The international epidemiology of child sexual abuse: a continuation of Finkelhor (1994)

Prevalence and Characteristics of People with Disabilities Among Abused Victims in Saudi Arabia

BACKGROUND

Abuse is an ongoing public health issue that results in increased morbidity and mortality rates. Abuse against individuals with disabilities is a pervasive and deeply concerning issue, often compounded by factors of vulnerability and dependence. The majority of disabled individuals experience abuse, with the majority enduring it repeatedly. Identifying the problem is the first step towards preventing abuse. This study aimed to identify the prevalence of people with disabilities among abused victims and the victim's associated risk factors in Saudi Arabia.

METHODS

This cross-sectional study obtained data from the National Family Safety Registry. All registered children and adults between April 2017 and December 2022 from 93 centers across 13 regions of Saudi Arabia were included. Logistic regression models were used to determine the association between independent variables and victim-related risk factors such as the onset of abuse complications, the victim being an adult or child, the victim's gender, and whether they had been previously abused.

RESULTS

Individuals with disabilities comprise 1.4% (n = 199) of all reported cases of abuse (n = 14,004), and the trend of violence against people with disabilities has decreased during the 6-year study period. Of the abused people with disabilities, 72.4% were children, 57.8% were males, 45.2% were previously abused, and 65.3% had complications from the abuse. Caregiver type, perpetrator gender, perpetrator age, and previous abuse status were significant factors.

CONCLUSIONS

This study highlights the disability prevalence among reported abuse cases and evaluates victim's risk factors in Saudi Arabia, which demonstrates an urgency for targeted intervention and support. People with disabilities constitute a vulnerable demographic who require increased support and resources. Comprehensive data collection can be utilized for effective violence prevention strategies. Further research should explore qualitative methods and survey the rates of abuse among people with disabilities in the community to gain deeper insights.

The prevalence of child sexual abuse perpetrated by leaders or other adults in religious organizations in Australia

BACKGROUND

Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce.

OBJECTIVE

To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia.

METHODS

The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS).

RESULTS

One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3-0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5-1.2 %), compared to women (0.1 %, 95 % CI, 0-0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3-0.6 %), compared to women (0 %, 95 % CI, 0-0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16-24-year-old men).

CONCLUSIONS

Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.

'What do I do?' A study to inform development of an e-resource for maternity healthcare professionals and students caring for people with lived experience of childhood sexual abuse

BACKGROUND

The impact of childhood sexual abuse can last a lifetime. It is more prevalent than many common complexities that require additional care during the childbirth cycle but is rarely part of the education of healthcare professionals and students. This study informed the development of an e-resource to support maternity healthcare professionals and students caring for people with lived experience of childhood sexual abuse.

OBJECTIVES

To identify any previous learning of pre-registration students and healthcare professionals in relation to care of survivors of childhood sexual abuse, explore their clinical experience in caring for survivors, identify related learning needs, explore what survivors of childhood sexual abuse would like healthcare professionals to know about their maternity care needs.

DESIGN

A qualitative descriptive study using focus groups and interviews. Data derived qualitative content analysis was employed to address the objectives.

SETTING

The study was designed in consultation with The Survivors Trust and took place in South London, UK PARTICIPANTS: Thirty seven health care professionals and students participated, comprising 25 students of midwifery, health visiting and medicine; 9 midwives, health visitors and doctors with specialist obstetric training. Eight women with lived experience took part in focus groups.

FINDINGS

Care of women and birthing people who have experienced childhood sexual abuse had not been part of the undergraduate/pre-registration curricula, nor in specialist training for obstetricians. Many practitioners felt unprepared to care for those with lived experience of abuse and their learning needs were wide-ranging. The need for a learning resource was acknowledged and the outline plan that had been produced following the focus groups was endorsed by participants with lived experience.

CONCLUSION

Care for women and birthing people with lived experience of childhood sexual abuse can be challenging for both personal and professional reasons. This study confirmed the need for a resource that could facilitate the classroom teaching of students and be used for the Continuous Professional Development of qualified practitioners.

Knowledge of Child Abuse and Neglect among General Practitioners and Pediatricians in Training: A Survey

Child abuse and neglect is a common, underreported, and worldwide problem. Health care providers play an important role in detecting and reporting this problem. This study examined the knowledge on the clinical signs and mimickers of child abuse among Belgian trainees in family medicine and pediatrics. Participants filled out an anonymous online survey of 15 fictional but realistic cases with either suspicious or non-suspicious signs of abuse or neglect in the context of primary or emergency care. The overall score on all cases, the number of correct answers per case, and the median score were calculated, and the association of the participant's demographic characteristics with their score was examined using regression analysis. A total of 70 participants completed the survey. The overall median score was 73.3% (IQR 20.0%). The suspicious cases were solved more correctly than the non-suspicious cases (median: 85.7% versus 62.5%, p < 0.001). Regression analysis could not reveal a significant association of type and level of education with the performance on the survey. Knowledge of the clinical signs of child maltreatment among pediatricians and general practitioners in training is good, but there is still room for improvement.

Childhood Sexual Abuse and Relationship Satisfaction: The Moderating Role of PTSD and Sexual-Related Posttraumatic Stress Symptoms

Research on childhood sexual abuse (CSA) has consistently demonstrated the long-term effects of such abuse, not only on survivors' development, but also on the nature and quality of their adult relationships, particularly romantic ones. In this study we examined the moderating role of posttraumatic stress disorder (PTSD) and sexual-related posttraumatic stress symptoms (sexual-related PTSS) between CSA and relationship satisfaction. Survey data from 529 individuals who reported being currently in a romantic relationship were analyzed. In the first set of analyses, results demonstrated that participants with CSA reported significantly lower relationship satisfaction and significantly greater severity of PTSD and sexual-related PTSS than participants without CSA. Sexual-related PTSS but not PTSD moderated the association between CSA and participants' relationship satisfaction, with the model of sexual-related PTSS explaining 20.8% of the variance in relationship satisfaction and the model of PTSD explaining 11.3% of this variance. In the second set of analyses conducted among survivors of CSA only, higher sexual-related PTSS severity was linked with ongoing abuse and with abuse by a non-family member. This study points to the potential contribution made by sexual-related PTSS to relationship satisfaction among survivors of CSA.

Understanding healthcare services response to technology - assisted child sexual abuse: A freedom of information study

BACKGROUND

The reported rates of technology-assisted child sexual abuse (TA-CSA) have increased in the last decade. It is unclear how services are currently responding to cases of child sexual abuse that involve an online element.

OBJECTIVE

The aim of this study is to understand the current framework of support offered by National Health Service (NHS) UK Child and Adolescent Mental Health Services (CAMHS) and Sexual Assault Referral Centres (SARC) for cases involving TA-CSA. This includes understanding if a services' current assessment tools refer to TA-CSA, whether interventions address TA-CSA, and assessing what training for TA-CSA is offered to practitioners.

