Sexual abuse in childhood and physical and mental health in adulthood: an Australian population study

Adapting a selective parent-focused child sexual abuse prevention curriculum for a universal audience: A pilot study

Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape-parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation-interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N = 31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants' mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.

Gender and coping with HIV: a qualitative study of older childhood sexual abuse survivors living with HIV

People living with HIV often have complex identities and histories. Understanding how these experiences influence adherence to treatment and quality of life are critical to the HIV care. The experiences of older adults living with HIV are uniquely embedded within biology and aging as well as gender. This study described the gendered strategies for coping with HIV among older adults who are childhood sexual abuse survivors. Audio-recorded semi-structured interviews were performed with 24 adults who are 50 years and older from a clinic in South Carolina. Thematic analysis approach was used to discuss key concepts, reconcile codes, and name emergent themes. Overall, the participants used a spectrum of coping strategies including spirituality, seclusion, social support, substance use, engagement in HIV care, information acquisition and sharing, and cognitive reframing. Our findings suggest the potential for growth and recovery is heightened if the interplay of HIV diagnosis, aging, coping, and mental health is considered. Healthcare providers should assess the ways in which individuals interpret their HIV diagnosis and other lived experiences to better understand their patients' mental health. Knowledge of gender-based coping strategies used in HIV-relevant outcomes can be translated into more effective treatment plans to improve the overall quality of life.

Sexual and Physical Victimization and Health Correlates Among Norwegian Adolescents

Large-scale epidemiological studies have documented that many children and adolescents are exposed to different forms of victimization experiences. However, such population-based studies have rarely examined how specific types of victimization are correlated with health indicators. Thus, we investigated sexual victimization, physical victimization by parents, and physical victimization by peers and their associations with sexual health, mental health, and substance use. We gathered data from a nationally representative sample of Norwegian 18-19-year-old students in their final year of senior high school (N = 2075; 59.1% girls). The analyses showed that 12.1% of the adolescents reported sexual victimization experiences. Physical victimization was more prevalent: 19.5% of the respondents had been exposed to victimization from parents and 18.9% from peers. Multivariate analyses revealed specific associations between sexual victimization and a range of sexual health indicators, such as early sexual intercourse debut, many sexual partners, engaging in sex without contraception while intoxicated, and participating in sexual acts for payment. Neither physical victimization from parents nor from peers were correlated with these variables. However, all three forms of victimization were associated with impaired mental health and potential substance use problems. We conclude that a variety of victimization experiences should be addressed in policies for prevention of adolescent mental health and substance use problems. In addition, a special emphasis is warranted regarding sexual victimization: Sexual health policies should address such potential experiences in addition to more traditional themes such as reproductive health and should also include low-threshold services for young victims of sexual victimization.

Child Maltreatment, Mental Health, and Self-Reported Health Among Adolescent Girls in Child Welfare: Mediating Pathways

Child maltreatment is common in the US and has been shown to be associated with physical and psychological health problems in adolescence and adulthood. Based on the allostatic load theory, this study examined the association between different types of child maltreatment (emotional, physical, and sexual abuse, and physical neglect) and self-rated health, and the mediating roles of post-traumatic stress and depression in these relationships. Participants were 249 girls involved in the child welfare system, ages 12-19 years, the majority of whom were African American. A one item self-reported general health measure, the Child Trauma Questionnaire-Short Form (CTQ-SF), Child PTSD Symptom Scale (CPSS) and the Child Depression Inventory (CDI) measured self-reported health, child maltreatment, and posttraumatic and depression symptoms, respectively. Higher levels of emotional, physical, and sexual abuse, and physical neglect were significantly associated with poorer ratings of health. PTSD and depression were significant mediators between histories of childhood emotional, physical, and sexual abuse and physical health. In conclusion, results indicate that the pathways from child abuse to physical health problems in adolescents are through psychological distress. Trauma focused interventions to reduce symptoms of PTSD and depression among this vulnerable group of adolescents are essential to improve health.

Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care

Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.

