The relationship between childhood sexual abuse and mental health outcomes among males: Results from a nationally representative United States sample

PTSD Symptoms Among College Students: Linkages with Familial Risk, Borderline Personality, and Sexual Assault

College students have high rates of post-traumatic stress disorder (PTSD) symptoms as well as high rates of sexual assault. What is less clear, however, is whether different sexual assault types (e.g. coercive, physically forced, and incapacitation) are associated with greater PTSD symptoms. Moreover, understanding early familial and mental health histories of college students is important for explaining PTSD symptoms. As such, we use a social stress framework to examine the relationships between early familial risk (i.e. child abuse, perceived maternal rejection), borderline personality (BP) symptoms, and three sexual assault types with PTSD symptoms among college students. A total of 783 undergraduate students (65.4% female) completed paper and pencil surveys in fall 2019 and spring 2020 at a large public university. Results revealed that females were more likely to experience child sexual abuse and all three forms of sexual assault, while males experienced higher rates of child physical abuse. OLS regression results showed positive associations between child sexual abuse, perceived maternal rejection, BP symptoms and all three types of sexual assault with PTSD symptoms. Females also experienced more PTSD symptoms compared to males. Findings have implications for targeted interventions to improve mental health outcomes.

Specific domains of positive childhood experiences (PCEs) associated with improved adult health: A nationally representative study

Background

Positive childhood experiences (PCEs) are supportive relationships and environments associated with improved health when aggregated into composite scores. Adverse childhood experiences (ACEs), a reciprocal measure to PCEs, are associated with worse health in aggregate scores and when disaggregated into measures of specific ACE types (hereafter domains). Understanding the associations between specific PCE domains and health, while accounting for ACEs, may direct investigations and intervention planning to foster PCE exposure.

Methods

We analyzed data from the nationally representative United States longitudinal Panel Study of Income Dynamics. Five PCE domains were examined: (i) peer support and healthy school climate, (ii) neighborhood safety, (iii) neighborhood support, and nurturing relationships with (iv) maternal and (v) paternal figures. Survey weighted logistic regression models tested associations between each PCE domain measure and adult general health rating, controlling for demographic covariates and nine ACE exposures: physical, emotional, or sexual abuse/assault; emotional neglect; witnessing intimate partner violence or household substance use; having a parent with mental illness; any parental separation or divorce; and/or having a deceased or estranged parent. Secondary outcomes included adult functional status and mental and physical health diagnoses. We also tested for statistical interactions between PCE domain and ACE score measures.

Results

The sample included 7105 adults. Higher scores for the "peer support and healthy school climate" and "neighborhood safety" domain measures showed the most protective relationships with the adverse health conditions tested, most notably for mental illness. The relationship between PCE domain measures and health outcomes was attenuated, but not statistically moderated by ACE exposure.

Conclusion

Experiencing childhood peer support, a healthy school climate, and neighborhood safety were especially protective against multiple adult health conditions, including for ACE exposed individuals. Interventions that promote PCEs may yield population health gains.

International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications

BACKGROUND

Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence.

OBJECTIVE

The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations.

RESULTS

Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children.

DISCUSSION

Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

The experience of childhood sexual abuse: An exploratory description of psychological and adaptive functioning in Canadian men

BACKGROUND

Childhood sexual abuse (CSA) affects a number of men yet knowledge gaps remain around comprehensively describing psychological and adaptive outcomes for this population.

OBJECTIVE

Examine how a Canadian sample of men with and without CSA histories compares on broader areas of psychological and adaptive functioning.

PARTICIPANTS AND SETTING

This exploratory study included 109 adult men aged 25-60 years who were grouped according to whether they experienced CSA (n = 69) or not (n = 40). Participants were recruited from Ottawa, Ontario, Canada.

METHOD

Using a multi-method approach, we conducted an exploratory and comprehensive examination of how CSA contributes to various areas of psychological (e.g., depression, anxiety, stress, dissociation, anger, PTSD) and adaptive functioning (e.g., friendship quality, employment) using self-report and clinician-administered measures.

RESULTS

CSA men were an average of 8.5 years old at abuse onset. Most (62.3 %) had disclosed their CSA experience, waiting an average of 13.6 years before disclosure. After controlling for covariates (i.e., other types of maltreatment, non-maltreatment adversities, education, income), results indicated a significant association between CSA and men's psychological functioning, but not their adaptive functioning.

CONCLUSIONS

Findings highlight the importance of broadening our understanding of how the experience of CSA, controlling for important covariates, can contribute to the well-being of men in order to better respond to their psychological needs.

Comparisons Between Young, Middle-Aged, and Older Adult Sexual and Gender Minority Male Sexual Assault Survivors

OBJECTIVE

This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors.

DESIGN

Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial.

SETTING

SGM males 18 years or older, residing in the U.S. or Canada, were recruited online.

PARTICIPANTS

This study included younger (aged 18-39; n = 1,435), middle-aged (aged 40-59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault.

MEASUREMENTS

Participants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement.

RESULTS

Older SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group.

CONCLUSION

While there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources.

