Child sexual abuse is largely hidden from the adult society. An epidemiological study of adolescents' disclosures

Differences Between Girls and Boys in the Disclosure of Sexual Violence

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

Factors related to delayed disclosure among victims of child sexual abuse in Singapore

BACKGROUND

Delayed disclosure is a prevalent and serious issue among victims of child sexual abuse (CSA). Identifying the factors associated with delayed disclosure can identify the profile of children who are at risk of delaying disclosures and inform measures to facilitate timely disclosure.

OBJECTIVE

The current study represented a pioneering effort to investigate factors that are related to disclosure of CSA in Singapore. It examined the influence of various victim and abuse characteristics on the time taken for a victim to disclose CSA.

PARTICIPANTS AND SETTING

A total of 252 CSA cases that were referred to the psychology department of Singapore's Ministry of Social and Family Development (MSF) from 2017 to 2021 were analyzed.

METHODS

Cases were coded for the study variables and multivariate Cox regression was conducted to analyze the impact of each variable of interest on the time taken to disclose the abuse.

RESULTS

It was found that the following sub-populations of CSA victims were associated with delayed disclosure: younger victims, female victims (as compared to male victims), victims with higher severity of sexual abuse (e.g., forced intercourse), and victims who were abused by in-home caregivers (as compared to acquaintances).

CONCLUSIONS

The findings from the study generated practical implications to help reduce the time victims take to disclose CSA in the Singaporean context.

Stereotypical Victims: Visibility of #MeToo Disclosures on Twitter

The #MeToo movement has brought greater visibility to the topic of sexual assault in public discourse. We analyzed a dataset of 1,070 Twitter #MeToo self-disclosures to examine the relationship between online visibility (retweets and favorites) and the content of victim-survivors' self-disclosures such as victim's gender, relationship to the perpetrator, and the emotions expressed in the tweet. The visibility of sexual assault self-disclosures was shaped by the extent to which they align with stereotypical misconceptions of victimization. These findings carry significant implications for understanding patterns of victimization, and for identifying whose voices are being amplified or not on Twitter.

Understanding the Narratives of Child Sexual Abuse

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked - temporally, culturally, generationally, materially, and emotionally - and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse.

Cross-sectional examination of correlates of sexual victimization disclosure via #MeToo

Background: Sexual victimization is a serious public health problem, with a range of negative impacts on mental and physical health. Responses that individuals get to disclosure of sexual victimization play an important role in recovery. With the increased use of social media, more survivors are talking about their experiences of sexual victimization online. Research is needed to document the correlates of online disclosure of sexual victimization.Objective: The current study examined the role of demographic characteristics, assault severity, coping strategies, and social isolation as putative correlates of disclosing sexual victimization online via the hashtag #MeToo.Methods: A sample of 637 adults recruited via social media who reported a history of sexual victimization since the age of 14 completed self-report surveys using online survey software to assess disclosure of sexual victimization, assault severity, coping strategies, and social isolation.Results: Multivariate analyses suggest that levels of emotion-focused coping were positively associated with the disclosure of sexual victimization online via #MeToo. Further, individuals who had experienced completed rape by verbal coercion were less likely to disclose via #MeToo, compared to individuals who experienced other forms of assault.Conclusion: Coping strategies and assault severity play an important role in determining whether survivors disclose sexual victimization online via #MeToo. Findings suggest that individuals may disclose via #MeToo to seek support or express their emotions. Further, individuals whose sexual victimization experiences do not conform to 'typical' sexual victimization experiences are less likely to disclose via #MeToo.

A systematic review of factors associated with disclosure of child sexual abuse

BACKGROUND AND OBJECTIVE

Disclosure of CSA is key to victims having access to support and protection, but the current understanding of what factors play a key role is still limited. The present review aims to understand a range of socio-ecological factors that can either facilitate or obstruct the disclosure of CSA.

METHODS AND RESULTS

Through a systematic review of 27 quantitative studies published from 2000 to 2022, the current review identified 17 significant predictors of CSA disclosure. Facilitators of disclosure included older age, being female, higher IQ, recent abuse, resistance during abuse, clergy perpetrator, non-offending caregiver support, and acculturation. Barriers to disclosure included intellectual disability, avoidant coping, romantic relationships with the perpetrator, family criminality, domestic violence, adherence to traditional Asian values, and ethnic minority identity. The findings also suggested that the relationship between predictors and disclosure tends to be mixed, contradictory, or indirect/interactional, emphasizing the importance of situating the findings in specific social-ecological contexts.

CONCLUSIONS

The findings can inform future research and practice by providing a comprehensive understanding of the predictors of CSA disclosure and highlighting the importance of considering the socio-ecological context when interpreting findings. Moreover, the review provides a valuable resource for professionals who work with victims of CSA, helping them better identify factors that may facilitate or hinder disclosure and allowing for tailored interventions.

Understanding how peers respond to online child maltreatment disclosures: A qualitative content analysis of family violence discussions on social media

BACKGROUND

Positive, supportive responses to child maltreatment disclosure are critical for victims to receive appropriate resources and support for healing. Young people often prefer to disclose to their peers, frequently on social media platforms.

OBJECTIVE

We assessed young people's use of TalkLife, an online peer-to-peer support platform, to respond to the disclosure of child maltreatment.

METHODS

We conducted a qualitative content analysis of 1090 comments on childhood maltreatment-related posts on TalkLife between 2013 and 2020. We used an iterative, team-based qualitative content analysis approach to understand how peers responded to maltreatment disclosure.

FINDINGS

Peer responses tended to be supportive, including asking questions about the abuse and offering advice, emotional support, and other positive responses. Most commonly, peers advised the victim to report, focus on their strengths instead of the abuse, reach out to adults for more support, or confront the perpetrator. On occasion, however, peers began an irrelevant discussion, joked about the situation, or even directly attacked the discloser.

CONCLUSIONS

Learning about child maltreatment disclosures on social media builds the foundation for research to assist in identifying and applying interventions on online platforms. Further, these findings can inform programs that teach how to provide healthy responses to child maltreatment disclosures.

Respect for the journey: a survivor-led investigation of undergoing psychotherapy assessment

PURPOSE

Psychotherapy assessments are key decision points for both clients and services, carrying considerable weight on both sides. Limited research indicates that assessments have immediate and long-term impacts on clients, particularly where trauma has been experienced, affecting engagement with therapy. Understanding assessments from clients' perspectives can inform service development and improve client experience.

METHODS

This is a survivor-led exploration of clients' experiences of undergoing assessment for talking therapies. Interviews were conducted with seven people who had undergone assessment for psychological therapies in third sector and NHS services. Interviews were recorded, transcribed and analysed thematically.

RESULTS

The core theme was 'respect for the journey' reflecting the need expressed by participants for their life experiences prior to the assessment to be given full respect and consideration. Six sub-themes were identified: trauma and desperation, fear of judgement, search for trust and safety, sharing and withholding (a balancing act), feeling deconstructed, and finding hope.