Child sexual abuse and health outcomes in the Chinese context

Reported rates of child sexual abuse in China fall at the lower end of the range found in Western studies. However, most of the studies were conducted in only one city or province and thus their results may not be generalisable. Acknowledging the infeasibility of recruiting a truly representative sample, we conducted a survey during 2009–10 using a probability sampling procedure to obtain a large and diverse sample of school-aged adolescents from six regions in China. About one in every 13 children had had experience of sexual abuse. Routine screening in medical and social settings is urged. Efforts should be made to ensure wide awareness of this issue.

Physical and mental health of children with substantiated sexual abuse: Gender comparisons from a matched-control cohort study

When compared to children from the general population, sexually abused children receive more medical services, both for physical and mental health problems. However, possible differences between sexually abused boys and girls remain unknown. The lack of control group in studies that find gender differences also prevents from determining if the differences are specific to sexual abuse or to gender. The objective of the study was to assess differences in physical and mental health between sexually abused boys and girls in comparison to those from the general population. Administrative databases were used to document physical and mental health problems of 222 males and 660 females with a substantiated report of sexual abuse between 2001 and 2010. A comparison group individually matched to those from the sexually abused group on gender, age and geographic area was also used to document gender differences in the general population. Yearly incidence rates of diagnoses resulting from medical consultations and hospitalizations of males and females were compared over five years after a first substantiated sexual abuse report using the mixed general linear model. Sexually abused girls were up to 2.2 times more likely to consult a physician than sexually abused boys for physical health problems. Similar findings are observed in the general population. Conversely, results revealed that sexually abused boys were up to 2.3 times more likely than females to consult a physician for mental health problems. This gender difference was not apparent in the general population group.

The impact of childhood sexual abuse on the mental and physical health, and healthcare utilization of older adults

BACKGROUND

The aim of this study is to examine the long-term association between childhood sexual abuse (CSA) and mental and physical health, especially with conditions related to hypothalamic-pituitary-adrenal axis dysfunction such as mood disorders, cardiovascular disorders, gastrointestinal disorders, pain disorders, and measures of frailty and functional mobility. In addition, we examined the impact of CSA on self-reported health and healthcare utilization.

METHODS

Data from the Irish Longitudinal Study on Ageing were employed (N = 8,178). The effects of CSA on mental health, physical health, and healthcare utilization in old age population were estimated by ordinal least square, logistic regression, and Poisson regression, controlling for demographic factors, childhood adversities, and behavioral health.

RESULTS

Six percent of respondents reported CSA with little variation by gender. A significant association was found between CSA and mental health. Those who reported CSA were more likely to have depression, anxiety, worry, loneliness, and low quality of life. Poor self-reported health, lung disease, arthritis, peptic ulcer, chronic pain as well as high levels of total cholesterol and low-density lipoprotein were associated with CSA. Further, those who reported CSA were more likely to report doctor and hospital visits than those without a history of CSA.

CONCLUSIONS

Findings from the present study show that CSA has significant long-term mental and physical consequences, whereby early life events are linked to later life health outcomes.

Child sexual abuse as reported by Israeli adolescents: social and health related correlates

The objectives of the study were to assess the prevalence of child sexual abuse (CSA) in a nation-wide representative sample of 14-17 year old Israeli adolescents, and to examine the associations between CSA, socio-demographic correlates and various measures of physical and mental health. The study population consisted of 906 mother-adolescent dyads, belonging to a community based, representative sample of Israeli 14-17 year olds, interviewed in 2004-5. Response rate was 68%. Subjects provided demographic data, and information about CSA, physical symptoms, body image, well-being and use of mental health services. DAWBA was used to obtain information regarding mental disorders and suicidality. SDQ was used to obtain data on bullying. Statistical analyses were conducted using an SPSS-17 complex sample analysis module and multivariate analyses were conducted to assess the associations between CSA and risk factors and social and health related correlates. Findings show that CSA was reported by 3.3% of adolescents. Higher risk of exposure to CSA was found among girls, among adolescents living in a one-parent household and among adolescents with a chronic disability. In multivariate models adjusting for gender, learning disabilities and depression, CSA was associated with suicidal attempts, stomach ache, dizziness, sleep problems, well being at home and bullying behaviors. No association was found with suicidal ideation or other physical symptoms. Our findings confirm that the associations between CSA and different outcomes vary depending on the socio-psychological context, and underline the importance of addressing the complexity of variables associated with CSA.