Frontline support services for boys who have experienced child sexual exploitation: A thematic review of survey data from seven countries

Child sexual exploitation and abuse (CSEA) affects all children, but research on the needs and experiences of boys is lacking, support services are limited, and workers lack specialized training to meet their specific needs. This paper explores the perspectives and experiences of 404 Frontline Support Workers providing services to children with CSEA experiences in seven countries, considering trends and implications for boys. A mixed-methods online survey of 121 questions explores characteristics of cases, perceived vulnerabilities, and gender-based challenges in CSEA response. A descriptive analysis of survey data, disaggregated by country, was conducted, allowing for a discussion of broad themes and trends. Despite differences, participants described similar vulnerabilities for boys across these contexts, including poverty as well as sex and sexuality-related taboos, stigmas, and other gendered beliefs, which were perceived to not only increase vulnerability to CSEA but also complicate disclosure in all countries. The implications of these findings on service delivery and recommendations are discussed.

A Meta-Analysis of the Effects of Childhood Maltreatment on Elderly Depression

Background: The present study aimed to synthesize the effects of five types of child maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect) on late-life depression.Method: Four English-language databases (Web of Science, PsycINFO and PsycARTICLES, PubMed, and Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang Database, and Weipu Database) were systematically reviewed, and data related to the association between child maltreatment and late-life depression were extracted. Ten studies involving 30,308 older adults were included, and the effect sizes were pooled using random-effect models.Findings: Except for sexual abuse, four types of child maltreatment were found to be positively associated with late-life depression. Physical abuse, emotional abuse and physical neglect were associated with elderly depression (PA: OR = 1.73, 95% CI = 1.55-1.95, p < .001; EA: OR = 1.92, 95% CI = 1.73-2.12, p < .001; PN: OR = 2.05, 95% CI = 1.15-3.67, p < .01) at a small level, and emotional neglect was associated with elderly depression (OR = 3.25, 95% CI = 1.43-7.39, p < .001) at an approximately moderate level. Gender moderated the relationship between physical neglect, emotional neglect, and late-life depression.Conclusion: Our findings highlight the significance of child maltreatment in the development of late-life depression, and underscore the need for future research and practice to explore potential ways to address late-life depression among older adults who suffered child maltreatment.

Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales

OBJECTIVES

Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms.

DESIGN

Secondary analysis of combined data from eight cross-sectional general population ACE surveys.

SETTING

Households in England and Wales.

PARTICIPANTS

20 556 residents aged 18-69 years.

MEASURES

Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure.

RESULTS

Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined.

CONCLUSION

Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.

Risk and protective factors for mental health outcomes among sexual minority and heterosexual college women and men

Objective: Understand the relationship between risk factors (eg, different sexual assault types - coercive, physical, incapacitation by alcohol/drugs) and protective factors (eg, strong maternal ties) with depressive symptoms and post-traumatic stress disorder (PTSD) symptoms among college students. Participants: Six hundred twenty-five undergraduate students. Methods: Students completed paper and pencil surveys in fall 2019 at a large public university. Results: Risk factors of child physical and sexual abuse, all three sexual assault types, and combined sexual assault were associated with greater PTSD symptoms while maternal relationship quality and religious influence served as protective factors. Risk factors of child physical and sexual abuse, coercive sexual assault, and combined sexual assault were associated with depressive symptoms while maternal relationship quality served as a protective factor. Males who identified as sexual minority (SM) had more PTSD symptoms compared to females who identified as SM. Conclusions: Findings have implications for targeted interventions to improve mental health outcomes.

A Vignettes-Based Exploration of Attitudes of Parents Toward Reporting of Child Sexual Abuse in Ghana

Reporting child sexual abuse (CSA) to law enforcement institutions is the ideal child protection imperative. The role of parents in this process is unquestionably profound. Yet, there is limited evidence on parental perspectives on reporting CSA to law enforcement agencies in developing country contexts. We apply vignettes to describe the views of parents about reporting CSA perpetrated by "family members, schoolteachers, and strangers." Data was collected from 89 parents from four culturally diverse regions of Ghana. A systematic inductive approach was used to determine patterns and similarities in participants' attitudes toward reporting. We note that the attitudes of participants about reporting CSA varied considerably; these are influenced by the nature of social relationships between the victim and perpetrator. In a seeming order of severity, CSA perpetrated by a family member was viewed less seriously compared to victimization by a teacher or a stranger. The desire to preserve familial/kin ties and reputation and keeping to the cultural heritage of resolving "disputes and disagreements" amicably were primary norms against reporting CSA. However, attitudes toward reporting CSA by teachers were influenced by expectation of higher moral standards, which made reporting CSA by a teacher a reasonable cause of action. Positive attitudes toward reporting CSA by "strangers" were prevalent. Child protection programs must recognzse the segmented attitudes toward CSA and tackle the deep-seated cultural and social norms through social and behavioral change communication (SBCC).

A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County

Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.

Adverse childhood experiences are associated with altered cardiovascular reactivity to head-up tilt in young adults

Adverse childhood experiences (ACEs) are associated with greater prevalence of cardiovascular disease and altered acute stress reactivity. The current study investigated the effect of ACEs on hemodynamic and autonomic responses to orthostatic stress imposed by 60° head-up tilt (HUT) in young adults. Two-hundred twenty-six healthy young adults (age = 22.6 ± 1.5 yr; n = 116 females) without cardiovascular disease participated and had complete data. Participants underwent supine blood pressure (BP), R-R interval (RRI), cardiac output (CO), total peripheral resistance (TPR), and cardiovagal baroreflex sensitivity (cvBRS) testing followed by a transition to 60° HUT where measures were reassessed. Childhood adversity exposures were assessed based on categorical exposure and nonexposure to childhood household dysfunction and maltreatment, and <4 and ≥4 types of ACEs. Significantly greater increases in SBP (P < 0.05), DBP, MAP, and TPR (P < 0.01; all) following 60° HUT were observed in individuals with ≥4 compared with those with <4 types of ACEs. Attenuated decreases in RRI and cvBRS were observed in those with ≥4 types of ACEs (P < 0.05). Experiencing ≥4 types of ACEs was associated with augmented BP and TPR reactivity and a blunted decrease in cvBRS in response to 60° HUT in young adults. Results suggest that a reduced vagal response to orthostatic stress is present in those who have experienced ≥4 types of ACEs that may promote autonomic dysfunction. Future research examining the sympathetic and vagal baroreflex branches is warranted.