SETTING

Sixty-eight NHS Trusts with either an affiliated CAMHS or SARC.

METHOD

A Freedom of Information Act request was sent to NHS Trusts. Under this Act, the Trust had 20 working days to respond to the request, which included 6 questions.

RESULTS

86 % Trusts (42 CAMHS and 11 SARC) responded to the request. Of the responses, 54 % CAMHS and 55 % SARC offer relevant training to practitioners. 59 % CAMHS and 28 % SARC provide tools for their initial assessment that reference online life. No Trust provided a clear treatment approach for TA-CSA, with 35 % CAMHS and 36 % SARC responding that treatment would address the mental health needs of the young person.

CONCLUSIONS

There is a need for a nationwide understanding of how to clearly define TA-CSA in policies and how to approach TA-CSA during an initial assessment. Further, a consistent approach on how to equip practitioners with tools to support individuals who have experienced TA-CSA is urgently needed.

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Effects of Childhood Sexual Abuse, Mental Health, and Motives for Sex on Sexual Risk-Taking Among United States Men Who Have Sex with Women

This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors.

Prevalence, Characteristics, and Factors Associated With Sexual Violence in Adulthood Among Brazilian MSM

Most studies of sexual violence are with women, and although men who have sex with men (MSM) is the group of the men that has been most investigated for sexual violence, there are still several questions to be answered about sexual violence and sexual revictimization among MSM. This study aimed to estimate the prevalence of sexual violence in different stages of life and identify factors associated with sexual violence in adulthood among Brazilian MSM. We conducted an analysis with data from the study conducted in 2016 with 4,176 MSM from 12 Brazilian cities recruited through respondent-driven sampling (RDS), who answered a survey to a set of questions, among which some specific about sexual violence. Most participants were under 25 years old (56.5%), with more than 12 years of schooling (71.2%), mixed race (40.8%), single (86.2%), and belonging to some religion (50.9%). The lifetime prevalence of sexual violence was 20.3%. In our analyses, having experienced sexual violence in childhood and adolescence increased the odds of experiencing sexual violence in adulthood (prevalence ratio ratios [PRR] 4.93 (95% CI [1.99, 12.21]), as did experiencing physical violence (PRR 1.99; 95% CI [1.07, 3.71]) and receiving money for sex (PRR 2.26; 95% CI [1.17, 4.36]). In addition to violence in childhood and adolescence being risk factors for sexual violence in adulthood, we also observed that half of the sample experienced sexual violence repeatedly, characterizing sexual revictimization. It is important that health services are prepared to receive boys and men victims in order to reduce the chances of revictimization and other outcomes.

"Psychologically and emotionally, it affects me 'til this day": exploration of childhood sexual abuse perspectives among older adults living with HIV in South Carolina

OBJECTIVES

The influence of childhood sexual abuse (CSA) may be seen immediately or across the life course. CSA is also associated with increased HIV-risk behavior, and greater likelihood of an HIV/STI diagnosis. The aim of this study was to explore the perspectives of CSA among older adults living with HIV.

METHODS

Twenty-four adults living with HIV aged 50 to 67 years (mean age = 58.5 years), with a history of CSA, receiving care from an HIV clinic in South Carolina, participated in the study. In-depth semi-structured interviews were conducted, audio recorded and analyzed using a thematic analytic approach. The iterative analytic process included a three-step approach: discussion of initial thoughts and key concepts, identification and reconciliation of codes, and naming of emergent themes.

RESULTS

Four themes emerged: Psychological issues due to CSA, relationship challenges due to CSA, self-blame, and reliving childhood trauma (subtheme: lack of influence of CSA today). Some participants reported feeling the influence of CSA several years after the event while others noted that that there was a lack of influence of CSA at present.

CONCLUSIONS

Trauma-informed intervention programs are needed for older adults living with HIV who still experience the influence of their CSA experience. Future research should delve into the design and feasibility of implementing these programs.

Experiences of Women Survivors of Childhood Sexual Abuse in Relation to Nonsupportive Significant Adults: A Scoping Review

Childhood sexual abuse (CSA) is a complex trauma with devastating long-term, negative effects on survivors. This study extended the understanding of experiences of women survivors of CSA in relation to nonsupportive significant adults documented in literature, as to date, there exists no summary in literature on this particular topic. As such, a scoping review was conducted on publications between 1980 and January 2020. A total of 26 733 were selected for analysis in accordance with the search terms. After duplicates were removed and the exclusion criteria were applied, a total of 58 articles were selected for inclusion in the review. Thematic analysis was conducted on the studies included, and three themes were developed pertaining to the experiences of women survivors of CSA in relation to nonsupportive significant adults. Theme 1 identified nonsupportive behaviors experienced before disclosure or discovery of abuse. Theme 2 identified nonsupportive behaviors experienced during or after disclosure or discovery of abuse. Theme 3 identified the long-term negative consequences of nonsupportive experiences. These three themes support the findings of Freyd's betrayal trauma theory and Bowlby's attachment theory, extend on the global knowledge base of this topic, and identify gaps for further exploration.

The use of corporal punishment against children in Myanmar: An analysis of data from the 2015-2016 Myanmar Demographic and Health Survey

BACKGROUND

The corporal punishment of children is a significant public health concern; corporal punishment also violates children's rights and may have negative impacts on children's long-term health.

OBJECTIVE

This study investigates the prevalence of corporal punishment of children in Myanmar and associated factors.

PARTICIPANT AND SETTING

This study is a secondary data analysis of the 2015-2016 Myanmar Demographic and Health Survey (MDHS). The study targeted 13,235 (weighted) children between 2 and 14 years old.

METHODS

Corporal punishment of children by caregivers was assessed using six questions that utilized UNICEF's child disciplinary module. Multiple logistic regression analyses were carried out to identify associated factors.

RESULTS

Nearly half of the children in the study (44.5 %; 95 % confidence interval (CI): 42.60, 46.50) were found to have been subjected to corporal punishment, and the most common form of corporal punishment was "spanking, hitting, or slapping the child on the bottom with a bare hand" (29.1 %; 95 % CI: 27.53, 30.80). Multivariable analyses revealed that a child's sex, age, education level, location of residence, and number of family members; the primary caregiver's sex and attitude toward corporal punishment; and the family's socio-economic status were all factors significantly associated with corporal punishment. The prevalence of corporal punishment of children in Myanmar was high, and many significant predictors were identified.

CONCLUSION

The implementation of child protection policies and the promotion of nonviolent parenting methods should be conducted immediately to community members. Community education should particularly focus on uneducated caregivers and families with low socioeconomic status.