Experiences of sexual coercion in a representative sample of adults: the Second Australian Study of Health and Relationships

Background It is important to have current reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults and to identify changes over time in prevalence and consequences.

METHODS

Computer-assisted telephone interviews were completed by a representative sample of 20094 Australian men and women aged 16-69 years. The participation rate among eligible people was 66.2%.

RESULTS

Sexual coercion (i.e. being forced or frightened into sexual activity) was reported by 4.2% of men and 22.4% of women. Sexual coercion when aged ≤16 years was reported by 2.0% of men and 11.5% of women. Correlates of sexual coercion were similar for men and women. Those who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex and more likely to have acquired a sexually transmissible infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. There were no significant differences between the First and Second Australian Study of Health and Relationships in whether men or women had experienced coercion, talked to anyone about this or talked to a counsellor or psychologist.

CONCLUSION

Sexual coercion has detrimental effects on various aspects of people's lives. It usually occurs at the ages at which people become sexually active. There is a need to reduce the incidence of sexual coercion, better identify experiences of sexual coercion, and provide accessible services to minimise the detrimental effects of sexual coercion.

Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand

OBJECTIVES

Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30.

METHODS

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.

RESULTS

After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

CONCLUSIONS

CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

HIV-infected men who have sex with men and histories of childhood sexual abuse: implications for health and prevention

A personal history of childhood sexual abuse (CSA) is prevalent and deleterious to health for people living with HIV (PLWH), and current statistics likely underrepresent the frequency of these experiences. In the general population, the prevalence of CSA appears to be higher in men who have sex with men (MSM) than heterosexual men, but there are limited data available for HIV-infected MSM. CSA is associated with poor mental and physical health and may contribute to high rates of HIV risk behaviors, including unprotected sex and substance abuse. CSA exposure is also associated with low engagement in care for PLWH. More information is needed regarding CSA experiences of HIV-infected MSM to optimize health and wellbeing for this population and to prevent HIV transmission. This article reviews the epidemiology, implications, and interventions for MSM who have a history of CSA.

Perceptions of childhood sexual abuse survivors: development and initial validation of a new scale to measure stereotypes of adult survivors of childhood sexual abuse

The Childhood Sexual Abuse Stereotypes Scale was developed to assess stereotypes of adult survivors of childhood sexual abuse. Scale items were derived from two studies that elicited cultural and personal beliefs about, and emotions experienced towards adult childhood sexual abuse survivors among university undergraduates. Two scales, Emotions and Characteristics, were developed and administered online to 182 participants. Exploratory factor analysis produced 7 factors, 4 for the Emotions Scale and 3 for the Characteristics Scale. Study 2 replicated this factor structure using confirmatory factor analysis (N = 457). Reliability and validity analyses suggest that the Childhood Sexual Abuse Stereotypes Scale has satisfactory psychometric properties. The Childhood Sexual Abuse Stereotypes Scale can be used to examine stereotypes of legal and health care professionals likely to work with survivors as well as in stereotyping research.

Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18–64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.

Physical and psychological maltreatment in childhood and later health problems in women: an exploratory investigation of the roles of perceived stress and coping strategies

OBJECTIVE

This retrospective, cross-sectional study investigated the association between childhood physical and psychological maltreatment and self-reported physical health concerns in adult women. The mediating roles of perceived stress and coping strategies were examined.

METHODS

Participants were 235 women (aged 18-59 years) recruited from the community. Semi-structured interviews and questionnaires were used to assess self-reported childhood maltreatment and current perceived stress, coping strategies, and health status. Data were analyzed using structural equation modeling.

RESULTS

After controlling for a history of child sexual abuse and relevant demographic variables, child physical and psychological maltreatment were significantly associated with greater physical health concerns. Support was found for models in which perceived stress and emotion-focused coping partially mediate the relation between maltreatment and health problems; problem-focused and avoidance coping did not operate as mediators. Multi-mediation model testing indicated that emotion-focused coping and perceived stress together better explain the relationship between child maltreatment and physical health than either variable alone.