Childhood Sexual Abuse, Dyadic Empathy, and Intimate Partner Violence Among Men Seeking Psychological Help

Childhood sexual abuse (CSA) and intimate partner violence (IPV) have both been associated with numerous negative repercussions. The first aim of this study is to understand IPV perpetrated by men within a clinical population, by examining the effects of two potential predictors: CSA and dyadic empathy (cognitive and emotional). The second aim of this study is to explore whether dyadic empathy is an intermediary variable of the association between CSA and IPV. A sample of 198 men (aged 18-69 years old) who were seeking help for relationship problems, completed a set of self-administered questionnaires. While controlling for social desirability and family violence history, our findings outlined the mediating and moderating role of dyadic empathy in the link between CSA and perpetrated psychological, but not physical, IPV. Emotional empathy mediated and moderated the link between CSA and psychological IPV, whereas cognitive empathy only moderated this link. The examination of the direct links between the variables also revealed that CSA was related to lower emotional empathy and higher rates of both types of IPV. In addition, cognitive empathy was negatively associated with physical and psychological IPV, whereas emotional empathy was positively associated with psychological IPV. This study contributes to the literature by documenting some of the mechanisms that could explain the perpetration of IPV and highlights the importance of investigating CSA and empathy in men who are seeking help.

A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder

This study aimed to systematically review the evidence for an association between adversity experienced in childhood (≤ 17 years old), and the diagnosis of psychiatric disorder in adulthood. Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies examining child or adolescent exposure to adversity, and adult-diagnosed depression, anxiety, psychotic disorder, eating disorders, substance abuse disorder, illness anxiety disorder, somatoform disorder, or personality disorder. A total of 39 manuscripts were retained. Results revealed a significant association between the following childhood exposures and adult mental disorder (1.24 ≤ Odds ratios ≤ 2.09): bullying (victimhood, and frequency); emotional abuse; neglect; physical abuse; parental loss; and general maltreatment (unspecified and/or multiple adversity exposure). There were opposing results for being a victim and perpetrator of bullying, and the result for sexual abuse was not statistically significant. There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more two and a half times odds of developing a mental disorder (Odds ratio = 2.59). The result for sexual abuse is likely an artefact of the prospective assessment of this adversity. In summary, there was strong evidence of an association between childhood adversity and later mental illness, and this supports previously reported meta-analyses. The evidence suggests that childhood and adolescence is an important time for risk for later mental illness, and an important period in which to focus intervention strategies for those known to have been exposed to adversity, particularly multiple adversities.

A rapid review to determine the suicide risk and risk factors of men who are survivors of sexual assault

This rapid review assessed the suicide risk and risk factors of men who are survivors of sexual assault. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles in English published between 2010 and 2022. We rated the quality of the evidence based on the National Health and Medical Research Council Levels of Evidence. One systematic review and 16 papers featuring primary studies were included relating to suicide rates and risk. Findings suggest men who have been sexually assaulted (as a child or adult) are at increased risk of suicidal thoughts, attempts and behaviours compared with men who have not been sexually assaulted. Factors such as frequency of abuse and other concurrent forms of childhood abuse may further increase the risk of suicidal thoughts and behaviours. This evidence base was rated as good. The strength of this evidence supports a need for targeted suicide prevention in this high risk group.

Child Sexual Abuse, Self-esteem, and Delinquent Behaviors During Adolescence: The Moderating Role of Gender

To reflect the complex phenomena of child sexual abuse (CSA), studies should examine possible gender specificities and explore potentially explanatory mechanisms. The current study aimed to test the moderating effect of gender in the mediated relationship between CSA, self-esteem, and delinquency during adolescence. A moderated mediation model was tested among a representative sample of 8,194 high school students (57.8% girls and 42.2% boys) age 14 to 18 in the province of Quebec in Canada. Results showed that self-esteem has an indirect effect on the relationship between CSA and delinquency. Gender (being a boy) was associated with a higher level of self-esteem and an increased risk of delinquent behaviors. Among victims of CSA, boys reported lower levels of self-esteem than girls, which was associated with an increased risk of displaying delinquent behaviors. Self-esteem may be an important target of intervention for sexually abused youth, especially for boys. Focusing on promoting positive self-esteem may also reduce the risk for male adolescents struggling with the deleterious consequences of delinquency.

Cumulative lifetime violence severity, social determinants and anxiety in a national sample of Canadian men

BACKGROUND

Despite anxiety disorders being the ninth leading cause of disability and associated with social inequities, little attention has been given to how intersections among social determinants of health and chronic stressors such as cumulative lifetime violence affect the likelihood of experiencing anxiety disorders. Our purpose was to explore the relationships among cumulative lifetime violence severity as target and perpetrator, social determinants of health and generalized anxiety disorder in Canadian men.