Childhood Sexual Abuse, Spirituality/Religion, Anxiety and Depression in a Jewish Community Sample: the Mediating Role of Religious Coping

Childhood sexual abuse (CSA) is a pervasive problem impacting a broad range of mental health outcomes. Previous research has shown that spiritual and religious (S/R) factors both positively and negatively relate to mental health issues among survivors of CSA, but mediating mechanisms of effect are unclear. The present study examined CSA, anxiety, depression, and positive/negative religious coping among 372 Jewish community members with and without CSA histories. Individuals who experienced CSA endorsed significantly higher anxiety and depression as well as negative religious coping than those without CSA. Negative religious coping mediated the relationship between CSA and anxiety and depression. We discuss clinical and social implications of these findings, including the need to address S/R factors in treatment of CSA, especially within religious communities. Further research examining abuser identity, survivors' disclosure experience, and other S/R mediators of effect is warranted.

Pediatricians' Attitudes Toward Child Sexual Abuse in the Republic of Srpska

Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians' training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.

Knowledge and Myths About Child Sexual Abuse in Mexican Women

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

Predictors of Suicide Re-Attempt in a Spanish Adolescent Population after 12 Months' Follow-Up

Background: This study aims to identify the main predictive factors that allow for the recognition of adolescents with a higher risk of re-attempting suicide. Method: A longitudinal 12-month follow-up design was carried out in a sample of 533 Spanish adolescents between 12 and 17 years old. The data collection period comprised September 2013 to November 2016, including a one-year follow-up after hospital discharge. Results: A statistically significant regression model was obtained to predict suicide re-attempt at 12-months’ follow-up (χ2 = 34.843; p < 0.001; Nagelkerke R2 = 0.105), including personal history of self-injury (OR = 2.721, p < 0.001, 95% CI [1.706, 4.340]) and age (OR = 0.541, p = 0.009, 95% CI [0.340, 0.860]), correctly classifying 82.6% of the sample. Our results show that having a personal history of self-injury and being younger than 14 years old were predictors of suicide re-attempt during the first year after an adolescent’s first admission to emergency services. Conclusions: Considering these factors could contribute to the design of more tailored and effective interventions to prevent suicidal behavior in adolescents at high risk of re-attempting suicide.

Disclosing Child Sexual Abuse to a Health Professional: A Metasynthesis

Objective

Sexual abuse is a major public health problem. Its disclosure to a health professional could help to reduce its impact on survivors' lives. The objective of this metasynthesis, combining a systematic review and an analysis of the qualitative studies, was to explore the qualitative literature concerning the experience of a survivor disclosing sexual violence experienced in childhood to a health professional, from the perspective of both.

Methods and Data Sources

We used four databases and two journals (Medline, PsycINFO, EMBASE, and SSCI, and the Journal of Sexual Abuse and Child Abuse and Neglect) to identify studies concerning this disclosure of sexual abuse to healthcare professionals from the point of view of the survivors and the health professionals. After assessing the methodological quality of the articles with the "Critical Appraisal Skills Program (CASP)," we conducted a thematic analysis of the data extracted during the review.

Results

This review includes 20 articles, covering the data of 612 participants: 291 who were adults at the time of the study but abused in childhood, 152 minors, 14 parents of adolescents, and 155 healthcare professionals. Two themes emerged from the analysis: (1) the disclosure as experienced by the professionals, and (2) the disclosure as experienced by the survivors.

Conclusion

Our results show that survivors had a diachronic approach to the experience of disclosure. They suggest a change over time in how survivors experience disclosure: relief and release were seen only among the adult participants, at a distance from - long after - the disclosure. This study made it possible to identify new perspectives for research in the field of child psychiatry and to formulate concrete clinical proposals, in particular, by applying the principle of patient experts to involve now-adult survivors in training and increase the awareness of the healthcare professionals concerned.

The Gender Perspective on Parent-to-child Aggression: Gender and Gender-constellations

Parent-to-child aggressive behavior is a common risk factor for children's health. Gender is correlated also to the odds of using aggression and the odds of being a victim of aggression. Yet, only few studies have considered the constellation of perpetrator's and victim's gender as a factor of parental aggression. The current study addresses parent-to-child aggressive behavior while focusing on the constellation of perpetrator's and victim's gender (i.e., mother-daughter, mother-son, father-daughter, father-son). It utilizes a community sample of Israeli university students (N = 508), 78% of which are female, on average 25.67 years of age (SD = 8.29). The participants reported the incidence and frequency of verbal and physical aggressive behavior of their parents against them during the years of middle school. The results show gender and gender-constellation to be significantly correlated with parental aggression. Overall, sons were more likely to suffer both verbal and physical aggression from their parents than daughters were. Only paternal verbal and physical aggression was more common against daughters, and only maternal verbal and physical aggression was more common against sons. Parental verbal and physical aggression from both parents were more common against sons. For all types and forms of parental aggression, daughters reported higher frequencies. These results suggest that while parent's gender might predict their overall aggressive behavior, and child's gender might predict their overall odds to be victimized by parental aggression, gender-constellation might create gender-specific selective patterns of parental aggressive behavior. Thus, the theoretical contribution of this study is in emphasizing that gender-constellations have an explanatory value beyond gender alone. These findings might be valuable to assess the risk of daughters and sons to suffer parental aggression, and for practitioners to provide apt professional response.

Self-affirmation and False Allegations: The Effects on Responses to Disclosures of Sexual Victimization

The rise of the #MeToo movement highlights the prevalence of sexual victimization and gives a voice to victims who may have been silent before. Nevertheless, survivors or victims of sexual violence who come forward may be blamed or not believed. These reactions are evident both with adult and child victims. Further, fears about false accusations of sexual misconduct may negatively impact responses to disclosures. This study aimed to examine gender differences in perceptions toward the #MeToo movement, and the extent to which these translate into a skeptical response to disclosure. Further, we wanted to explore whether proximity to false allegations of sexual violence was linked with more negative responses and whether use of self-affirmations may decrease the likelihood of such a response. Through an online survey (N = 235) on Amazon's Mechanical Turk, we assessed participants' exposure to and perceptions of the #MeToo movement. Further, we asked them about their proximity to sexual violence (victimization or perpetration) and to false allegations. Using a threat manipulation (news article about false accusation) and a self-affirmation exercise, we studied the effects of both variables on responses to disclosure. Results indicated that after reading an article about a false accusation, male participants were more likely to blame a victim of childhood sexual abuse and to perceive the abuse as less harmful, compared with female participants. Further, we found that self-affirmation was linked with more supportive responses to a disclosure. These findings highlight the threatening nature of false accusations of sexual violence for men, and how this threat may shape the narrative regarding sexual violence. Opportunities to use self-affirmation to change this narrative to a more supportive one are discussed.