CONCLUSIONS

The findings highlight the heightened emotional power surrounding psychotherapy assessments, reflecting the journey participants had undertaken to reach this point. The dilemma facing clients at the heart of an assessment-how much to share and how much to withhold-demonstrates the importance for services and assessors of treating the journey a client has made to the assessment with care and respect. Findings indicate the value of services and practitioners undertaking a trauma-informed approach to assessment encounters.

Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey

BACKGROUND

Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population.

METHODS

Participants were adolescents (n = 6351) age 13-17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth - DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test.

RESULTS

Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19-1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02-1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03-1.11). This effect was modified by age (13-15 vs. 16-17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80-3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14-1.50) among 16-17-year-olds.

CONCLUSIONS

Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

Associations between adolescents watching pornography and poor mental health in three Swedish surveys

The aim of this study was to examine the association between watching pornography and poor mental health in three repeated cross-sectional surveys in Sweden (2004, 2009, 2014) among high school seniors (13,277 students) with an average age of 18 years. The same index questions concerning ever having watched pornography and the frequency of watching pornography during the last year were combined with three different measures of psychological health and background control variables in multiple logistic regression and forward stepwise logistic regression models. The repeated cross-sectional surveys did not find any consistent associations across years between poor mental health and ever having watched pornography or the frequency of watching pornography. Having watched deviant pornography (containing violence, children and/or animals) was associated with poor mental health among boys in two surveys but only in one survey among girls. Other characteristics, such as mother's unemployment (especially boys), parenting style (especially high controlling parents among boys) and experiences of sexual abuse (especially penetrating abuse among girls), were more consistently and strongly associated to poor mental health across the three surveys. This study stresses the importance of controlling for multiple background variables when studying the association between watching pornography and mental health, since the association might primarily be explained by underlying confounding variables.

Assessment of Child Sexual Abuse in Victimized Women

Child sexual abuse (CSA) is a frequent phenomenon, and women who report it are at a higher risk of mental disorders and sexual dysfunction. The application of a brief questionnaire could help gynecologists assessment of CSA history in women. This study was carried out including women (n = 593) who had been victims of CSA before the age of 18 years. We used the Early Trauma Inventory Self Report-Short Form (ETISR-SF) Part 4, the Female Sexual Function Index (FSFI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and a semi-structured instrument to assess CSA. Among the 593 women included, 77 agreed to answer the questionnaires, 62(80.5%) had traumatic sexual events, 53(68.8%) had a total FSFI score ≤ 26.55, and 64(84.2%) considered themselves victims of CSA. There was an association regarding the belief that CSA influenced their sex life and their being at risk for GAD (p = 0.001), PTSD (p = 0.02), and sexual abuse by a family member (p = 0.01). The risk factors were the presence of risk for GAD (OR = 5.88[1.3-27.03]) and CSA by a family member (OR = 5.78[1.57-21.28]). This methodology can assist gynecologists in assessing a patient's history of CSA.

Sexual harassment and abuse; disclosure and awareness of report- and support resources in Norwegian sport- and non-sport high schools: a prospective exploratory study

Purpose

To examine high school students' disclosure of sexual harassment and abuse (SHA), and awareness of reporting systems and support mechanisms in school among students, leaders, and coaches.

Method

Norwegian 17-year-old high school elite athletes (n = 630), recreational athletes (n = 307), and reference students (n = 263) responded to an online questionnaire at two measurement points, 1 year apart (T1 and T2). Leaders and coaches (n = 249) at the participating high schools responded to an adapted version of the questionnaire at T1. Data were analyzed using ANOVA or Welch test, Pearson Chi-Square test, and McNemar test.

Results

In total, 11.4 and 34.0% of the adolescents were aware of reporting systems and support mechanisms, respectively, in their schools. Nearly all the leaders, and half of the coaches were aware of these resources. Among the adolescents with lifetime experience of SHA, 20.1% had disclosed their experiences to someone. Girls disclosed more frequently than boys. The elite- and recreational athletes disclosed less often compared with the reference students. A negative change from T1 to T2 was found in disclosure of SHA and awareness of support mechanisms. At T2, 6.5% of the adolescents reported that their school had implemented measures against SHA during the last 12 months.

Conclusion

The results emphasize a need for institutional effort to improve information about available report- and support resources and increase the relevance of use of such systems for adolescents.

The Impact of the Consistency of Child Witness and Peer Reports on Credibility

Adults' perceptions of children's disclosures have important implications for the response to that disclosure. Children who experience adult transgressions, such as maltreatment, often choose to disclose this experience to a peer. Thus, peer disclosure recipients may transmit this disclosure to an adult or provide support for the child's own disclosure. Despite this, the influence of peer disclosure on a child witness's credibility, as well as on the perceptions of peer disclosure recipients, is unknown. The present study examined how child witnesses' and peer disclosure recipients' credibility is impacted when the peer either confirms or contradicts the witness's disclosure (or concealment) of an adult transgression. Participants listened to a child witness and peer being interviewed by an adult in one of four disclosure patterns (consistent disclose, consistent conceal, witness disclose/peer conceal, or witness conceal/peer disclose). Participants rated both the witness and the peer on dimensions of credibility (honesty and cognitive competence). Results revealed that both the witness and peer were more credible when their reports were consistent with one another. When inconsistent, the witness/peer who disclosed was considered more credible than the one who concealed. The findings indicate the potential importance of peers in the disclosure process as they may support the witness's report and even be a credible discloser when the witness is reluctant to disclose.

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

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

Women Receive More Positive Reactions to Childhood Sexual Abuse Disclosure and Negative Reactions are Associated With Mental Health Symptoms in Adulthood for Men and Women

Although disclosure of sexual abuse has become more socially acceptable for both men and women in recent years, there is much yet to be understood about differences in the disclosure process and associated pathology between men and women. The current study aimed to (a) investigate differences in aspects of the childhood sexual abuse (CSA) disclosure process between adult men and women and (b) explore how timing of disclosure, perceived parental style, and negative social reactions to disclosure relate to various mental health symptoms. Using a cross-sectional, quasi-experimental design, adult men and women in the United States recruited through Amazon's Mechanical Turk (N = 299) completed self-report surveys. Women reported disclosing to a significantly greater number of people than men, and were more likely to disclose to parents, while men were more likely to tell friends. Results revealed that women reported receiving significantly more positive responses and emotionally supportive responses to their CSA disclosures than men. Negative reactions to disclosure were positively associated with internalizing symptoms and externalizing symptoms, while both negative reactions to disclosure and perceived parental dysfunction were positively associated with substance use symptoms. Results signify a need for resources to aid individuals in supporting survivors of CSA, as reactions have the potential to impact recovery trajectory and for clinicians to consider how disclosure experiences impact survivor cognitions and symptom exacerbation.