METHODS

Using a community sample of 592 Canadian men who self-identified as having experienced violence, we developed and tested an evidence-based model of generalized anxiety disorder including indicators of cumulative lifetime violence, gender, social location, socio-economic disparity, personal resources and other chronic stressors using logistic regression.

RESULTS

Most men (76.4%, n = 452) reported experiences as both target and perpetrator. The model accounted for 50.8% of the variance in anxiety severity χ2 (8) = 264.43, p = .000). The prevalence of probable generalized anxiety disorder was 30.9%, a rate higher than that found among Canadian men in general in the same period. Remarkably, the likelihood of generalized anxiety disorder increased by a factor of 5.30 for each increase of 1 in cumulative lifetime violence severity, and six-fold for feeling overwhelmed by demands of everyday life (aOR = 6.26). Masculine discrepancy stress, having been born in Canada, unemployment, and food insecurity also contributed significantly to increasing the likelihood of generalized anxiety disorder. Both social support and mastery had significant aORs < 1, suggesting possible protective effects. Together these findings delineate characteristics and social determinants that may heighten vulnerability to generalized anxiety disorder and influence its progression among men who have experienced lifetime violence.

CONCLUSIONS

These findings are the first evidence that Canadian men with lifetime violence histories are a sub-group disproportionately affected by chronic stressors and socio-economic disparities and that together the presence and/or severity of these factors increases their vulnerability to generalized anxiety disorder. Our results highlight the importance of strengths-based trauma- and violence-informed approaches to care, including practical resources to reduce the stress of everyday life, improve social support, and reinforce personal control and choice.

Childhood Sexual Abuse and Coping as Young Adults: The Roles of Attachment and Mattering

This study examined whether a history of childhood sexual abuse (CSA), attachment to mother, father, and friends, and mattering were related to the coping behaviors of 171 male and 85 female, ethnically diverse, low-income, young adults. The 74 survivors of CSA reported lower attachment to father and less mattering to parents than did the 97 who reported no abuse. Compared to male survivors, female survivors reported greater use of problem-focused coping and also perceived their abuse experience, particularly the use of force, as having a more negative impact on them. Stronger attachment to mother and to friends predicted more positive problem-focused coping. Mattering to friends moderated the relation between CSA history and problem-focused coping, with the CSA survivors who reported the highest mattering to friends also using the most problem-focused coping strategies. The role of attachment and mattering in problem-focused coping among young adults, especially those with a CSA history, is discussed.

The relationship of cumulative psychosocial adversity with antepartum depression and anxiety

BACKGROUND

Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy.

METHODS

This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated.

RESULTS

Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude.

CONCLUSION

High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.

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.

Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study

BACKGROUND

Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited.

AIMS

We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm.

METHOD

A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition.

RESULTS

Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants' CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm.

CONCLUSIONS

CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.

Childhood maltreatment, psychiatric symptoms, and suicidal thoughts among adolescents receiving substance use treatment services

INTRODUCTION

Childhood maltreatment experiences are associated with future suicidal thoughts and suicide attempts, yet the roles of specific psychiatric symptoms mediating this relation remain to be clarified. To clarify these relations, we tested a model incorporating multiple forms of childhood maltreatment (sexual abuse, physical punishment, emotional neglect), past year psychiatric disorder symptoms during adolescence (anxiety, mood, and conduct disorders) and recent suicidal thoughts.

METHODS

We administered structured interviews to 394 adolescents receiving outpatient substance use treatment services in the Southeastern United States (280 males; Mage = 16.33; SDage = 1.15). Structural equation models (SEMs) were used to evaluate the degree to which relations between childhood maltreatment and suicidal thoughts were mediated by specific past-year psychiatric symptoms.

RESULTS

Mood disorder symptoms significantly mediated the relation between neglect/negative home environment and suicidal thoughts. This path of influence did not vary by gender.

CONCLUSIONS

Childhood maltreatment and subsequent psychopathology influence suicidal thoughts among adolescents receiving substance use treatment services. The findings of the present study have implications for the adaptation and delivery of substance use treatment services to adolescents to enhance treatment engagement and outcomes.

Determination of the knowledge and awareness of nursing students about elder neglect and abuse: The case in Turkey

PURPOSE

This study determined the level of knowledge and awareness of elder neglect and abuse among nursing students in Turkey.

DESIGN AND METHODS

This cross-sectional, descriptive study surveyed 2128 nursing students across seven Turkish universities.

FINDINGS

Results indicated that 31.1% of students had received training on elder neglect and abuse; 77.5% considered their knowledge of the topic to be sufficient; 18.7% had encountered elder neglect and abuse during their education; 58.7% did nothing for the situation; 95.2% thought that people living alone were exposed to elder neglect and abuse more frequently; and 94.8% of students thought that elders who could not meet their own needs were exposed to more neglect and abuse.

PRACTICE IMPLICATIONS

Future nurses need to increase their level of knowledge about abuse and neglect of the elderly.