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

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

The Incredible Years Parenting and Child Treatment Programs: A Randomized Controlled Trial in a Child Welfare Setting in Spain

Incredible Years (IY) is a well-established multicomponent group-based program designed to promote young children's emotional and social competence, to prevent and treat child behavioral and emotional problems, and to improve parenting practices and the parent-child relationship. This study presents the first randomized controlled trial carried out in Spain to test the effectiveness of the Incredible Years Basic Parenting and Small Group Dinosaur Programs in a sample of families involved in child welfare due to substantiated or risk for child maltreatment. One hundred and eleven families with 4- to 8-year-old children were randomly allocated to IY or to a control group who received standard services. Baseline, post-intervention, and 12-month follow-up assessments were compared. Results showed that compared to the control group, the IY intervention made a significant positive difference in parents' observed and reported use of praise, and a significant reduction in reported use of inconsistent discipline, parenting stress, depressive symptomatology, and perception of child behavior problems. A full serial mediation effect was found between participation in IY, changes in parenting practices, subsequent parenting stress reduction, and both final child abuse potential reduction and perception of child behavior problems. No moderating influence on IY effects was found. Findings provide evidence that transporting the IY Basic Parenting and the Small Group Dinosaur Programs with fidelity is feasible in Child Welfare Services in Spain.

Comparison Between Male and Female Survivors of Sexual Abuse and Assault in Relation to Age at Admission to Therapy, Age of Onset, and Age at Last Sexual Assault: Retrospective Observational Study

BACKGROUND

Sexual abuse and sexual assault are complex phenomena that involve many factors (or correlates) and have many health and financial implications for individuals, families, and society. Every correlate needs to be studied in detail, individually and in relation to other correlates. Only with a thorough understanding of these correlates can more efficient and targeted prevention and intervention programs be designed.

OBJECTIVE

The purpose of this study was to examine the differences between male and female survivors of sexual abuse and sexual assault regarding the correlates of the survivors' age of onset of assault, age at the last assault, and age at which they entered therapy.

METHODS

Therapists at eight sexual assault centers in the province of Alberta, Canada, completed a questionnaire on each of their clients over a period of 7 years. A total of 3302 participants, of whom 2901 (87.86%) were female and 401 (12.1%) were male survivors of sexual abuse and assault, were included in this study. Mostly descriptive analyses were carried out on the 4 variables of concern in this study.

RESULTS

Regarding the number of survivors who sought therapy, female survivors outnumbered male survivors by a ratio of 7:1, with different ratios for different age groups. As children age, their risk of being sexually assaulted for the first time decreases. Male children are more likely to be sexually abused at a younger age, whereas female children are more vulnerable to being assaulted at all ages, particularly in adolescence. The mean age of onset of sexual abuse was found to be 6.71 (SD 2.86) years, and the odds of experiencing the first sexual assault during childhood, as opposed to adolescence, were 4:1 for females and 9:1 for males. Male survivors were two times more likely than female survivors to experience their first sexual assault in childhood. The vast majority of survivors sought help many years after being sexually assaulted, and male survivors waited an average of 3 years longer from the last sexual assault before seeking therapy.

CONCLUSIONS

The majority of survivors of sexual abuse and sexual assault live with the consequences for many years before they seek help, and a large proportion of male survivors are not likely to seek help.

Current of Child Sexual Abuse in Asia: A Systematic Review of Prevalence, Impact, Age of First Exposure, Perpetrators, and Place of Offence

BACKGROUND: Child sexual abuse (CSA) is a serious global problem and challenge for all people because it increases the risk of various issues. AIM: This study investigated the CSA in Asian countries focusing on prevalence rates, impact, victim’s age of first exposure, type of CSA, perpetrator, and places of CSA offence. METHODS: We searched PubMed, Medline, ProQuest, ScienceDirect, CINAHL, Academic Search Complete, ClinicalKey, PsycINFO, Google Scholar, and manual search for studies published between January 2011 and November 2020. Only articles related to CSA in Asia were included in this review. RESULTS: The results showed that prevalence of CSA ranged from 2.2% - 94% for girls and 1.7% - 49.5% for boys. The prevalence rates for non-contact abuse were 12.6% - 56.5% for girls and 0.7% - 68.7% for boys; contact abuse was 5.3% - 67.2% for girls and 2.2% - 53.3% for boys; penetrating abuse was 0.5% - 88.24% for girls and 1.7% - 57.1% for boys. The findings reported most victims’ age of first exposure was preteen. The rate of the violation occurring in the victim’s house was 6.1% - 41.9%; most CSA perpetrators are known by victims. This study reported adverse impacts on CSA victims such as psychological, health, and physical disorders, and changes in behavior. In addition, other findings were found, including recovery, perceptions, values, causes, and expectations of victims of CSA. CONCLUSIONS: The incidence of CSA in Asia is still high and the age of the first victims is early adolescence. The majority of victims are women who already know the perpetrator, and taboo cultural factors are thought to play a role in increasing CSA in Asia. The results indicate the need to develop CSA prevention efforts that involve culture.

The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania

BACKGROUND

Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied.

OBJECTIVES

This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims.

METHODS

Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students).

RESULTS

Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a "waste of time" for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics.

CONCLUSIONS

Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.

Descriptive Analysis of the Characteristics of Proven Cases of Sexual Abuse in Victims With Intellectual Disabilities and Children With Typical Development in Spain

Children and people with intellectual disability (ID) are considered to be highly vulnerable and in need of special protection against sexual abuse (SA). The objective of this work was to analyze the characteristics of cases of SA in children with typical development and in people with ID in Spain. To do so, 25 cases of each type that had been investigated by specialized groups of the Judicial Police of the Spanish Civil Guard and that had been classified as proven and confirmed by police and forensic-medical evidence were analyzed. The results allowed the establishment of the typical minor victim profile as Spanish female (76%), with an average age of 8.64 years. Typical victim with ID was characterized as being of Spanish, aged 20.28 years on average, without prior sexual experience, and similar percentages of males (40%) and females (60%). In both cases, the aggressor usually acted alone, was known to the victim, had an average age of 42 years, and without a history of sexual offenses. The most common child sexual crime was SA with penetration, practiced repeatedly, using strategies such as the use of force, authority, rewards, or secrecy. Victims with ID suffered sexual abuse with penetration, using force, authority, threats or blackmail. Finally, 36% of minors not disclose the events by only 8% of victims with ID. Spontaneity was found in the 40% first disclosure in both victims, with greater police evidence and greater recognition of guilt on behalf of the aggressors against victims without disabilities. Minors took an average of 26.26 days to report the facts, and victims with ID of 64.94. It is necessary to know more about these types of offenses to design appropriate prevention and detection programs.

