implications for culturally relevant prevention and intervention approaches are presented.

Is childhood physical abuse associated with peptic ulcer disease? Findings from a population-based study

This study investigated childhood physical abuse and ulcers in a regionally representative community sample. Age, race and sex were controlled for in addition to five clusters of potentially confounding factors: adverse childhood conditions, adult socioeconomic status, current health behaviors, current stress and marital status, and history of mood/anxiety disorders. Childhood physical abuse is associated with many negative physical and psychological adult health outcomes. Two recent studies demonstrate a potential link between childhood physical abuse and peptic ulcer disease in adulthood. The authors use regional data for the Canadian provinces of Manitoba and Saskatchewan from the 2005 Canadian Community Health Survey. Of the 13,069 respondents with complete data on abuse and ulcers, 7.3% (n = 1,020) report that they had been physically abused as a child by someone close to them and 3.0% (n = 493) report that they had been diagnosed with peptic ulcers by a health professional. The regional response rate is approximately 84%. Findings show that those reporting abuse had more than twice the prevalence of ulcers than did those not reporting abuse (6.6% vs. 2.7%). The fully adjusted odd ratio of peptic ulcers among those who had reported childhood physical abuse is 1.68 (95% CI = 1.22, 2.32). A significant and stable relationship between childhood physical abuse and peptic ulcers is found, even when taking into account five clusters of potentially confounding factors. Prospective studies that apply the biopsychosocial model are likely to be the most effective for identifying the pathways that connect childhood physical abuse and ulcer disease.

Differences in perceptions of child sexual abuse based on perpetrator age and respondent gender

Child sexual abuse changes the lives of countless children. Child sexual abuse victims experience short and long term negative outcomes that affect their daily functioning. In this study, undergraduate students' perceptions of CSA were obtained using vignettes with an adult or child perpetrator and a general questionnaire. Results indicated participants receiving the child-on-child vignette were less likely to rate the vignette as abuse, saw the abuse as less severe, and assigned less blame to the perpetrator than participants reading the adult-on-child vignette. On a general questionnaire, male participants saw child-on-child abuse as less severe and more encouraged by society than did female participants. The information can be utilized by professionals in treatment planning and preventing revictimization at disclosure.

Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women

A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.

An experimental investigation of emotional willingness and physical pain tolerance in deliberate self-harm: the moderating role of interpersonal distress

Although theoretical and clinical literature emphasize the role of both an unwillingness to experience emotional distress and physical pain tolerance in deliberate self-harm (DSH), research on their associations with DSH remains limited. This study sought to examine the relationships between DSH and the willingness to experience emotional distress and tolerate physical pain, including the moderating role of interpersonal distress in these relationships. To this end, young adults with recent DSH (n = 43) and controls without any DSH (n = 52) were randomly assigned to 1 of 2 emotion-induction conditions (distressing or neutral), after which behavioral measures of both the willingness to experience distress and physical pain tolerance were obtained. Consistent with hypotheses, findings indicated heightened physical pain tolerance among self-harming individuals only under conditions of interpersonal distress. Furthermore, findings provided some support for the hypothesized association between DSH and the unwillingness to experience emotional distress, suggesting that self-harming women evidence less willingness to experience emotional distress only under conditions of depleted regulatory capacity (eg, following an interpersonal stressor).

Sequelae of sexual trauma in women treated for non-trauma-related psychiatric disorders in a psychiatric hospital in Switzerland

OBJECTIVE

We sought to explore the impact of sexual trauma on symptom severity, sense of coherence, and control orientation in female psychiatric inpatients diagnosed with and admitted for non-trauma-related mental disorders.

METHODS

A sample of 31 female inpatients with a reported history of sexual trauma (two thirds abused in childhood, one third raped in adulthood) were compared with 31 female inpatients with similar sociodemographic backgrounds, matched for age and psychiatric diagnosis.

FINDINGS

Compared with the sexually nontraumatized patients, the patients with a reported history of sexual trauma were neither more symptomatic nor did they have a more severe course of illness. No significant differences were found between the two groups with regard to sense of coherence and control orientation. Patients who had been raped in adulthood rated lower than all other patients in the Meaningfulness subscale of the Sense of Coherence Scale, indicating that their belief that there is good reason to care about what happens has been affected.

CONCLUSION

Based on the dimensions assessed, female psychiatric inpatients with a reported history of sexual trauma were not found to be significantly different from female inpatients without such a history. The burden of a mental disorder ensuing from the severity of illness symptoms and illness course is probably so high that the potential impact of a sexual trauma cannot manifest.

Are males and females sexually abused as children socially anxious adults?

It is well documented that childhood sexual abuse is associated with deleterious outcomes in the areas of anxiety, depression, and sexual functioning. However, very little research has been conducted to specifically investigate childhood sexual abuse's relationship to adult social anxiety in both males and females. Participants included 250 undergraduate students from a large metropolitan university. Results indicated that almost one-third of males and a little over a third of females reported being sexually abused as a child or adolescent. Although a large portion of the sample exhibited socially anxious symptomology, childhood sexual abuse did not place males and females at increased risk for social anxiety. The use of a nonclinical, college student sample may provide researchers the opportunity to investigate resiliency in individuals with a history of childhood sexual abuse.

The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations

Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, Massachusetts, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes -- depressed mood, drug use, and antisocial behavior -- were reported 2 years later during the transition to adulthood. Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.

Adverse childhood experiences and mental health in young adults: a longitudinal survey

BACKGROUND

Adverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in children and adults. However, the long-term effects of ACEs on mental health during the early adult years have been understudied. In addition, many studies are methodologically limited by use of non-representative samples, and few studies have investigated gender and racial differences. The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes-depressive symptoms, drug abuse, and antisocial behavior-two years later during the transition to adulthood.

METHODS

The study has a two-wave, prospective design. A systematic probability sample of high school seniors (N = 1093) was taken from communities of diverse socioeconomic status. They were interviewed in person in 1998 and over the telephone two years later. Gender and racial differences in ACE prevalence were tested with chi-square tests. Each mental health outcome was regressed on one ACE, controlling for gender, race/ethnicity, and SES to obtain partially standardized regression coefficients.

RESULTS

Most ACEs were strongly associated with all three outcomes. The cumulative effect of ACEs was significant and of similar magnitude for all three outcomes. Except for sex abuse/assault, significant gender differences in the effects of single ACEs on depression and drug use were not observed. However, boys who experienced ACEs were more likely to engage in antisocial behavior early in young adulthood than girls who experienced similar ACEs. Where racial/ethnic differences existed, the adverse mental health impact of ACEs on Whites was consistently greater than on Blacks and Hispanics.

CONCLUSION

Our sample of young adults from urban, socio-economically disadvantaged communities reported high rates of adverse childhood experiences. The public health impact of childhood adversity is evident in the very strong association between childhood adversity and depressive symptoms, antisocial behavior, and drug use during the early transition to adulthood. These findings, coupled with evidence that the impact of major childhood adversities persists well into adulthood, indicate the critical need for prevention and intervention strategies targeting early adverse experiences and their mental health consequences.