Linking the hemodynamic consequences of adverse childhood experiences to an altered HPA axis and acute stress response

Adverse childhood experiences (ACEs), such as maltreatment and severe household dysfunction, represent a significant threat to public health as ACEs are associated with increased prevalence of several chronic diseases. Biological embedding, believed to be rooted in dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, is the prevailing theory by which chronic diseases become imprinted in individuals following childhood adversity. A shift towards HPA axis hypoactivity occurs in response to ACEs exposure and is proposed to contribute towards altered cortisol secretion, chronic low-grade inflammation, and dysregulated hemodynamic and autonomic function. This shift in HPA axis activity may be a long-term effect of glucocorticoid receptor methylation with downstream effects on hemodynamic and autonomic function. Emerging evidence suggests syncopal tendencies are increased among those with ACEs and coincides with altered neuroimmune function. Similarly, chronic low-grade inflammation may contribute towards arterial baroreceptor desensitization through increased arterial stiffness, negatively impacting autonomic regulation following posture change and increasing rates of syncope in later life, as has been previously highlighted in the literature. Although speculative, baroreceptor desensitization may be secondary to increased arterial stiffness and changes in expression of glucocorticoid receptors and arginine vasopressin, which are chronically altered by ACEs. Several research gaps and opportunities exist in this field and represent prospective areas for future investigation. Here, we synthesize current findings in the areas of acute psychosocial stress reactivity pertaining to HPA axis function, inflammation, and hemodynamic function while suggesting ideas for future research emphasizing systemic interactions and postural stress assessments among those with ACEs. This review aims to identify specific pathways which may contribute towards orthostatic intolerance in populations with history of childhood adversity.

[Trauma, Psychological Stress and Family Situation of Fathers who Experienced Child and Youth Welfare Services: Implications for Youth Welfare Interventions and Therapy]

Trauma, Psychological Stress and Family Situation of Fathers who Experienced Child and Youth Welfare Services: Implications for Youth Welfare Interventions and Therapy This paper explores the current family situation and psychological stress of fathers who experienced trauma and different kinds of youth welfare services including out-of-home placement during their childhood. The main group consisted of n = 119 fathers and was compared to a group of n = 36 fathers whose families never received services from the child and youth welfare authority. In the main group, a high correlation was found between trauma and current psychological stress, albeit the out-of-home care intervention or intensive home-support by child and youth welfare services during childhood. The higher stress level in the main group of fathers in contrast to the comparison group effects their current family situation, especially concerning the contact between fathers and their children. Fathers with higher stress levels were less likely to be in contact with their children. Acting on the assumption that fathers are important for their children, the results implicate a heightened focus on earlier trauma-informed interventions in families with difficulties and out-of-home care settings, to reduce stress levels and prevent intergenerational transmission of problematic family experiences. Current child and youth welfare services, in particular out-of-home placements, should take these trauma-informed approaches and therapy into account.

Maternal adverse childhood experiences and postpartum depressive symptoms in young, low-income women

OBJECTIVES

Exposure to adverse childhood experiences (ACEs), such as child maltreatment and family dysfunction, is highly prevalent. Previous research has shown an association between ACEs and adult depression. The aim of the current study was to expand the existing literature by testing the association between ACEs and postpartum depression (PPD) symptoms in an urban, ethnically diverse sample of women.

METHODS

Participants (N = 746; ages 18-47; mean age = 27.3) were recruited at a large, urban university medical center as part of the Longitudinal Infant and Family Environment (LIFE) study. The association between ACEs and PPD symptoms were tested via hierarchical linear regression models.

RESULTS

The majority of the participants (61%) reported experiencing at least one type of ACEs prior to age 18. ACEs were positively associated with PPD symptoms (β = .29, p < .001), controlling for maternal race/ethnicity, age, educational attainment, marital status, household income, and infant gender and birth order.

CONCLUSIONS

The results showed that exposure to ACEs was related to PPD symptoms among low-income women. Screenings for ACEs during prenatal checkups may help identify women at risk of depression and facilitate timely prevention and treatment efforts.

Physical, Psychological and Sexual Abuse of the Minor in the Families from the Northwestern Region of Romania- Social and Medical Forensics

BACKGROUND

In Romania, the abuse within the family of the minor child is a widespread phenomenon, its extent is insufficiently known because of ignorance/not reporting all the existing cases.

METHODS

The participants of the research are represented by two independent groups from the NW Romania 2007-2011, one for sociological study (1544 parents and 1283 children) and another for forensic statistical study (2761 cases of abused children). The sociological study was carried out by analyzing questionnaires applied in schools located in Bihor County, both to children and parents. The statistical analysis was carried out by studying the cases of the physically, sexually, and psychologically abused minors, recorded at Bihor County Forensic Service.

RESULTS

Physical neglect and physical abuse are the most common forms of child abuse. The forensic analysis highlight that most of the victims are male from urban areas. Physical abuse is more common in the 16-18 age group, psychological abuse in children aged between 6-10 yr, and sexual abuse in children under the age of 14 years. Girls were subject to sexual abuse, neglect, and emotional abuse, more frequently in rural areas; boys were most often victims of exploitation, physical, and emotional abuse in both urban and rural areas.

CONCLUSION

The results of the study led to the formulation of general guidelines on this phenomenon and highlight the need for proposals to improve the current situation of child abuse within the family.

Gender, rights and responsibilities: The need for a global analysis of the sexual exploitation of boys

The United Nations Convention on the Rights of the Child confirmed child and youth rights globally. Their right to participation is a critical driver for the 2030 Sustainable Development Goals (SDGs). Youth prioritize the need to end violence against them, charging adults with safeguarding, and identify gender inequality as an underlying cause of child sexual exploitation (CSE). SDG 5 includes targets for ending sexual exploitation of girls; however, it is critical to review whether we are supporting both boys and girls adequately. Based on recent research, it is clear that male victims of CSE are prevalent, yet they have been relatively excluded in policy, research, and interventions. The aim is not to minimize the importance of understanding and eliminating CSE of girls, but to acknowledge that vulnerable sub-groups of boys exist in community (street-connected boys, refugees, sexual minorities) and service systems (justice, child welfare, humanitarian aid). Gender-based challenges persist in protection, disclosure, help-seeking, professional recognition, programming and prevention. In this discussion article, we outline responsibilities in human rights law to understand and address boys' CSE and overview key literature on its impact on boys. It is argued that gender-, trauma-, and violence-informed approaches are expanded to address the contribution of harmful gender norms, and to target prevention in the adolescent years for sexually transmitted infections, mental health, and substance abuse and violence problems. This discussion advances a pressing need for a global analysis of CSE among boys.