Associations of adverse childhood experiences with adolescent total sleep time, social jetlag, and insomnia symptoms

STUDY OBJECTIVE

Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15.

METHODS

Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15.

RESULTS

Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents.

CONCLUSION

ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.

Male-type depression symptoms in young men with a history of childhood sexual abuse and current hazardous alcohol use

The prevalence of male-type or externalising depression symptoms (e.g., anger, risk-taking, emotion suppression) were examined with cross-sectional online convenience sample of 1,277 help-seeking young men (M=23.64, SD=3.61 years). Almost a quarter (21.9%) of the sample reported childhood sexual abuse (CSA) exposure, and most (68.8%) endorsed past 2-week suicide ideation. All male-type depression symptoms were frequently (>30%) endorsed across the sample, and were positively correlated with past 2-week suicide ideation. An adjusted CSA exposure × alcohol risk interaction (p=.013) indicated elevated male-type depression scores for those with a CSA history and hazardous alcohol use. Results are interpreted in line with young men's adherence to masculine norms, which may be particularly complex for young men reporting a CSA exposure history. Findings support the need for enhanced screening efforts, especially among young men with a history of CSA and hazardous alcohol use, with a need to also improve gender-sensitive service offerings for young men with a CSA exposure history.

High-risk sexual behaviours, from the neurotica to complex trauma: Psychopathologies of repetition

In adolescent psychiatry, when patients present high-risk sexual behaviours, analysing the symptoms usually leads back to a traumatic sexual event in childhood. These clinical situations include a first stage in which the trauma is constituted and a second adolescent stage in which the mnemic trace can lead to the traumatic experience being reproduced within a destructured psychic apparatus that is seeking restructuration through actions. These two psychopathological stages are examined in the light of the connection between Freud's two paradigms of the neurotica and the theory of fantasy, focusing therapeutically either on the primacy of sexual abuse or on the psychic representation of a traumatic sexuality, respectively. Here, the elaboration of these behaviours relates either to the individual traumatic history or the transgenerational history, or to both histories, intermingled or even undifferentiated. The repetition processes and the temporary loss of reality-testing in these clinical situations are analysed there, including by the yardstick of the psychopathology of complex trauma, as well as by that of containment in the familial and therapeutic environment, from which the subject will benefit in the context of the revelation processes.

Psychological intervention with adult victims of sexual abuse: A comprehensive review

Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short- and long-term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult CSA survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA and demonstrates the need to conduct further research on the effectiveness of intervention.

Child Victimization and Polyvictimization Among Young Adults in Northern Chile

This study examined the prevalence of victimization and polyvictimization and gender differences in young adults from Arica in northern Chile. In all, 718 college students participated (46.9% men, 53.1% women), aged between 17 and 28 years old (M = 21.6; SD = 4.11). The Spanish version of Juvenile Victimization Questionnaire ( JVQ) was used to access five categories of child victimization (conventional crime, child maltreatment, peer and siblings victimization, sexual victimization, and indirect victimization). In total, 98.7% of young adults reported at least one type of victimization throughout their life. In general, males are more exposed to victimization for conventional crimes and indirect victimization and women to sexual victimization and bullying. A total of 89.1% of the sample was considered polyvictims (i.e., experienced five or more forms of victimization). This research provides information about the epidemiology of victimization and polyvictimization in young adults in the international context, and is the first study from this point of view in a South American country. The results show that young adults in northern Chile experience a high level of victimization, even mostly higher than others studies realized in the international context. Gender is a variable that has a significant influence and must be taken into account in the analyses of this complex subject of study.

Prevalence and associated mental health outcomes of child sexual abuse in youth in France: Observations from a convenience sample

CONTEXT

Child sexual abuse (CSA) is an important public health problem associated with an array of negative consequences. Although prevalence rates are well established from North America, few studies have focused on the extent of CSA and associated outcomes in youth from France.

OBJECTIVES

This study aimed to: 1) estimate the prevalence of CSA, 2) assess the associations between CSA and health outcomes while exploring possible gender specificities and 3) document the contribution of revictimization on symptom complexity.

METHOD

The sample involved 2309 participants aged between 14 and 23 years old (M = 19.55). Measures assessing CSA, other forms of child maltreatment and mental health problems were administered. Sexual revictimization and a host of protective factors (resilience, coping strategies, parental support) were also assessed.

RESULTS

CSA was reported by 13.1% of girls and 4.2% of boys. Regression analyses revealed that CSA was associated with all mental health outcomes except alcohol and drug use (other than cannabis) after controlling for sociodemographics and other forms of child maltreatment. Sexual revictimization was associated with symptom complexity. Emotion-centered and avoidance coping predicted symptom complexity while resilience and paternal support acted as protective factors.

LIMITATIONS

The study relied on a cross-sectional design with a convenience sample, which limits the generalizability of results. The small number of boys reporting CSA precludes drawing firm conclusions as to the gender specificities in the outcomes associated with CSA.

CONCLUSIONS

Findings underscore the relevance of developing efficient prevention programs as CSA is linked to a host of negative outcomes.

Disclosure of Sexual Violence Among Girls and Young Women Aged 13 to 24 Years: Results From the Violence Against Children Surveys in Nigeria and Malawi

Understanding factors that are associated with disclosure of sexual violence (SV) is important for the delivery of health services as well as developing strategies for prevention and response. The Violence Against Children Surveys were conducted in Malawi and Nigeria. We examined the prevalence of SV, help-seeking behaviors, and factors associated with disclosure among girls and young women aged 13 to 24. The self-reported prevalence of SV was similar in Nigeria (26%) and Malawi (27%). Among females who experienced SV, approximately one third (37%) in Nigeria and one half (55%) in Malawi ever disclosed their experience of SV. Females in Nigeria were significantly more likely to disclose to their parents (31.8%) than females in Malawi (9.5%). The most common reason for nondisclosure in Nigeria was not feeling a need or desire to tell anyone (34.9%) and in Malawi was embarrassment (29.3%). Very close relationships with one or both parents were significantly associated with disclosure among Nigerian females (odds ratio [OR] = 5.5, 95% confidence interval [CI] = [2.1, 14.6]) but were inversely associated with disclosure among Malawian females (OR = 0.05, 95% CI = [0.01, 0.33]). Reasons for nondisclosure of SV and factors associated with disclosure among females differ in the African nations studied. The stigma associated with shame of SV may prevent females from disclosing and thus receiving necessary support and health, social, and other services. This study demonstrates a need to reduce barriers for disclosure to improve the delivery of health, social, and other response services across African nations, as well as to develop culturally appropriate strategies for its response.