Adult and Adolescent Disclosures of Child Sexual Abuse: A Comparative Analysis

The recent attention focused on child sexual abuse (CSA) disclosure pathways has highlighted complex psychological processes that influence disclosure both for children and adults. Some authors have suggested that such processes may differ between children and adults yet few studies have examined distinct samples within the same study. This paper addresses this gap by exploring adolescent (n = 20) and adult (n = 10) experiences of disclosure of childhood sexual abuse. Interviews were conducted with both samples, using the same interview schedule and a comparative analysis was conducted of the key themes identified from a grounded theory analysis. Those themes that were found to be common to both samples included pressure cooker effect, telling would make it worse, and self-blame. Themes that were found to be more prevalent in the adolescent sample included police/court involvement, concern for other children, being asked, and peer influence. It is suggested that such potential differences reflect the changing social context over the past few decades which is characterised by increased awareness of sexual abuse as a crime and the risks of recidivism of offenders.

Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors’ and health professionals’ experiences of addressing child sexual abuse

Background

Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA.

Method

Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA.

Results

Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA.

Conclusion

The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.

Auditory hallucinations, childhood sexual abuse, and limbic gray matter volume in a transdiagnostic sample of people with psychosis

Childhood sexual abuse (CSA) is a potentially unique risk factor for auditory hallucinations (AH), but few studies have examined the moderating effects of sex or the association of CSA with limbic gray matter volume (GMV) in transdiagnostic samples of people with psychotic disorders. Here we found that people with psychotic disorders reported higher levels of all surveyed maltreatment types (e.g., physical abuse) than healthy controls, but people with psychotic disorders with AH (n = 41) reported greater CSA compared to both those without AH (n = 37; t = -2.21, p = .03) and controls (n = 37; t = -3.90, p < .001). Among people with psychosis, elevated CSA was most pronounced among females with AH (sex × AH status: F = 4.91, p = .009), held controlling for diagnosis, medications, and other maltreatment (F = 3.88, p = .02), and correlated with the current severity of AH (r = .26, p = .03) but not other symptoms (p's > .16). Greater CSA among patients related to larger GMV of the left amygdala accounting for AH status, diagnosis, medications, and other maltreatment (t = 2.12, p = .04). Among people with psychosis, females with AH may represent a unique subgroup with greater CSA. Prospective high-risk studies integrating multiple measures of maltreatment and brain structure/function may help elucidate the mechanisms linking CSA with amygdala alterations and AH.

Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths' experiences of systematic assessment of sexual health and risk-taking (SEXIT)

Sexual ill health among young people, in terms of sexually transmitted infections (STIs), unintended pregnancy, transactional sex and sexual violence, is a global public health concern. To that end, the SEXual health Identification Tool (SEXIT) was developed. The purpose of this study was to explore the visitors' experiences of a youth clinic visit when SEXIT was used. A purposively selected sample of 20 participants (16-24 years of age) was recruited from three Swedish youth clinics using SEXIT. Participants were interviewed individually in March and April 2016, and data were analysed using inductive qualitative content analysis. The analysis resulted in four main categories describing the participants' experiences of using SEXIT: "Issues of concern" includes descriptions of the items in SEXIT as important; "Enabling disclosure" describes how SEXIT serves as an invitation to talk and facilitates disclosure of negative experiences; "Road to change" captures experiences of the conversation with the healthcare professional; and "Managing power imbalance" describes experiences regarding the response and attitudes of the healthcare professional as well as the participants' fears of being judged. The categories are connected by the overarching theme "Ask me, listen to me, treat me well and I shall tell". This study contributes knowledge on young people's experiences of a tool-supported dialogue on sexual health and risk-taking initiated by the healthcare professional. Structured questions in a written format, as a basis for dialogue, are appreciated and experienced as a functioning way of addressing sexual ill health and risk-taking at Swedish youth clinics.

Patterns of disclosure and perceived societal responses after child sexual abuse

BACKGROUND

Disclosure of child sexual abuse (CSA) is key for abused children to access help and to protect them and other children.

OBJECTIVE

The aim of this study was to investigate patterns of disclosure of child sexual abuse and how children perceived responses from people they disclosed to.

PARTICIPANTS AND SETTING

Data were collected online in classrooms and during home studies in a national probability-based sample of 3282 third-year students in Swedish high schools in 2020-2021 (the age of the students varied between 16 and 23 years (M = 18,2)).

METHODS

Results are presented with frequencies (n) and percentages (%). Pearson's chi-squared test was used for comparisons between groups.

RESULTS

First, a substantial share of abused girls and most abused boys had not yet told anyone about the abuse, leaving them unable to access protection or rehabilitation. Second, participants who had disclosed sexual abuse had most often turned to a peer, more rarely to an adult, and seldom to a professional or volunteer. Third, although the societal responses that the participants perceived were mixed, more severe abuse was associated with more negative societal responses. Fourth, most participants stated that they did not need any professional support. Fifth, among the minority who had sought help, half were satisfied and a third dissatisfied.

CONCLUSIONS

Results showed that most children with experience of CSA did not have access to the protection, support, and rehabilitation that they have a right to. Preventive measures need to target children and young people, while societal responses after CSA, especially severe CSA, need to be improved.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.

Nicht nur Doktorspiele – (rechts)medizinische Aspekte von Sexualdelikten an Kindern durch Kinder

Hintergrund

Sexualisierte Handlungen zwischen gleichaltrigen Kindern sind in der Regel Ausdruck eines normalen, altersgerechten Verhaltens. Doch auch zwischen Minderjährigen gibt es sexualisierte Gewalt, die über das altersentsprechende Interesse hinausgeht und in der medizinischen Literatur bislang wenig Beachtung fand.

Methode

Es wurde eine selektive Literaturrecherche in der Datenbank PubMed sowie mithilfe des Suchdienstes Google Scholar durchgeführt. Außerdem wurde eine retrospektive Analyse eigener Fälle durchgeführt.

Ergebnisse

Die erfassten Studien ergaben Prävalenzen von 6 bis 50,7 % für unerwünschte sexuelle Kontakte. SchülerIn an einer Highschool und weiblich zu sein oder einen Migrationshintergrund zu haben, wurde als Risikofaktor für sexuelle Übergriffe identifiziert. Mehr als die Hälfte (54 %) der Täterinnen und bis zu 16 % der Täter waren zuvor selber von Missbrauch und/oder Vernachlässigung betroffen. In der eigenen Erhebung gaben 37 % der Mädchen an, penovaginal penetriert worden zu sein, während 60 % der Jungen eine penoanale Penetration angaben. In keinem Fall konnten objektivierbare Verletzungen festgestellt werden.

Schlussfolgerung

Auch wenn bei der medizinischen Untersuchung von minderjährigen Geschädigten nach Sexualdelikten nur äußerst selten eindeutige Befunde festzustellen sind, sollte jede/jeder MedizinerIn Kenntnis über die Wertigkeit und Bedeutung von kindlichen Genitalbefunden haben. Weiterhin gilt es, den fließenden Übergang von „Doktorspielen“ zu sexualisierter Gewalt zwischen Minderjährigen korrekt zu erkennen.