Emotion regulation deficits mediate childhood sexual abuse effects on stress sensitization and depression outcomes

Child sexual abuse (CSA) is a notable risk factor for depressive disorders. Though multiply determined, increased sensitivity to stress (stress sensitization) and difficulty managing distress (emotion regulation) may reflect two pathways by which CSA confers depression risk. However, it remains unclear whether stress sensitization and emotion regulation deficits contribute to depression risk independently or in a sequential manner. That is, the frequent use of maladaptive emotion regulation responses and insufficient use of those that attenuate distress (adaptive emotion regulation) may lead to stress sensitization. We tested competing models of CSA, stress sensitization, and emotion regulation to predict depression symptoms and depressive affects in daily life among adults with and without histories of CSA. Results supported a sequential mediation: CSA predicted greater maladaptive repertoires that, in turn, exacerbated the effects of stress on depression symptoms. Maladaptive responses also exacerbated the effects of daily life stress on contemporaneous negative affect (NA) levels and their increase over time. Independent of stress sensitization, emotion regulation deficits also mediated CSA effects on both depressive outcomes, though the effect of maladaptive strategies was specific to NA, and adaptive responses to positive affect. Our findings suggest that emotion regulation deficits and stress sensitization play key intervening roles between CSA and risk for depression.

Self-Reported Sexual Behavioral Similarities and Differences Among Young Men Who Have Sex With Men With Childhood Sexual Abuse Histories: A Qualitative Exploratory Study

Young men who have sex with men (YMSM) have the highest burden of sexually transmitted infections (STIs), including HIV. Childhood sexual abuse (CSA) is a risk factor for high-risk sexual behavior and STI acquisition. Studies that have explored sexual behavior based on the type of reported sexual abuse are limited. This study aimed to further understand current sexual behaviors and perceptions among YMSM that have experienced different types of CSA. Sixteen YMSM who were survivors of CSA were interviewed utilizing a phenomenological conceptual framework and methodology. Thematic findings were divided into two parts. Part I gave an overview of the entire sample, and themes were as follows: unprotected oral sex used to evaluate penile abnormalities, trust promoting unprotected sex, and alcohol and other drugs not cited as the reason for casual sex. Part II demonstrated the differences among those with a history of CSA involving non-penile-anal intercourse and those with a history of CSA involving penile-anal intercourse. The major themes in Part II were that victims of CSA involving penile-anal intercourse reported the following: a hypersexual self-definition, an STI diagnosis and noncondom use history, and a third sexual partner during sexual activity. Based on the findings, early life experiences such as CSA should be considered when developing preventative sexual health strategies and individuals who experienced penetrative sexual abuse may have different needs which should be further explored.

Life within a limited radius: Investigating activity space in women with a history of child abuse using global positioning system tracking

Early experiences of childhood sexual or physical abuse are often associated with functional impairments, reduced well-being and interpersonal problems in adulthood. Prior studies have addressed whether the traumatic experience itself or adult psychopathology is linked to these limitations. To approach this question, individuals with posttraumatic stress disorder (PTSD) and healthy individuals with and without a history of child abuse were investigated. We used global positioning system (GPS) tracking to study temporal and spatial limitations in the participants’ real-life activity space over the course of one week. The sample consisted of 228 female participants: 150 women with PTSD and emotional instability with a history of child abuse, 35 mentally healthy women with a history of child abuse (healthy trauma controls, HTC) and 43 mentally healthy women without any traumatic experiences in their past (healthy controls, HC). Both traumatized groups—i.e. the PTSD and the HTC group—had smaller movement radii than the HC group on the weekends, but neither spent significantly less time away from home than HC. Some differences between PTSD and HC in movement radius seem to be related to correlates of PTSD psychopathology, like depression and physical health. Yet group differences between HTC and HC in movement radius remained even when contextual and individual health variables were included in the model, indicating specific effects of traumatic experiences on activity space. Experiences of child abuse could limit activity space later in life, regardless of whether PTSD develops.

Sexual Abuse Prevention Education for Preschool-Aged Children: Parents' Attitudes, Knowledge and Practices in Beijing, China

The purpose of this study was to investigate Chinese parents' attitudes, knowledge, and practices with their preschool-aged children on sexual abuse prevention education, and to explore the associated factors of parental educative practices on child sexual abuse (CSA) prevention. Four hundred and forty parents of young children from 16 classes in 3 preschools in Beijing completed the questionnaire anonymously and voluntarily (response rate = 80%). Less than one third of parents believed that children most often were sexually abused by familiar persons, and less than 30% of parents believed that if a child has been sexually abused, there will usually be no obvious physical evidence. Parents were reluctant to discuss CSA protective skills with their young children. Less than half of the parents had told their children that if sexual abuse happens, parents or other trusted adults should be told. The multivariate linear regression equation showed that both parents' knowledge (B = 0.11, SE B = 0.05, p = 0 .03) and attitudes (B = 0.27, SE B = 0.10, p = .01) were significant factors for parents' communication about CSA prevention with their children. Findings from this study suggest that it is urgent to implement the sexual abuse prevention education with Chinese parents of preschoolers. Applications and limitations of these findings are discussed.