CONCLUSION

Findings suggest that child maltreatment is an important risk factor for adverse health outcomes in later life and that current stress and coping strategies may influence this relationship. Implications for the physical health of maltreatment survivors are discussed.

PRACTICE IMPLICATIONS

The management of perceived stress and the use of adaptive emotion-focused coping responses in the everyday lives of maltreated women may be particularly useful points of intervention in order to mitigate physical health concerns in adulthood.

The impact of childhood sexual abuse on psychological distress among women in New Zealand

PROBLEMS

In order to better understand the long-term impact of child sex abuse, this study examined the association between women's experience of abuse, health symptoms, and psychological distress in adulthood. There is limited information about child abuse outside the United States.

METHODS

Nine hundred sixty-one women participated in a structured interview.

RESULTS

Participants who had experienced abuse (13%) were significantly more vulnerable to psychological distress in adulthood if they were younger, less satisfied with their standard of living, and resided in urban areas.

CONCLUSION

Dissemination and evaluation of therapies for the treatment of sex abuse in the New Zealand context is warranted.

Psychological distress and experience of sexual and physical assault among Australian prisoners

BACKGROUND

Prison populations are made up of individuals from disadvantaged, often abusive backgrounds, who are more likely to suffer from psychological problems than the general community.

AIM

This study aimed to determine associations between current psychological distress and history of having experienced sexual coercion and/or physical assault among prisoners in two Australian states (Queensland and New South Wales).

METHODS

We conducted a random sample survey of prisoners by computer-assisted telephone interview. Prisoners were asked about forced sexual encounters in or outside prison, and physical assault in prison. Psychological distress was estimated using a dichotomised score obtained from the Kessler 6-Item Psychological Distress Scale (K6), and a logistic regression analysis was employed to investigate associations.

RESULTS

A total of 2426 prisoners were interviewed of 3055 prisoners invited to participate, a response rate of 79%. We categorised 236 men (12%) and 63 women (19%) as 'severely' psychologically distressed according to the K6, and 13% of the men and 60% of the women reported that they had been sexually coerced prior to imprisonment. Physical assault in prison was common, reported by 34% of the men and 24% of the women. On multivariate analysis, prisoners were more likely to be psychologically distressed if they had ever been threatened with sexual assault in prison or physically assaulted in prison. Sexual coercion outside prison was an important associate of psychological distress among men but not among women.

CONCLUSIONS

As psychological distress and experiences of assault are closely statistically linked among male prisoners and both are very common among female prisoners, their screening for psychological distress should include efforts to find out about sexual and violent assaults against them both before and during imprisonment. Further, longitudinal research with prisoners is required to establish causal relationships.

Violence and Men’s Health

Although violence affects everyone, men’s health is disproportionately affected. To better understand the etiology of men’s violence, it is essential to comprehensively examine the factors influencing the development and trajectories of violence perpetration and victimization. This review offers a broad perspective on the burden of violence for men and the characteristics of individuals, relationships, communities, and society that combine to influence men’s experience with interpersonal violence, including child maltreatment, youth violence, intimate partner violence, and sexual violence. Men’s experience with violence is influenced by physiological, emotional, and behavioral factors; relationships with family and peers; and social norms. In collaboration with professionals from other sectors, health professionals can help prevent or intervene in male’s perpetration of violence across the lifespan through identification of factors that place men at risk and referral of male patients to evidence-based prevention and intervention resources.

Childhood sexual abuse and its relationship with psychosocial outcomes among children affected by HIV in rural China

This study assessed the prevalence of childhood sexual abuse (CSA) and its association with psychosocial outcomes among children residing in communities with a high prevalence of HIV in rural China. Data were collected from HIV orphans (n = 417; children who had lost one or both parents to HIV), vulnerable children (n = 326; children living with HIV-infected parents), and comparison children (n = 276; children who had not experienced HIV-related familial illness or death). Approximately 30% of the children reported having experienced at least one form of CSA; boys (37%) reported more cases of CSA as compared with girls (24%); 24% reported experiencing only nonphysical CSA, 5% reported both physical and nonphysical CSA, and 2% reported only physical CSA. Multivariate analysis revealed that CSA was significantly associated with problem behaviors and quality of life independent of key demographic factors. These findings suggest that the children in this study were vulnerable to CSA and also highlight the need to address the issues of CSA in this population.