Do children unintentionally report maltreatment? Comparison of disclosures of neglect versus sexual abuse

BACKGROUND AND AIMS

Children's initial reports often play a key role in the identification of maltreatment, and a sizeable amount of scientific research has examined how children disclose sexual and physical abuse. Although neglect constitutes a large proportion of maltreatment experiences, relatively little attention has been directed toward understanding whether and how children disclose neglect. The overarching aim of the present study was to document this process by comparing disclosure patterns in cases of neglect to those in cases of sexual abuse.

METHOD

Redacted jurisdiction reports (N = 136) of substantiated dependency cases of neglect (n = 71) and sexual abuse (n = 65) in 4- to 17-year-olds were coded for why maltreatment was suspected, and for children's perceived awareness and disclosure of the maltreatment.

RESULTS

Neglect was most often initially suspected via contact with emergency services (e.g., police, emergency medical services), whereas sexual abuse was most often initially suspected as a result of children's statements. Children evidenced greater perceived awareness of sexual abuse than neglect and were more likely to disclose the former in their first investigative interview. Perceived awareness was further associated with a higher likelihood of children's statements initiating discovery of maltreatment and disclosing in the first investigative interview.

CONCLUSIONS

Children may benefit from greater knowledge about their needs for safety, supervision, and provision in the home, which could increase the likelihood they would disclose neglect. Such, in turn, could lead to earlier interventions for children and families.

My Sister's Keeper: Survivors Disclosing Sexual Violence to a Sibling

Siblings are often cited as a source of support throughout life, but they have not been included in studies of sexual violence disclosure. Survivors of sexual violence often delay or do not disclose their sexual violence. The current study investigated if and why survivors of sexual violence decided to disclose to their sibling. This qualitative investigation included 10 female participants, of which six had disclosed their abuse to their sibling. The participants ranged in age from 20 to 58, five identified as Hispanic, one as Hispanic and White three identified as White, and one identified as Middle Eastern. Thematic analysis was used to examine the data. Three major themes were identified that affected sibling disclosure decisions: sibling dynamics, perceived and real reactions to disclosure, and words of advice. The findings from this study demonstrate the continued need to investigate siblings and their role in disclosure of sexual violence. Practitioners may also want to examine the sibling relationship as a source of support for survivors of sexual violence. Finally, as policies continue to develop around support of survivors of sexual violence, inclusion of siblings in family policies, outreach centers, and counseling services may be beneficial.

PTSD and complex PTSD in sentenced male prisoners in the UK: prevalence, trauma antecedents, and psychiatric comorbidities

BACKGROUND

Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities.

METHOD

Randomly selected male, sentenced prisoners in a large medium-security prison in south London (N = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms.

RESULTS

A total of 7.7% (95% CI 4.5-12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1-22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD.

CONCLUSIONS

This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.

Evaluation of attachment style, parent's attitude, depression and anxiety in adolescents who are sexually abused

Purpose: The aim of this article was to describe the sociodemographic attributes of the adolescents who were sexual abused child and the characteristics of the sexual abuse encountered by adolescents; it was also aimed to compare their attachment styles to their parents, attitudes of their parents, their scale scores of depression and anxiety between healthy control group who haven't had sexual abuse. Materials and Methods: The research sample was formed by 34 adolescents in age range of 13-18 who had sexual abuse and 34 healthy adolescents in age range of 13-18 who haven't had sexual abuse. Sociodemographic data of all adolescents who joined the study were collected. Relationship Scales Questionnaire, Parental Attitude Scale, Children's Depression Inventory, State-Trait Anxiety Inventory were used to compare severity of depression and anxiety, parrental attitudes, the attachment styles to the parents of adolescents who had sexual abuse and adolescents who haven't had sexual abuse. Results: The average age of cases were calculated as 15.29±1.31. The fearful attachment subscale score average of sexual abuse group is significantly higher than the control group. The authoritarian attitude subscale score average of sexual abuse group is significantly higher than the control group. In addition, the depression and state-trait anxiety score average of sexual abuse group is significantly higher than the control group. Conclusion: It is extremely important to define the sociodemographic characteristics, characteristics of abuse and risk factors of children and adolescents who have been sexually abused, to increase mother-child interaction, to have parent trainings for the realization of secure attachment, to adopt a democratic parental attitude in terms of protecting the mental health of children and adolescents.

Protecting Children From Sexual Abuse by Health Care Professionals and in the Health Care Setting

Sexual abuse or exploitation of children is never acceptable. Such behavior by pediatricians and health care professionals is particularly concerning because of the trust that children and their families place on adults in the health care profession. The American Academy of Pediatrics stands strongly behind the social and moral prohibition against sexual abuse or exploitation of children by health care professionals. Pediatricians and health care professionals should be trained to recognize and abide by appropriate provider-patient boundaries. Medical institutions should screen staff members for a history of child abuse issues, train them to respect and maintain appropriate boundaries, and establish policies and procedures to receive and investigate concerns about patient abuse. Everyone has a responsibility to ensure the safety of children in health care settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures.

How can school help victims of violence? Evaluation of online training for European schools’ staff from a multidisciplinary approach

The interventions used to prevent or treat violence against children, particularly sexual abuse, tend to only consider the target audience as their main source of data. We tested the effect of an online training for school staff members in Europe through three studies. In Study I, we interviewed 5 adult women (Mage = 49.2, SD = 5.81) who were victims of sexual abuse during childhood to assess what school could have done during that time to protect them. Through Study II, we collected data on 66 school staff members to assess feasibility (based on quantitative indicators) and to explore the changes they would make to their everyday practice due to the training course (using qualitative analysis). In Study III, we used network analysis to assess to what extent the actions described by school staff in Study II met the needs expressed by the victims in Study I. Findings of Study I revealed new proposals from the victims’ perspective, such as working with the perpetrators. Study II showed the feasibility of training and identified five types of action that school staff members will include in their everyday working dynamics due to the training: detection (e.g., Greater attention to relationships with peers), reporting (e.g., Now I know that suspecting a case of child abuse is enough to report), everyday practices (e.g., Introducing a calming space), changes at school level (e.g., Propose the training course to the school management team) or practices that could belong to more than one category (e.g., Greater awareness of the activities undertaken by the school). Study III provided evidence that some of these changes (e.g., reporting without looking for proof) were in line with some of the victims’ expectations (e.g., listen to the children). We also identified gaps that need to be further developed.