Psychological evaluation of children victims of sexual abuse: development of a protocol

Sexual abuse (SA) is associated with significant psychological problems in childhood, making it increasingly important to develop evaluation protocols. This study examined clinical aspects and cognitive measures of 49 children (24 with SA history and 25 controls). It employed a SA assessment questionnaire, clinical evaluations of posttraumatic stress disorder, risk indicators and neuropsychological tests in order to elaborate a specific forensic psychological evaluation protocol for this population. Conflicting couples (80%), separated parents (68%) and parents' alcohol/drug abuse (76%) were revealed as major risk factors. Fathers represented the primary perpetrator (24%). The main cognitive complaint was difficulty concentrating. Regarding the association between clinical and cognitive variables, it was observed that children who were anxious or referred to having fear, difficulties with operational memory and difficulty sleeping, had more trouble performing tasks that required attention and memory (operational, immediate and late). Children with SA history demonstrated inferior performance in visual attention/task switching and memory; with an emphasis in the loss of set in the Wisconsin test. The findings suggest the possibility of a primary attention deficit in children with SA history, possibly influencing the performance of other cognitive functions.

Influence of the history of abuse and suicidal attempts behavior among women victims of violence in Nicaragua

Suffering traumatic experiences linked to violence seems to be related to suicide attempts, especially, when the physical or sexual abuse has been experienced at an early age. This study examines the relationship between the history of abuse and suicide attempts among women victims of violence living in poverty in Nicaragua. This sample was subjected to a particularly serious range of stressful situations and experiences related to violence throughout their lives. The results show that women who experienced abuse during childhood were more likely to report a history of suicide attempts than women without a history of childhood abuse. Therefore, suicide attempts seem to be related more to those traumatic experiences during childhood than to violence suffered afterward. Identifying this type of abuse is particularly important because of its implications for the victims' health, as suicide attempts are maladaptive behaviors with which the women in the sample could have been addressing the trauma they experienced in their childhood. It is, therefore, necessary to highlight this problem in a developing country, which has been the focus of a limited number of studies, and where there are no support mechanisms for victims whose rights have been violated.

Childhood maltreatment compromises resilience against occupational trauma exposure: A retrospective study among emergency medical service personnel

BACKGROUND

Childhood maltreatment (CM) compromises resilience against stress and trauma throughout life. Therefore, it could present a major risk factor for the health of frequently trauma-exposed professionals such as emergency medical service (EMS) personnel.

OBJECTIVE

We investigated, whether EMS personnel's history of CM increased their risk for mental and physical stress symptoms after occupational trauma exposure.

PARTICIPANTS AND SETTING

Data from 103 German EMS personnel (age: Mdn±QD = 26.00 ± 8.50 years) were collected as part of a cross-sectional survey distributed among employees of the regional German Red Cross EMS division (response rate 46.6%). The sample corresponded well to the division's entire staff in terms of socio-anagraphic characteristics.

METHODS

CM and occupational trauma exposure as well as posttraumatic, depressive, and somatic symptoms were assessed with self-report questionnaires.

RESULTS

Moderation analyses indicated stronger positive associations between occupational trauma exposure and the severity of posttraumatic (β = .30, p < .001), depressive (β = .20, p = .026), and somatic symptoms (β = .18, p = .059) among EMS personnel who reported a higher exposure to CM.

CONCLUSIONS

Our study provides initial evidence that CM could increase the EMS personnel's vulnerability to the detrimental consequences of critical incidents on duty. Future research is needed (i) to replicate and generalize our observation on various trauma-exposed professions as well as (ii) to develop preventive measures for targeting the mediating and protective factors which influence the relationship between CM and the negative consequences of occupational trauma exposure.

Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

Background

The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields.

Methods

We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender.

Results

A total of 2200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home.

Conclusions

The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders.

METHODS

Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment.

RESULTS

All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD).

CONCLUSIONS

There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.

Childhood Sexual Abuse Profiles and Psychological Functioning in Adult Males

This study used a person-centered approach to generate profiles of males' sexual abuse characteristics and then link profiles to other types of childhood maltreatment and adversity, and adult outcomes. Data were drawn from 215 North American males (86% Caucasian) aged 17-61 years recruited from websites offering support for sexual abuse. Latent profile analysis identified three profiles, ranging from 1-2 instances of fondling by an unfamiliar extrafamilial perpetrator to chronic, penetrative abuse by individuals within and outside the family. Profiles were labeled Severe (26%), More Severe (33%), and Most Severe (41%). Chi-squares and analysis of variance showed that men in the Most Severe profile were more likely to experience childhood emotional and physical abuse, and a greater number of non-victimization adversities, than men in the other two profiles. After controlling for multiple victimization and adversity, men in the More Severe and Most Severe profiles reported significantly greater internalizing problems than men in the Severe profile, and men in the Most Severe profile reported significantly more trauma symptoms than men in the Severe profile. While these results require replication, they suggest that treatment should be tailored to the individual needs of male survivors.