Co-production of an e-resource to help women who have experienced childhood sexual abuse prepare for pregnancy, birth, and parenthood

BACKGROUND

This paper reports the development of a co-produced e-resource to support those who have experienced childhood sexual abuse through pregnancy, birth, and parenthood. These are times of major transition for any woman but can present particular challenges for those who have experienced childhood sexual abuse. Re-traumatisation during the perinatal period is common and can occur in ways that may not be anticipated by those involved. Survivors often do not disclose their abuse and the childbearing journey can be lonely.

METHODS

The work was conducted in collaboration with The Survivors Trust and in keeping with the Survivor's Charter. A participatory approach was used. There were two phases: the generation of new qualitative data and development of the resource. To encourage participation from this hidden population, data were collected by a variety of means including focus groups, telephone interviews and an on-line survey. Survivors who had children and those who hoped to one day participated. Resource development was facilitated by two workshops and email feedback.

RESULTS

Overall, 37 women participated, all of whom were positive about development of the resource. Although many issues identified during data collection were specific to the participants' history of abuse other areas of concern would be relevant for any woman contemplating the journey to parenthood. Women often assumed that they were alone in their concerns and were reassured to discover that others shared their experiences. The final resource is hosted on The Survivors Trust Website and is accessible from all electronic devices. It follows the journey from deciding to have a baby, pregnancy, labour, birth, and the postnatal period through to parenthood. Links are provided to further information and sources of support. The process of developing the resource used trauma-informed principles and it speaks with women's words in a peer-to-peer voice.

CONCLUSIONS

This paper describes the development of an innovative and accessible e-resource that is based on the words and experiences of survivors of childhood sexual abuse. It recognises the importance of control and feeling safe and aims to empower those who use the resource as they embark on pregnancy, birth, and parenthood.

Reactions of non-abused children aged 3-9 years to the Sexual Knowledge Picture Instrument: an interview-based study

BACKGROUND

The Sexual Knowledge Picture Instrument (SKPI) is a child-friendly picture book that was developed as a diagnostic tool for sexual abuse in young children and is currently being validated. The aim of the current study was to explore the verbal and non-verbal reactions of non-abused Dutch children, aged 3-9 years, to the SKPI and to assess differences in reactions between genders and age groups.

METHODS AND ANALYSIS

Subject recruitment took place at preschools and primary schools. All children underwent a recorded video semi-structured interview with the SKPI. Interview recordings were scored by an independent rater who used scoring lists for verbal and non-verbal reactions. Non-parametric tests were used in statistical analyses.

RESULTS

Of the 90 children (median age 5 years) participating in the study, most correctly named the genitals and their non-sexual functions. Only 34 showed an understanding of the picture depicting adult sexuality, with just one child describing a sexual function. Girls (n=45) gave more correct answers (median 87%) than boys (n=45, median 78%; p=0.006). Giggling was the most frequently observed non-verbal reaction, with a total of 186 instances in 54 children.

CONCLUSION

Non-abused children up to 9 years of age showed only limited knowledge of the sexual function of the genitals and hardly any insight into adult sexuality.

Multi-sectoral response to child maltreatment in Switzerland for different age groups: Varying rates of reported incidents and gaps in identification

BACKGROUND

As many countries lack (multi-sectoral) data on the epidemiology of agency responses to child maltreatment, they do not know if children in different regions of the country have equal chances to receive help and protection. The Optimus Study, the first nationally representative Swiss study on multi-sectoral responses to child maltreatment, examines gaps in identifying children in need and reveals opportunities for improved support and protection.

METHODS

A stratified sample of 351 agencies (participation rate 81 %) in the social and health sector, public child protection, and the penal sector provided data on new cases between September 1 and November 30, 2016. The resulting study data on 7651 cases included information on the maltreatment incident, specifics of the report/referral, and child characteristics. The weighting procedure to produce national estimates was based on inverse sampling probabilities and inverse response rates.

RESULTS

In the 3-month period, an estimated 10,335 cases were referred/reported to agencies in multiple sectors of the child protection system in Switzerland. This corresponded to 66 cases per 10,000 children. Rates were highest for adolescents (aged 13+), with 69 cases per 10,000 children. Lower rates for school-aged children coincided with a relatively low percentage of reports/referrals from the schools (8 %). Regional variance was extensive, with rates more than quadrupling from a low of 26 cases to a high of 107 cases per 10,000 children. Types of child maltreatment handled by agencies in the different sectors varied. Gender distribution was lopsided for sexual abuse, with many more girls experiencing incidents of sexual abuse, and unequal for incidents of neglect and psychological maltreatment.

CONCLUSIONS

There are gaps in the identification of maltreated preschoolers. Promoting health checkups for this age group is a potential solution. However, school-aged children up to age 11 are underreported as well, as the schools contribute only marginally to child maltreatment reporting. The findings of the study are being used to initiate the implementation of continuous and multi-sectoral child maltreatment surveillance in Switzerland.

Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature

BACKGROUND

Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth.

OBJECTIVE

This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth.

METHODS

Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies.

RESULTS

The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation.

CONCLUSIONS

The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.

Prevalence of childhood trauma measured by the short form of the Childhood Trauma Questionnaire in people with substance use disorder: A meta-analysis

BACKGROUND

Substance use disorder is known to be associated with childhood trauma, yet prevalence estimates have varied markedly due to methodological differences. The meta-analysis presented here aimed to estimate prevalence rates of childhood trauma for people with substance use disorder using the short form of the Childhood Trauma Questionnaire (CTQ-SF).

METHODS

Four major public databases (PubMed, Embase, The Cochrane Library and PsycINFO) were searched for eligible studies until April 2nd, 2018.

RESULTS

Ten studies were included with a total sample size of 1,310 across six countries. The prevalence estimates of each subtype of childhood trauma across all substance use disorder samples were: emotional abuse (38%, 95% CI: 28%-48%); physical abuse (36%, 95% CI: 27%-45%); sexual abuse (31%, 95% CI: 23%-41%); emotional neglect (31%, 95% CI: 18%-45%) and physical neglect (32%, 95% CI: 25%-40%). Subgroup analysis by continent demonstrated that the highest prevalence rates of emotional abuse were found in North America and South America (45%). Compared with other continents, the prevalence rates of North America were the highest for physical abuse, sexual abuse, emotional neglect and physical neglect (39%-44%).

CONCLUSIONS

Childhood trauma is prevalent among substance use disorder samples compared to the general population. Different continents have different levels of prevalence of childhood trauma, which may be due in part to socioeconomic, cultural and definitional variations.