Child sexual abuse: is it a risk factor for pregnancy?

AIM

This paper is a report of a study of the relationship of post-traumatic stress symptoms, depression, and health status to high risk pregnancy status in survivors of childhood sexual abuse.

BACKGROUND

Studies examining the long-term effects of childhood sexual abuse have delineated diverse psychological, cognitive, and social difficulties in adult survivors that often manifest somatically.

METHODS

A random sample of 1835 mid-pregnant Jewish women was recruited in Israel over an 18-month period in 2005-2007. Participants were divided into three sub-groups consisting of the different combinations between pregnancy at risk (yes/no), childhood sexual abuse (yes/no), other than childhood sexual abuse trauma (yes no), and no trauma (yes/no). They completed a self-administered questionnaire consisting of five scales: a demographic variables scale, the Post-traumatic Stress Disorder Symptom Scale, Center for Epidemiologic Studies Depression Scale, Traumatic Events Questionnaire, and Childhood Sexual Experiences Scale.

FINDINGS

Pregnant survivors of childhood sexual abuse suffered higher distress levels which heightened poor health, hence increasing the probability of high risk pregnancy compared to women who had had other than sexual abuse trauma or reported no trauma. Post traumatic stress symptoms and avoidance (a sub-category) were found to explain chronic illnesses, whereas depression was found to explain gynecological problems in pregnant sexually-abused survivors.

CONCLUSION

Healthcare workers need to recognize and address the psychological state of pregnant child sexual abuse survivors. Screening of pregnant women for child sexual abuse is needed to assess survivors' psychological well-being and recognize their unique concerns during pregnancy monitoring.

Adult Coping with Childhood Sexual Abuse: A Theoretical and Empirical Review

Coping has been suggested as an important element in understanding the long-term functioning of individuals with a history of child sexual abuse (CSA). The present review synthesizes the literature on coping with CSA, first by examining theories of coping with trauma, and, second by examining how these theories have been applied to studies of coping in samples of CSA victims. Thirty-nine studies were reviewed, including eleven descriptive studies of the coping strategies employed by individuals with a history of CSA, eighteen correlational studies of the relationship between coping strategies and long-term functioning of CSA victims, and ten investigations in which coping was examined as a mediational factor in relation to long-term outcomes. These studies provide initial information regarding early sexual abuse and subsequent coping processes. However, this literature is limited by several theoretical and methodological issues, including a failure to specify the process of coping as it occurs, a disparity between theory and research, and limited applicability to clinical practice. Future directions of research are discussed and include the need to understand coping as a process, identification of coping in relation to adaptive outcomes, and considerations of more complex mediational and moderational processes in the study of coping with CSA.

Long-term physical health consequences of childhood sexual abuse: a meta-analytic review

OBJECTIVE

The purpose of the present article was to systematically review the literature investigating the long-term physical health consequences of childhood sexual abuse (CSA).

METHODS

Literature searches yielded 31 studies comparing individuals with and without a history of CSA on six health outcomes: general health, gastrointestinal (GI) health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity. Exploratory subgroup analyses were conducted to identify potential methodological moderators.

RESULTS

Results suggested that a history of CSA was associated with small to moderate group differences on almost all health outcomes assessed, such that individuals with a history of CSA reported more complaints for each health outcome. Suggestive trends in moderating variables of study design and methodology are presented.

CONCLUSIONS

Results highlight the long-term physical health consequences of CSA and identify potential moderators to aid in the design of future research.

Men who were sexually abused in childhood: coping strategies and comparisons in psychological functioning

OBJECTIVE

Coping strategies of men who were sexually abused in childhood were examined to ascertain their relationship to clinical diagnoses. Time elapsed since the abuse occurred was examined for its relationship to psychological functioning. Clinical psychopathology of this primary sample of sexually abused men was compared to a community sample of men.