Demographic characteristics of convicted child sexual abusers in South of Sweden, between 2013 and 2018: a pilot study

This study evaluates variables concerning demographic characteristics for all adult male offenders convicted of Child Sexual Abuse (CSA) aged 0–17 in Malmö, Sweden between 2013 and 2018. All convictions (n = 18) based on court documents from the District Court, the Court of Appeals and information from the Swedish Tax Agency were reviewed. A total of 30 victims were identified. Frequency analyses show that the most common features were that of a single offender, averaging 25 years old, with a non-Swedish background and a high school degree. The predominately extrafamilial CSA (i.e. committed by an acquaintance to the family) occurred in a private setting and consisted of penetrative acts. Girls averaging 13 years old were abused multiple times, under fear and pressure. Although assumptions based on these results are preliminary, they provide a clearer image of the typical circumstances under which CSA occurred within this time frame and geographical location. This study is a first attempt to construct an overview of demographic characteristics of CSA. As more data are gathered from this region, more sophisticated analyses can be conducted, providing stronger generalizations. Information of this kind may be important for research, classification of offender profiling and in case linking.

Theory of Mind and Concealing vs. Forthcoming Communication in Adolescence

Concealing information requires that adolescents manage the information that they share, which requires cognitive skills, for example, theory of mind (ToM). This study explored motivations for concealment that early adolescents (N = 90, M = 12.81 years, SD = 5.10 months, range 12–14 years, and 58% female) endorsed concealing or disclosing to friends and parents, in relation to their theory of mind. We found that adolescents broadly endorsed disclosure to both parents and friends, even when it might mean they would face consequences, be impolite (by not protecting another’s feelings), or face negative identity-related emotions. We found that ToM ability was associated with a tendency to endorse being forthcoming and sharing information with both friends and parents. These findings provide new insight into how the relation between ToM and concealment may change with age, specifically how in early adolescence it may foster open communication rather than concealment as is the case in early and middle childhood.

Physical evidence of rape against children and adolescents in Brazil: Analysis of 13,870 reports of sexual assault in 2017

Introduction:

The medical literature reports child and adolescent maltreatment since the 8th century. Unfortunately, even today, the incomplete knowledge of this event persists. Several forms of violence are applied to children and adolescents, mainly sexual violence including rape and sexual assault. Forensic medical examinations routinely include the genital area, anus, and the body of the victims for signs of a recent or old injury. The main goal of this study is to show the results of physical and sexual examinations regarding confirmation of rape in children and adolescents, based on the medicolegal reports.

Methods:

We made a descriptive cross-sectional study conducted by collecting data from Medicolegal Institute (IML-São Paulo, Brazil) in 2017. We examined 13,870 reports of sexological examinations of victims of the alleged rape. The variables analyzed were age; sex; physical examination; sexological examination; and direct search for sperm in the vaginal, anal, or oral cavity. We selected 11,725 reports from victims under 18 years.

Results:

As for the medical-legal findings, only 1735 reports (14.8%) confirmed sexual abuse. The most affected ages were between 3 and 5 years in the male group and 11 to 14 years in the female group. The most frequent injuries were bruises and abrasions, fissures in the anal region. In 96.2% of the examined males and 85.8% of the females under 14 years old, the examination was inconclusive, and somebody cannot prove the alleged rape. Only 1735 reports (113 from men and 1622 from women) concluded beyond any doubt the alleged rape (14.8%). The search for sperm was positive in only 1582 cases (13.5%).

Conclusion:

This study shows that the results of the medicolegal examinations were quite limited in recording evidence. Sexual violence against children and adolescents reaches mostly females under 13 years of age. Besides, it is a complicated crime to prove, as 85.8% of female examinations and 96.2% of male exams revealed: “no supporting elements” or “undetermined” to characterize the felony. Therefore, to prevent it, the communication of the alleged rape must be made as quickly as possible.

Sexual Assault Is the Biggest Risk Factor for Violence against Women in Taiwan-A Nationwide Population Cohort Study from 2000 to 2015

Objective: To understand the main types of risk of violence against women in Taiwan. Materials and methods: This study used the outpatient, emergency, and hospitalization data of 2 million people in the National Health Insurance sample from 2000 to 2015. The International Classification of Diseases, Ninth Revision diagnostic N-codes 995.5 (child abuse) and 995.8 (adult abuse) or E-codes E960−E969 (homicide and intentional injury by others) were defined as the case study for this study, and the risks of first violent injury for boys and girls (0−17 years old), adults (18−64 years old), and elders (over 65 years old) were analyzed. Logistic regression analysis was used for risk comparison. A p value of <0.05 was considered significant. Results: The proportion of women (12−17.9 years old) who were sexually assaulted was 2.71 times that of women under the age of 12, and the risk of sexual assault for girls and adult women was 100 times that of men. Girls who were insured as labor insurance, farmers, members of water conservancy and fishery associations, low-income households, and community insured population (public insurance as the reference group) were significantly more likely to seek medical treatment from sexual assault than adult women. Among them, the risk was greatest for girls from low-income households (odds ratio = 10.74). Conclusion: Women are at higher risk of sexual assault than men regardless of whether they are children or adults, and the highest risk is for women in senior high schools, especially for girls from low-income households. Therefore, the protection of women’s personal autonomy is the direction that the government and people from all walks of life need to continue to strive for. Especially for high school students from low-income households, protection must be strengthened through education, social work, and police administration.

Children's Disclosures of Physical Abuse in a Population-Based Sample

Few studies have explored the disclosure of child physical abuse although child sexual abuse disclosure has been widely studied and debated for years. The present study explores the characteristics of child physical abuse disclosures and compares them to previously published findings on child sexual abuse disclosure from the same data. The data consist of a representative sample of 11,364 sixth and ninth graders. Participants responded to a wide variety of questions concerning experiences of violence, including child physical abuse and child sexual abuse, in the Finnish Child Victim Survey conducted in 2013. Within this sample, the prevalence of child physical abuse was 4.1%. Children reporting abuse experiences also responded to questions regarding disclosure, reactions encountered during disclosure, and potential reasons for nondisclosure. Findings show that most of the children who disclosed physical violence had disclosed to their mother. The overall disclosure rate of child physical abuse was 74%. However, only 42% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for nondisclosure was that the youth did not consider the experience sufficiently serious to report (53%). These findings were largely in line with the child sexual abuse disclosure rates in our previous study. Analyses of variables associated with disclosing to an adult indicate that the strongest factors predicting disclosure to an adult are younger age, female gender, no previous experiences of child physical abuse, and parents knowing who their child spends her or his spare time with. Implications for further research and practice are discussed.

Factors affecting disclosure time of sexual abuse in children and adolescents

BACKGROUND

The aim of this study is to determine the factors affecting early and delayed disclosure time of child sexual abuse (CSA). Early disclosure of CSA is considered to be crucial for child protection.

METHODS

A total of 125 sexually abused children and adolescents, who had been evaluated by child adolescent psychiatry and forensic medicine specialists, were enrolled in this study. Files of medical and criminal data were analyzed retrospectively and synchronously by child adolescent psychiatrist and forensic medicine specialist authors who had evaluated victims using the standard procedures of Düzce University Faculty of Medicine Child Abuse Assessment Council. Univariate and multivariate logistic regression analyses were conducted to evaluate predictors.