Thirty years of the convention on the rights of the child: Developments in child sexual abuse and exploitation

Since its adoption by the United Nations in November 1989, the Convention on the Rights of the Child (CRC) has become the most universally ratified human rights treaty in history; presently only the United States has not ratified it. The CRC articulates children's human rights and notably includes freedom from sexual abuse and exploitation. Yet thirty years after the Convention was adopted, child sexual abuse and exploitation (CSA/E) remain serious, persistent, and evolving global issues. This overview both describes the current state of research on child sexual abuse and exploitation and evaluates the CRC's legacy in terms of State-level responses to CSA/E. Points of agreement and disagreement over what constitutes CSA/E and how widespread it is are explored. Also presented are the contexts in which CSA/E takes place, and factors associated with children's risk of being sexually abused or exploited. Emerging issues in these areas are the internet and children's use of it, as children may now become subject to abuse or exploitation even when physically alone. The second part of the paper addresses the CRC's influence on States' domestic legislation and States' responses to CSA/E more broadly. Gaps in efforts to monitor and report on the CRC's implementation with respect to its impact on CSA/E are described. The discussion offers guidance for future efforts to research and respond to child sexual abuse and exploitation, and in particular the ongoing need for support to survivors beyond the legal response paradigm.

Male-On-Male Child and Adolescent Sexual Abuse in the Caribbean Region of Colombia: A Secondary Analysis of Medico-Legal Reports

Child and adolescent sexual abuse (CSA) is an important global health problem, especially in non-Western low- and middle-income countries. A number of studies have indicated that, in Latin American countries, male CSA is phenomenon of great concern. However, research on this topic is seriously lacking, and more specifically, on male-on-male CSA. We carried out a qualitative and quantitative secondary analysis of 680 cases of alleged male-on-male CSA that occurred between the years 2017 and 2018 in the Caribbean Region of Colombia. We analyzed the contents of forensic interviews with the alleged victims, conducted by professionals working at the Colombian Institute of Legal Medicine and Forensic Sciences. Our findings indicated a high prevalence of cases of alleged male-on-male CSA among young minors. Most of these cases were allegedly perpetrated by offenders known to the victim and involved high levels of violence. Evidence-based and culturally grounded preventative actions, such as training-based programs for teachers and parents among other public health initiatives are needed to address this type of CSA. Further research is also required to gain a more fine-grained understanding of the cultural and social context of CSA in the Caribbean Latin American countries.

Characterizing the prevalence and contributing factors of sexual violence: A representative cross-sectional study among school-going adolescents in two East African countries

BACKGROUND

Sexual violence against minors is a global phenomenon with wide-ranging negative consequences. Global reports suggest that it is a particularly serious issue in East African countries, although research on prevalence and characteristics of violence in these countries is scarce.

OBJECTIVE

The aim of this study was to assess sexual violence and its circumstances among Tanzanian and Ugandan adolescents.

PARTICIPANTS AND SETTING

Two representative samples of secondary school students aged 12-17 from Tanzania and Uganda (N = 1402) were included in this study.

METHODS

Data assessed using standardized questionnaires were analyzed to determine prevalence, characteristics, and contributing factors of sexual violence among youth.

RESULTS

We found high levels of sexual violence (27.2 %) exceeding global average estimates of under 20 %. Significantly more sexual violence experiences were reported by boys (29.9 %) than girls (24.6 %) and by older compared to younger adolescents (30.2 % vs. 19.6 %). Peers were the most frequent perpetrator group, named by 47.6 % of those reporting abuse. Several potential contributing factors for victimization were identified, such as rural living area, external financial support, and being in a romantic relationship.

CONCLUSIONS

Sexual violence is a relevant issue among East African adolescents that occurs in a variety of settings but appears to be most prevalent between peers. Comprehensive sexual education approaches may help to improve the protection of adolescents and to enhance autonomous sexual development.

Suffering whether You Tell or Don't Tell: Perceived Re-Victimization as a Barrier to Disclosing Child Sexual Abuse in Zimbabwe

Disclosing child sexual abuse (CSA) is a necessary first step to access the legal, health, and psycho-social services that survivors and their families need. However, disclosure rates are low: of young women who experienced CSA in Zimbabwe, only 9% disclosed the first incident. The purpose of this qualitative study was to explore and describe perceived barriers to disclosing CSA in Zimbabwe. We conducted focus group discussions with children aged 10-14 years (n = 40) and their parents/caregivers aged 20-62 years (n = 40), participating in an intervention trial in Chitungwiza, Zimbabwe. We found that potential retaliation against survivors and their families is a major barrier to disclosing CSA. These retaliatory acts, which we refer to as "re-victimization," arise from stigma or the victim feeling blamed or doubted and manifest through physical violence, emotional violence, and deprivation of family life and education. Our findings suggest that addressing social and cultural norms related to sex and strengthening legal protection for CSA survivors and their families could encourage CSA disclosure and could help end this violence. Our findings also highlight a need to increase children's awareness of their rights and to create safe systems for disclosure of sexual abuse.

Role of childhood maltreatment on weight and weight-related behaviors in adulthood

OBJECTIVE

This study investigated associations between child maltreatment and body mass, body weight perceptions, and weight control behaviors among men and women.

METHOD

Data were derived from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Multinomial logistic regression was used to investigate links between dimensions of childhood maltreatment and adult (a) classifications of body mass index (BMI), (b) discrepancies in perceived weight and actual BMI categories, and (c) normative and risky weight control behaviors.

RESULTS

Childhood maltreatment was highly predictive of BMI classification, weight perception discrepancies, and weight control behaviors for women. Women who reported physical abuse, sexual abuse, and neglect had increased risks for being slightly or very overweight, and among those who reported physical abuse and/or a combination of physical abuse and neglect, there is an increased likelihood of holding overweight perceptions. Finally, female victims of physical abuse, physical abuse and neglect, and of neglect only were more likely to adopt risky (e.g., diet pills or purging) versus normative (e.g., diet and exercise) weight control behaviors.

CONCLUSION

Results indicated that women who reported childhood maltreatment have increased risks for developing body and weight related issues, confirming research documenting female-specific effects of childhood maltreatment. For women, certain forms of maltreatment strongly predicted BMI groupings, discrepant weight perceptions, and risky weight behaviors. Taken together, findings suggest that child maltreatment is a predictor of health-related outcomes. Moreover, results highlight the importance of assessing gender-specific effects when examining outcomes related to body, weight, and dieting. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assisting decisions in child protection service institutions with the RIC - The Risk Indication in Child sexual abuse

BACKGROUND

The RIC (Risk Indication in Child sexual abuse) and its screening version (RIC:SV) are actuarial risk assessment instruments, developed at the Austrian Federal Evaluation Centre for Violent and Sexual Offenders and designed for child protection services to assess the likelihood of sexual recidivism in male contact child sexual abusers who still or again live within a family including children.

OBJECTIVE

The RIC was designed to require a minimum of forensic information, with the RIC:SV completely waiving such information.