METHODS

A primary sample of 147 Australian men was recruited from agencies and self-help groups who support adults who were sexually abused in childhood. For comparative purposes a secondary data set that consisted of 1,231 men recruited randomly in an Australian community survey was utilized. Both samples were administered the 28-item General Health Questionnaire (GHQ28). The primary sample was administered the 60-item coping style inventory instrument (COPE).

RESULTS

Coping strategies influenced the possibility of being classified as clinical or nonclinical. The most important strategies associated with better functioning were positive reinterpretation and growth and seeking instrumental social support. Whereas strategies that were more associated with a clinical outcome were themed around internalization, acceptance and disengagement. The sample of men who were sexually abused in childhood was up to 10 times more likely to be classified as "clinical" then the sample of community men. Time elapsed since the abuse occurred did not have a moderating effect on men's psychological functioning.

CONCLUSIONS

Men who have been sexually abused in childhood are more likely to have clinical diagnoses but coping strategies may play an important part in this outcome. Seeking active assistance appears to be important coping strategy in reframing the experience, however, the timing of this help seeking is not critical.

PRACTICE IMPLICATIONS

The findings reinforce the importance of professionals being aware that men's psychiatric symptoms might be the sequel to past child sexual abuse. Coping strategies that focus on internalization or disengagement are potentially damaging to the men's long-term psychological functioning. Importantly there are coping strategies that appear to have a moderating effect on clinical diagnoses. Focus needs to be given to support services to male victims that provide practical strategies and allow for cognitive reframing to assist men to see their strength and positive growth arising from survival.

Psychiatric state of college students with a history of childhood sexual abuse

BACKGROUND

Childhood sexual abuse (CSA) seriously influences children's psychological status. This study aimed to investigate the relationship between CSA and the psychiatric disorders.

METHODS

An anonymous and retrospective questionnaire survey was carried out in 1307 college students (aged 18-25 years; 701 females, 606 males) to investigate the participants' CSA experience by means of a complete random sampling method. The Symptom Check-List-90 (SCL-90) test was used to study the victims' psychiatric aspects.

RESULTS

22.11% (155/701) of the female students and 14.69% (89/606) of the male students experienced physical and/or non-physical contact CSA before age 18, with a significant difference between female and male (P<0.05). And 11.43% (80/701) of the female students and 7.26% (44/606) of the male students experienced physical contact CSA (P<0.05). Most abusers were male and young people, and only a few of them used violence. 78.7% of the females experienced non-physical contact CSA from strangers, while 71.3% experienced physical contact CSA from acquaintances. 89.9% of the male victims knew the abusers before. Females were more likely than males to experience physical contact CSA from members of the family circles. The CSA incidence increased with age in females, while 54.7% of the male victims experienced CSA from 12 to 16 years. The students who experienced CSA had higher SCL-90 scores than those who did not in somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The more serious the CSA experience was, the higher SCL-90 scores of the psychiatric disorders would be.

CONCLUSIONS

CSA is not uncommon in adolescents. Girls are more likely to experience CSA than boys. About half of the abusers are the victims' close relatives, neighbors and teachers; most abusers were male. Personal experience of CSA may seriously affect the victims' psychological health.

Childhood Sexual Abuse and Adult Sexual Problems: A New View of Assessment and Treatment

The New View recognizes that people may be dissatisfied with any emotional, physical or relational aspect of sexual experience and thus invites men and women with abuse histories to discuss sexual issues that are distressing. There are numerous pathways by which child sexual abuse (CSA) can lead to sexual dissatisfaction in adulthood. In addition to those outlined by learning theory and trauma formulations, the New View adds several important and hitherto neglected paths: anxiety about being `normal' or living up to perceived cultural standards, power imbalance in the sexual relationship, stress (because of the consequences of low socioeconomic status), and limited access to both quality health care and sexual information. Assessment of both sexual difficulties and treatment must address these kinds of economic, social and relational factors. How the New View contributes to our ability to understand and treat the sexual concerns of men and women with histories of childhood sexual abuse will be presented in this article and illustrated with clinical case material.