RESULTS

Delayed disclosers were found to be younger than early disclosers. Among the delayed disclosers, there were also more victims of intrafamilial CSA, fewer victims of penetration, and fewer voluntary disclosures. Multivariate logistic regression revealed that "younger age" and "intrafamilial CSA" were independent predictors of delayed disclosure of CSA.

CONCLUSIONS

The results of our study contribute to an understanding of the factors related to delayed disclosure and underline the need for age-appropriate education and prevention programs targeted to increase the awareness of sexual abuse, particularly intrafamilial abuse, and to promote voluntary disclosure in children and adolescents, especially for younger age groups. The education of potential recipients of CSA and further education of professionals is extremely important in order to support children and adolescents' voluntary disclosure of CSA.

Profiles of abuse and neglect and the association with mental health indicators among a large sample of boys and girls from India

BACKGROUND

Child abuse and neglect (CAN) is a major public health concern, but limited data are available on the occurrence, co-occurrence, and correlates of these phenomena outside Western societies.

OBJECTIVES

The first aim of this study was to establish the prevalence of CAN across two settings (inside and outside the home) among children and adolescents in Mumbai, India. Another aim was to use latent class analysis (LCA) to identify meaningful profiles of maltreatment, and to examine how class membership is associated with mental wellbeing.

PARTICIPANTS AND SETTING

Self-report data was collected from males (n = 4454; M_age = 12.77 years) and females (n = 3850; M_age = 12.87) at secondary schools.

RESULTS

Four latent classes of maltreatment were identified among males, including 'low victimisation' (50.4% of participants), 'intra-familial non-sexual abuse' (34.6%), 'intra- and extra- familial non-sexual abuse' (10.2%), and 'poly-victimisation' (4.8%). Among females, three latent classes were identified including, 'low victimisation' (68.1%), 'intra-familial non-sexual abuse' (28.8%), and 'poly-victimisation' (3.0%). Compared to the 'low victimisation' class, children in the abuse classes demonstrated higher levels of anxiety and depression and increased odds of self-injurious thoughts and behaviours. These associations were augmented for girls relative to boys.

CONCLUSION

There were very few maltreated children who were subjected to just one form of CAN and experiencing co-occurring patterns of abuse and neglect was associated with indicators of poor mental health, especially among girls. These findings highlight the complexity of the situation and will inform policy makers, health professionals and school counsellors.

Predicting disclosure latency in substantiated cases of child sexual abuse

OBJECTIVE

Children who experience sexual abuse (CSA) often delay disclosure, thus impeding early interventions. This study explores predictors of disclosure latency in a sample of forensically substantiated cases.

METHODS

Court files were analyzed for a total of 124 cases of CSA. The ground truth of the alleged victims' statements had been substantiated by at least one inclusion criterion-an evaluation of the alleged victims' statement as credible by psychological experts applying Statement Validity Assessment (SVA), or the conviction of the suspected offender by the court. Six possible predictors of disclosure latency were tested individually and in a joint negative binomial regression model.

RESULTS

Younger age of the child at abuse onset and intrafamilial (vs. extrafamilial) child-perpetrator relationships (including stepparents) were associated with prolonged disclosure latency. No predictive evidence was found for the child's gender, severity of abuse, or offender's usage of violent or nonphysical strategies to prevent disclosure.

CONCLUSION

This study contributes to understanding the processes of disclosure by reassessing formerly identified predictors of disclosure latency in a sample of forensically substantiated cases. Results are in line with suggestions to further develop effective prevention programs for younger children (e.g., for elementary school) and to explicitly discuss the issue of intrafamilial abuse.

Child Sexual Abuse-Challenging Conditions for Adult Oral Health: A Qualitative Study

The aim was to analyze perceptions of oral health in adults who have been exposed to child sexual abuse. Eleven participants (10 women), 19 to 56 y of age, who had experienced sexual abuse as children were purposively selected and interviewed in-depth. The participants were encouraged to describe how they perceived the effect of the sexual abuse on their oral health as adults. The interviews were recorded digitally and transcribed verbatim. The collected material was analyzed according to qualitative content analysis. The theme "challenging conditions for maintaining oral health" was identified, comprising 2 categories: first, "the emotional significance," with the subcategories 1) emotional barriers and 2) powerful relief, and second, "the obstacles to oral health," with the subcategories 1) daily self-care with complications and 2) dental appointments with difficulties. The findings indicate that the experience of sexual abuse during childhood can have a negative impact on oral care in adulthood. The informants stated that oral health was of utmost importance but also associated with strong emotions. There were obstacles to maintenance of oral health that were difficult to surmount.Knowledge Transfer Statement:The study provides access to the attitudes of survivors of child sexual abuse regarding oral health and the needs and obstacles that they experience. This is important knowledge for dental professionals to optimize dental care.

A review of child sexual abuse cases presenting to a paediatric emergency department

INTRODUCTION

Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA.

METHODS

Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old.

RESULTS

There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, P<0.001) and abused in their own home (55.7% vs 21.0%, P<0.001). Among all children, parental divorce and the absence of one or both biological parents in the household were prevalent, with 287/783 (36.7%) having divorced parents, and only 374/784 (47.8%) residing with both biological parents.

CONCLUSION

The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.

Child Sexual Abuse in Pakistan Schools: A Non-Systematic Narrative Literature Review

The current non-systematic narrative review of literature sought to explore the need for research into child sexual abuse (CSA) in Pakistan's schools. The limited literature that exists suggests that CSA is a pervasive problem in Pakistan as it is in neighboring India, and indeed, throughout the world. Government agencies and schools in Pakistan appear to be in their infancy in terms of recognizing and responding to CSA. High-profile media cases, however, have led to some promising child safety changes. The current narrative review identified the need for studies with methodological rigor to identify the nature and extent of children who have experienced CSA in Pakistan. Future studies also need to explore how best to conceptualize school-based abuse prevention in Pakistan. Recommendations are made for practice and research.

What do the potential recipients of disclosure of OSA say? Perspectives from adolescent residents in Scotland and Chile

BACKGROUND

With the increase in internet use, new forms of child victimization like Online Sexual Abuse (OSA) have emerged. Children and adolescents rarely disclose these incidents and most disclosure happens around peers.

OBJECTIVE

This research addresses the perspective of adolescents (not victims of OSA), potential recipients of the disclosure, within the context of disclosure of OSA committed by either adult or peer perpetrators.

METHODS

The study was performed in two stages. We interviewed adolescents in Scotland and then conducted focus groups with adolescents from Chile.

PARTICIPANTS AND SETTING

51 adolescents (6 from Scotland and 45 from Chile) aged 15-20 years participated.