PARTICIPANTS

Nine factors related to sexual recidivism could be identified by analyzing five-year follow-up data of N = 324 male contact child sexual abusers.

SETTING

The data was collected retrospectively from files between the years 2002 and 2011.

METHOD

Chi-Square Tests and ROC-analyses were calculated.

RESULTS

The RIC and the RIC:SV were found to significantly predict sexual recidivism with AUC values of .84 (RIC) and .78 (RIC:SV). The items of the RIC are: (a) offender has never had a live-in relationship, (b) unstable family background of the offender, (c) impulsivity of the offender, (d) previous psychiatric treatment(s) of the offender, (e) offender has prior prison sentence/s, (f) problems of the offender to accept rules and norms, (g) offender was a stranger to his former victim(s), (h) offender had at least one male victim, and (i) offender has ever committed an extrafamilial contact child sexual abuse offense.

CONCLUSION

The RIC and the RIC:SV need no extensive training to be used. The results may help CPS workers to justify risk related interventions.

The Relevance of Certain Case Characteristics in the Successful Prosecution of Child Sexual Abuse Cases in Indonesia

Successful prosecution in child sexual abuse (CSA) cases is an essential purpose of law enforcement agencies to ensure accountability of perpetrators and children's safety. However, research has shown that legal prosecution of CSA cases is a highly complex endeavor resulting in only a limited percentage of cases being prosecuted and ultimately proven in court. Most attrition occurs at the stage of the police investigation. The current study is the first study of CSA prosecution in an Asian country. We aimed to identify factors, which contribute to Indonesian CSA cases prosecution. We examined police files of CSA cases (N = 179) from three police units in greater Jakarta. We found that only 32% (n = 58) of cases were prosecuted. The following factors increased the odds of prosecution: victim being threatened, the suspect confessed, medical examination report being present, duration of investigations between one to 2 months, and the case being charged under the Child Protection Law. These findings (threat, suspect confession, and the presence of a medical examination report) correspond to previous studies in other jurisdictions.

Childhood sexual abuse perceptions and experience among college students of Panchkula

Background and Objective:

Child sexual abuse (CSA) is a global public health and human rights concern. Hence, the present study was conducted to assess childhood sexual abuse perception and experience among college students of Panchkula.

Methodology:

A self-administered anonymous questionnaire which assessed perception and experiences of childhood sexual abuse was given to a convenient sample of 1000 college students. Using descriptive statistics and Chi-square test, perception and the experience of childhood sexual abuse were calculated.

Results:

The study showed that 18% (boys = 20%, girls = 16%) of the students were exposed to CSA, with boys more often affected than girls. The student's perception about abuse was not very clear. Myths and cultural beliefs justified abuse.

Conclusion:

Although preliminary in nature, the present findings are among the first to demonstrate the nature of CSA among students of Panchkula. Further, the study revealed that CSA manifests both as contact and noncontact forms. More boys than girls are exposed to most forms of abuse.

Kindeswohlgefährdung – Ausweitung des Hellfeldes durch Neukonzeption der klinischen Kinderschutzarbeit

Hintergrund

Das Erkennen von Kindesmisshandlungen und der Umgang damit sind Herausforderungen im ärztlichen Alltag. Die Dunkelziffer bei Misshandlungen und Vernachlässigungen ist hoch.

Ziel der Arbeit

Das Ziel der Arbeit war, die Effektivität des neu strukturierten Kinderschutzprogrammes einer großen deutschen Kinderklinik zu untersuchen und durch die Präsentation der Vorteile der neuen Struktur die Verbesserung von Programmen für Kinder und Mediziner in anderen Kliniken anzuregen.

Methode

Es wurden retrospektiv alle Kinderschutzfälle im Altonaer Kinderkrankenhaus vor und nach Neukonzeption der Kinderschutzarbeit über einen Zeitraum von jeweils 2 Jahren untersucht und miteinander verglichen. Die Kinderschutzgruppe war neu strukturiert worden und wurde nachfolgend von einer hauptamtlichen Kinderschutzkoordinatorin geleitet.

Ergebnis

Die Prävalenz der Verdachtsfälle und der erhärteten Fälle von Kindeswohlgefährdung ist im Untersuchungszeitraum nach Neukonzeption hoch signifikant erhöht. Im Zeitraum vor der Neukonzeption wurden 24 Fälle mit dem Verdacht auf Kindswohlgefährdung untersucht, 23 erhärtet, danach 124 Fälle untersucht, 89 erhärtet. Eine Stigmatisierung der Familien bei der Abklärung wurde trotz des signifikanten Anstiegs falsch-positiver Verdachtsfälle durch sensibles Vorgehen und eine Konfrontation erst bei Erhärtung des Verdachtes vermieden.

Schlussfolgerung

Das vorgestellte Konzept zum medizinischen Kinderschutz in Kinderkliniken scheint das Hellfeld bei Kindeswohlgefährdung effektiv auszuweiten. Sowohl die Reduktion nichtdetektierter Fälle mit der Verhinderung potenzieller Eskalation mit prolongiertem Leidensweg als auch die Verminderung der immensen gesellschaftlichen Folgekosten rechtfertigen die personellen Investitionen.

Monitoring recent trends: The prevalence of disclosure of sexual abuse in a representative sample of the German population based on indicator 16.2.3 of the UN Sustainable Development Goals (SDG)

BACKGROUND

The monitoring of trends is important. The United Nations (UN) have defined indicators to monitor the proportion of young men and women who have experienced sexual abuse before the age of 18 (Indicator 16.2.3) as part of their global agenda, the Sustainable Development Goals (SDG).

OBJECTIVE

To examine recent trends in the disclosure of sexual abuse based on the indicator 16.2.3 of the SDG.

PARTICIPANTS AND SETTING

A total of 7530 participants across Germany (51.1% female) were included. The participants were between 14 and 94 years old.

METHODS

Three representative surveys were conducted using identical methods in 2010 (N = 2504), 2016 (N = 2510) and 2018 (N = 2516). A history of child sexual abuse (CSA) was assessed using the Childhood Trauma Questionnaire (CTQ). The prevalence rates of CSA among the age cohort of 18 to 29-year olds (indicator 16.2.3) were compared across the three waves.

RESULTS

There was no significant increase of rates in males in this specific age cohort (2010: 7.6%; 2016: 8.5%; 2018: 6.1%), but there was a significant increase among the females of this age cohort (2010: 12.8%; 2016: 13.5%; 2018: 26.1%). The increase was entirely between the survey in 2016 and 2018.

CONCLUSIONS

This is the first study to report on indicator 16.2.3 of UN's SDGs in Germany. The identified increase in rates of sexual abuse among 18-29 year old females might have been triggered by the attention the topic received in the time between 2016 and 2018, especially via social media and the #MeToo debate.