Child Sexual Abuse and Depression in Late Life for Men: A Population-Based, Longitudinal Analysis

OBJECTIVE

Research investigating long-term effects of childhood sexual abuse (CSA) on mental health for men is vastly underdeveloped. This study strengthened the knowledge base by examining: (a) long-term trajectories of depressive symptoms for men with and without a history of CSA, and (b) moderating effects of social support over time.

METHOD

We analyzed multiple waves of data from the Wisconsin Longitudinal Study. The sample (N = 2,451) consisted of men with histories of CSA and a stratified, randomly sampled comparison group. Growth curve modeling was employed for analyses.

RESULTS

After controlling for demographic, parental, and health factors, men with CSA histories had greater depressive symptoms than those with no history of CSA. For both groups, depressive symptoms decreased over time; slope patterns did not differ. We found a significant moderating effect of social support on the relationship between CSA and depressive symptoms.

DISCUSSION

This innovative, population-based, longitudinal study demonstrated that CSA can undermine mental health for men across the life span and into old age. Social support appears to mitigate these deleterious effects. In early, middle, and late adulthood, practitioners should assess for CSA and strengthen support resources for male survivors.

Bioethical Issues and Secondary Prevention for Nonoffending Individuals with Pedophilia

Child sexual abuse is a global problem with significant emotional, psychological, and financial implications to victims, perpetrators, and society. Most child sexual abuse prevention programs target young children or those who have already engaged in abusive behavior, in order to prevent further offending. There are numerous secondary prevention programs targeting individuals at-risk of various health conditions in an effort to reduce the likelihood they will go on to experience a particular illness or disease. Considerable research exists regarding the risk factors for engaging in child sexual abuse and more specifically the factors contributing to reoffense. We argue that engaging in secondary prevention programs for people with pedophilia, in order to prevent child sexual abuse, is an ethically responsible and necessary practice. Secondary prevention programs with this focus are reviewed, along with the implications of mandatory reporting in doing this work.

Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions

These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history.

INTRODUCTION

CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis.

METHODS

Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis.

RESULTS

Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis.

CONCLUSIONS

Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.

Childhood physical abuse and emotional neglect are specifically associated with adult mental disorders

Background: Childhood adversities and trauma (CAT) are associated with adult mental disorders. Nevertheless, although CAT of different domains mostly co-occurs, and co-morbidity is common, the associations between CAT and mental disorders, when taking these interrelations into account, are not well known.Aims: We aimed to study differential associations between the five core domains of CAT and current axis-I disorders, taking into consideration their interrelations.Methods: Four hundred and fifteen outpatients attending adult primary (n = 255) and psychiatric care (n = 160) were assessed with the Trauma and Distress Scale (TADS) and the Mini International Neuropsychiatric Interview (MINI). Associations between CAT core domains and diagnostic categories were examined by path analyses.Results: At least some infrequent experience of CAT (83.6%), mostly of neglect, and current mental disorders (49.4%), mostly depression, was frequent, as were co-morbidities and co-occurrence of CAT domains. Considering these interrelations in a path model of excellent fit, physical abuse predicted depressive, manic, psychotic and anxiety disorders, whereas emotional neglect predicted depressive, anxiety and substance misuse disorders.Conclusions: Of all five CAT core domains, physical abuse and emotional neglect had the strongest association with adult psychiatric disorders and might have transmitted earlier reported main effects of other CAT domains onto mental disorders.

A longitudinal perspective on boys as victims of childhood sexual abuse in South Africa: Consequences for adult mental health

Childhood sexual abuse of boys was examined in a longitudinal cohort in South Africa, with data on abuse collected at six age points between 11 and 18 years. Potential personal and social vulnerability of male sexual abuse victims was explored and mental health outcomes of sexually abused boys were examined at age 22-23 years. Reports of all sexual activity - touching, oral and penetrative sex - increased with age and sexual coercion decreased with age. Almost all sexual activity at 11 years of age was coerced, with the highest rates of coercion occurring between 13 and14 years of age; 45% of reports of coerced touching were reported at age 14, 41 percent of coerced oral sex at age 13, and 31% of coerced penetrative sex at age 14. Sexual coercion was perpetrated most frequently by similar aged peers, and although gender of the assailant was less often reported, it can be presumed that perpetration is by males. Boys who experienced childhood sexual abuse tended to be smaller (shorter) and from poorer families. No relationships to measured childhood intelligence, pubertal stage, marital status of mother or presence of the father were found. There was no significant association between reports of childhood sexual abuse and mental health in adulthood and when personal and social vulnerabilities were taken into account.

Typologies of adverse childhood experiences and their relationship to incarceration in U.S. military veterans

Numerous studies have reported that adverse childhood experiences (ACEs) are associated with negative psychosocial outcomes in adulthood, but no study has examined the different typologies of ACEs and the relationship of these with adult incarceration in military veterans. The current study used latent class analysis to examine the existence of different childhood maltreatment and household dysfunction typologies in a sample of U.S. military veterans identified through the National Epidemiological Survey on Alcohol and Related Conditions-III ((NESARC-III)). A total of 60.73% of veterans reported one or more ACEs. Four latent classes were identified and were named Low adversities, Moderate maltreatment with high household substance use, Severe maltreatment with moderate household dysfunction and Severe multi-type adversities. Relative to the Low adversities class, the three maltreatment/dysfunction classes had significantly elevated odds ratios (1.72-2.29) for adult incarceration, when controlling for sociodemographic characteristics and alcohol and drug use. The results point to the importance of examining childhood risk factors for incarceration and suggest that a certain sub-group of military personnel who are about to transition into the civilian life may need additional support to adjust and live successful lives.