RESULTS

Despite differences in age and cultural contexts, there were similarities in responses. Obstacles of disclosure included lack of clarity of OSA, prior levels of personal vulnerability, and gender factors (stereotypes and stigmatization). On the other hand, the disclosure process would be easier for adolescents with more personal resources (e.g. self-confidence) and when they have a supportive social environment, which includes parents, but especially peers.

CONCLUSION

Disclosure of OSA is considered similar to the disclosure of offline sexual abuse. However, differences such as a lack of clarity regarding the boundaries of the relationships on the Internet, and presence of a generational gap between adolescents and their parents or tutors in the use of internet makes early disclosure of OSA highly challenging. Plans to facilitate disclosure should consider different components: behavioral (risky behaviors), emotional (feelings of fear and shame) and cognitive (lack of information, self-blame, stigma). This should be focused on adolescents, potential recipients of disclosure (parents, authorities and peers) and society, where the prejudices and practices that prevent disclosure begin.

Staff's experiences of a pilot implementation of the SEXual health Identification Tool for assessing sexual ill health among visitors to Swedish youth clinics: A focus group study

BACKGROUND

Young people are disproportionally burdened by sexual ill health. The SEXual health Identification Tool (SEXIT) was developed for use at youth clinics, to facilitate identification of visitors exposed to or at risk of sexual ill health. The aim of this study was to explore experiences of using SEXIT among youth clinic staff who participated in a pilot implementation, with a focus on usefulness, implementation determinants, and feasibility of implementing SEXIT at Swedish youth clinics.

METHODS

Four focus group discussions were conducted with youth clinic staff from three clinics. The clinics had used SEXIT systematically in consultations with all visitors for one month. Data were analysed using qualitative analysis designed for focus groups.

RESULTS

Most participants experienced that the SEXIT routines were well functioning and that using SEXIT gave a comprehensive picture of the visitor and resulted in more concrete answers, which facilitated the risk assessment. The medical staff experienced that they identified more youth at risk with SEXIT, while the psychosocial staff were less convinced. Existing challenges related to the routines at the clinics and heavy workload during drop-in hours.

CONCLUSIONS

Staff experience SEXIT as useful for identifying young people exposed to or at risk of sexual ill health. Systematic use ensures consistency and quality in assessing the visitors, which may facilitate implementation. The use of SEXIT is challenged by heavy workload, conflicting routines, and the experience that some visitors identified through SEXIT decline further care. Implementation of SEXIT in Swedish youth clinics is considered feasible.

Institutional Betrayal: Who Is Most Vulnerable?

Institutional betrayal occurs when, following sexual victimization, institutions create hostile environments which normalize sexual violence, make it difficult to report the experience, mishandle the complaint, attempt to cover up the experience, or retaliate against survivors. These responses are not uncommon and have been linked to adverse survivor outcomes such as dissociation, anxiety, sexual dysfunction, poorer physical health, and depression, yet little is known about which survivors are most at risk for experiencing institutional betrayal. Using a sample of 404 sexual assault survivors recruited from Amazon Mechanical Turk, the current study employed logistic regression to identify risk factors for institutional betrayal. The findings indicate that institutional betrayal is more likely to be reported by survivors who identify as heterosexual, were older at the time of the assault, and endorse more severe PTSD symptoms yet, unexpectedly, less severe distress severity. Gender, race, assault characteristics, and disclosure tendencies did not significantly predict institutional betrayal risk. Although some relationships may be bidirectional, the results suggest that survivors already at risk for some negative post-assault outcomes may be particularly at risk for institutional betrayal.

Sexual abuse disclosure among incarcerated female adolescents and young adults

BACKGROUND

Childhood sexual abuse (CSA) is over-represented among incarcerated girls and women. In order to inform effective methods of response, they represent a critical group for better understanding disclosure processes.

OBJECTIVE

The purpose of the current study was to assess the CSA and CSA disclosure experiences of incarcerated female adolescents and young adults.

PARTICIPANTS AND SETTING

Participants were 94 serious female offenders, ages 15-24 (M = 18.72, SD = 1.94), incarcerated in a secure juvenile facility.

METHOD

In one-on-one interviews, participants answered questions about abuse characteristics, whether they had previously disclosed, to whom they had disclosed and after how long, and reasons for prior disclosure or nondisclosure.

RESULTS

Over half of the sample (51.8%,n = 44) reported experiencing CSA. Most individuals who reported a CSA history had previously disclosed (79.5%, n = 35), with approximately equal proportions claiming to disclose within one week (40%) and after a year or years (45.8%). However, 20.5% (n = 9) claimed that our study interview was their first disclosure. Several reasons for their disclosure patterns were endorsed: Most commonly feelings of shame or embarrassment prevented disclosure (56%) and no longer wanting to keep the abuse a secret motivated disclosure (44%).

CONCLUSIONS

Although many incarcerated girls and women share a history of CSA, our results indicate that the abuse and disclosure experiences of incarcerated females are diverse. Understanding their disclosure patterns can inform mental health services, rehabilitation, and professional interviewing strategies that may facilitate disclosure (e.g., forensic interviews, facility intake interviews).

Recipients of children's and adolescents' disclosures of childhood sexual abuse: A systematic review

Disclosure of childhood sexual abuse (CSA) is a complex, multifaceted process with many barriers that are largely shaped by individual, familial, and systemic characteristics. Children and youth tend to withhold or delay disclosure for many years, such that most CSA goes unreported. This systematic review aimed to synthesize evidence regarding the pathways and recipients of CSA disclosures and to identify potential developmental and gender differences in the recipients of disclosures. Thirty-seven studies conducted between 1990 and 2017 were selected for review. Results indicated that children and youth follow a gradual pattern of disclosure, whereby they first disclose to peers before disclosing to a parent or trusted adult, who can then help the child report to a person of authority. Key developmental patterns in CSA disclosure were identified, whereby older children and adolescents are significantly more likely to turn to peers, keeping the abuse largely hidden from adults. Gender differences were also found, whereby girls are more likely to seek emotional support by disclosing to peers, whereas boys are significantly less likely to disclose the abuse all together; when boys do disclose, they tend to do so for practical reasons, such as protection or accessing services. This review contributes to our understanding of the various pathways of CSA disclosure and highlights the importance of further understanding youth-directed disclosures and how the reactions of informal recipients of disclosures may impact further disclosures to authorities and professionals. Research and clinical implications of the findings are discussed.

Forcible Rape and Adolescent Friendship Networks

Studies have found that sexual victimization can adversely affect an adolescent's psychological well-being, physical health, and behavior. Little is known, however, about how friendships are influenced by such victimization. Drawing on research on sexual violence and the salience of peers among adolescents, the current study extends prior work by examining the effects of forcible rape on adolescent social networks. Using a subsample of females from the National Longitudinal Study of Adolescent to Adult Health (N = 4,386), the study employs multivariate regression analyses to estimate the effects of youth forcible rape on the popularity, centrality, and density of adolescent friendship networks and to determine whether depression and attachment to others (e.g., to friends and to school) mediate these effects. The analyses indicated that forcible rape was associated with a decrease in the popularity and centrality of females within their friendship networks; however, no effect on the density of these networks was identified. In addition, forcible rape effects on popularity and centrality were partially mediated by depression and social attachments. The results suggest that forcible rape may adversely affect adolescent females' levels of popularity and centrality within their friendship networks. Combined with prior research, the results indicate that the harmful effects of rape have the potential to extend across diverse domains, including social relationships. This possibility suggests that services and assistance to female adolescents may be useful in navigating these relationships after victimization. It suggests, too, that potential benefits that may arise from interventions that educate adolescents-victims and nonvictims alike-about the challenges that victims of sexual violence experience.

Dental care - an emotional and physical challenge for the sexually abused

The aim was to explicate persistent psychological and bodily memories of sexual abuse and how they are expressed during dental appointments. The participants comprised 13 sexually abused individuals (11 women), who recalled and expressed these experiences during a dental appointment. They were encouraged to describe, in detail, aspects of the appointment which triggered memories of the sexual abuse. The interviews were recorded, transcribed verbatim, and analyzed using Qualitative Content Analysis. The identified overall theme illustrating the latent content was 'An echo of sexual abuse transformed into (dys) functional reactions'. The first category covering the manifest content was 'The inner invisible struggle', with two subcategories: (i) mental inscriptions of the abuse experience; and (ii) consequences of the dental encounter. The second category was 'The discoverable manifestations', with two subcategories: (i) enigmatic communication; and (ii) expressions of bodily memories. The dental appointment arouses similar psychological stressful reactions as the episodes of abuse; both implicit and explicit expressions are recognizable. Dental staff can contribute to disclosure by improved understanding of the strain a dental appointment can cause in patients who have been subjected to sexual abuse and familiarity with the associated bodily expressions.

Dental care of patients exposed to sexual abuse: Need for alliance between staff and patients

The aim was to explore the experiences of sexually abused individuals as dental patients. Purposively selected were 13 informants (11 women) aged 19-56. All had experienced sexual abuse as children or adults and memories of this abuse had been triggered and expressed during a dental appointment. They were encouraged to relate in their own words their experiences of the dental appointment. The interviews were recorded digitally, transcribed verbatim, and analysed according to Qualitative Content Analysis. The overall theme illustrating the latent content was The dental appointment - a volatile base requiring predictability and a secure working alliance. The first category covering the manifest content was The dental care provider "assumes responsibility," with two subcategories: (i) contradictory disclosure, and (ii) alliance formation - a levelling of power. The second category was The patient is "in focus," with two subcategories: (i) alertness to signs of discomfort, and (ii) attention to obvious but subtle expressions of needs. On an understanding that the patient has been sexually abused, an individually tailored, patient-centered approach to treatment is suggested. Dental care providers may also need to be aware of and reflect on their position of power, in relation to the patient and its possible chairside implications.

Non-offending caregiver support in cases of child sexual abuse: An examination of the impact of support on formal disclosures

BACKGROUND

Childhood sexual abuse (CSA) is a highly prevalent issue, impacting a substantial number of children globally (12 %; Stoltenborgh et al., 2011). Past research has found many children who have been sexually abused will delay their disclosure until adulthood, if they disclose at all (McElvaney, 2015; Reitsema & Grietens, 2016). This is often likely because of the adverse impact that reporting abuse can have for the child and their families (especially when committed by an intrafamilial perpetrator). Non-offending caregiver support has evidenced promise in increasing rates of disclosure (Cyr et al., 2014).

OBJECTIVE

It was hypothesized that higher levels of caregiver support would result in shorter delays of disclosure and that less support is given when the abuser is closely related to the child.

PARTICIPANTS AND SETTING

CSA cases (n = 164) were pulled from the RCMP database of reported crimes for the greater Okanagan Area, British Columbia, Canada.

METHODS

Cases were coded for non-offending caregiver behaviors that indicated support and for relation to perpetrator.

RESULTS

Higher levels of non-offending caregiver support were found to lead to shorter delays of disclosure. Non-offending caregivers were significantly less supportive when the abuser was more closely related.

CONCLUSIONS

Caregiver support acted as a protective factor against delays of disclosure. However, this support decreased significantly when the abuser was closely related. The current study provides evidence for the need to support caregivers of children who have been abused with educational programs and resources so they can properly support the child impacted.

Meta-analysis of the effects of two interviewing practices on children's disclosures of sensitive information: Rapport practices and question type

BACKGROUND & OBJECTIVE

The forensic interview is an important part of the investigative process with child witnesses, and ensuring evidence-based practices is crucial to its success. This meta-analysis examined the overall effect of rapport practices and question type on children's disclosures during forensic interviews to determine (a) how large of an influence existing practices have on children's tendency to disclose information, and (b) how consistent the effect sizes of interviewing practices are across studies, given that inconsistent results have been found.

METHOD

A systematic review of child interviewing practices was conducted, and 35 studies met the inclusion criteria. Articles were categorized thematically according to interviewing practice. Two practices were predominantly represented in the literature and were selected for review and meta-analysis: rapport techniques, including interviewer support, (n = 9), and question type (n = 25 samples, 23 studies). Random-effects meta-analytic models were computed separately for rapport practices and question type, and moderator analyses were conducted to test for differences according to age and interviewing protocol.

RESULTS

Rapport techniques had a medium overall effect on children's disclosures (d = 0.55, p < .001), and was moderated by the interviewing protocol used, but not children's age. Open-ended questions compared to closed-ended questions had a medium overall effect on children's descriptions of sensitive events (d = 0.52, p < .001), and was not moderated by age or interviewing protocol.

CONCLUSIONS

These findings provide overarching support for the use of rapport and support, and the use of open-ended questions in forensic interviews with child witnesses.

Associations between Family Support and Online Sexual Abuse in Chilean Adolescents: The Mediational Role of Online Risk Behaviors

This study evaluated the association between perceived family support, online risk behaviors, and online sexual abuse. This is a cross-sectional, quantitative study. The participants were 380 Chilean students aged 15 to 17 (M =16.12, SD = 0.59, 49.7% female, 50.3% male) who answered self-report instruments. Females experienced more online sexual abuse; however, males engaged in more online risk behaviors. The results of the regression analysis suggested that online risk behaviors was a predictor for online sexual abuse in both males and females. However, high perceived family support was only a protective factor against online risk behaviors and online sexual abuse for females. In addition, online risk behaviors was found to partially mediate the relationship between perceived family support and online sexual abuse for females only. The results of this study highlight the importance of online risk behaviors in the process of online sexual abuse. Also, the results highlighted the importance of family support as a protective factor against online sexual abuse and online risk behaviors mainly in females. For that reason, we think it is necessary to consider the gender variables in the prevention and intervention programs to face the risk of the internet during the adolescence.