Child sexual abuse, disclosure and PTSD: A systematic and critical review

Disclosing Sexual Victimization Online and In-Person: An Examination of Bisexual+ and Heterosexual Survivors

Bisexual+ (bisexual, pansexual, queer, attraction to more than one gender) people are at elevated risk for sexual victimization relative to their heterosexual counterparts. Disclosure of sexual victimization and social reactions received upon disclosure can play a major role in recovery following an assault. Using an online survey, the current study examined whether bisexual+ and heterosexual survivors of sexual victimization (N = 657) varied in disclosure of victimization, the type of disclosure (in-person vs. online via #MeToo), and receipt of various social reactions to disclosure in person and online. A chi-square test examined differences in disclosure and differences in types of disclosure (in-person only vs. MeToo across sexual identity). MANOVAS were used to examine whether in-person and online reactions varied across sexual identity. Bisexual+ survivors were more likely to disclose sexual victimization relative to heterosexual survivors. Among those who disclosed, bisexual+ survivors were more likely to disclose in person only whereas heterosexual survivors were more likely to disclose online via #MeToo. Whereas we did not find any significant differences for in-person reactions, we did find significant differences for online social reactions using #MeToo. Heterosexual survivors received higher turning against reactions (e.g., avoided talking to you or spending time with you) and more unsupportive acknowledgment relative to bisexual+ participants. Whereas bisexual+ participants received less turning against reactions and unsupportive acknowledgment during #MeToo/online disclosure, they were also less likely to disclose using #MeToo. Findings suggest that bisexual+ and heterosexual people vary in the way they disclose sexual victimization, and in how they are responded to when disclosing in person and online.

Sexual Abuse of Children With Disabilities: Key Lessons and Future Directions Based on a Scoping Review

In recent years there has been a growing public and professional interest in situations of risk, abuse, and exploitation of children with disabilities (CWDs). Despite the increasing awareness of CWDs experiencing child sexual abuse (CSA) at high rates, research in this area is still in its infancy. The current study seeks to identify, map, and thoroughly analyze the existing knowledge to better inform future research, policy, and practice. A scoping review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying 35 articles addressing CSA among CWDs based on self-report surveys, official report data, and qualitative interviews. The findings addressed the phenomenon's epidemiology, disclosure, identification patterns, and consequences. Studies showed that CWDs experience CSA two to four times more often than children without disabilities and that they suffer longer and harsher abuse due to factors that complicate the identification of CSA of CWDs. This review highlights the diverse methodologies, producing a high variance in phenomenon rates, as well as unique methodological strategies for addressing challenges in CSA and disability research. Future research should focus on qualitative-retrospective studies of the perceptions of survivors and significant others in their lives (e.g., parents). Moreover, an intersectionality paradigm must be adopted in future studies to address the diverse contexts that construct the phenomenon (including sociocultural contexts). There is also a need to develop integrative interventions to allow higher accessibility of services, adaptive identification mechanisms, and more effective collaboration between professionals and CWDs.

Brain structural change associated with Cognitive Behavioral Therapy in maltreated children

BACKGROUND

Severely maltreatment child is a harmful social factor that can disrupt normal neurodevelopment. Two commonly reported effects of maltreatment are post-traumatic stress disorder (PTSD) symptoms and brain structural and functional alteration. While Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is effectively used to reduce PTSD symptoms in maltreated children, yet, its impact on brain structural alterations has not been fully explored. This study investigated whether TF-CBT can attenuate alterations in brain structures associated with PTSD in middle childhood.

METHODS

The study evaluated the longitudinal effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on post-traumatic stress disorder (PTSD) symptoms and gray matter volume (GMV) in two groups of children under 12 years old: maltreated children (MC) and healthy non- maltreatmentd children (HC). Structural magnetic resonance images T1 were obtained before and after TF-CBT in the MC group, while the HC group was scanned twice within the same time interval. Voxel-based morphometry (VBM) was used to analyze GMV changes over time.

RESULTS

After TF-CBT, maltreated children showed significantly reduced PTSD symptoms. Furthermore, a significant group-by-time interaction effect was observed in certain areas of the Left Temporal, Left Occipital, and bilateral Frontal Cortex, the Basal Ganglia and Cerebellum. These interaction effects were driven by a GMV decrease in the MC group compared to the HC group. GMV changes can be predicted with clinical improvement in the left Middle Temporal gyrus, left Precuneus, and Cerebellum.

CONCLUSIONS

Our results suggest that TF-CBT intervention in very young maltreated children may have an effect on gray matter. This evidence demonstrates the importance of timely intervention when neuroplasticity mechanisms may be activated.

Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study

AIM

Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial.

METHOD

Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period.

RESULTS

Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated.

CONCLUSION

This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.

Associations of caregiver-adolescent conflict and caregiver emotional support with adolescent trauma symptoms and adjustment after sexual abuse

BACKGROUND

Emotional support from a caregiver is believed to be important for reducing the likelihood of adolescent trauma symptoms and adjustment problems after sexual abuse. Conflict with a caregiver, another relational dynamic, is very common during adolescence, but little is known about how it might operate in tandem with emotional support to influence adolescent trauma symptoms and adjustment after sexual abuse.

OBJECTIVE

To better understand how caregiver emotional support and caregiver-adolescent conflict jointly contribute to adolescent trauma symptoms and adjustment after sexual abuse.

PARTICIPANTS AND SETTING

Participants were 477 adolescents (Mage = 13.59, SD = 1.77) and a non-offending caregiver presenting at a children's advocacy center.

METHODS

Adolescents completed measures of caregiver-adolescent conflict, caregiver emotional support, and their own trauma symptoms and adjustment. Caregivers completed a measure of adolescent adjustment.

RESULTS

Caregiver-adolescent conflict and caregiver emotional support each correlated in the expected direction with adolescent trauma symptoms and adjustment (conflict correlations ranged from 0.27 to 0.38, all p values ≤.001; support correlations ranged from -0.15 to -0.21, all p values ≤.01). Regression analyses, which simultaneously considered conflict and support, indicated that conflict related to adolescent trauma symptoms and each of the measures of adolescent adjustment, whereas caregiver emotional support contributed to caregiver reports of adolescent adjustment. Caregiver-adolescent conflict did not moderate any of the relations between caregiver emotional support and adolescent trauma symptoms or adjustment.

CONCLUSIONS

In the aftermath of sexual abuse, caregiver-adolescent conflict contributes to adolescent trauma symptoms and adjustment.

A network approach to the symptom-level associations between smoking and posttraumatic stress disorder (PTSD) among young adults exposed to childhood sexual abuse

Background

Previous empirical literature has examined the associations between childhood sexual abuse (CSA) exposure, posttraumatic stress disorder (PTSD), and smoking. However, few studies examined symptom-level associations between smoking and PTSD among CSA victims. Thus, the aims of this study were 1) to explore symptom-level associations between smoking and PTSD among combustible cigarette (CC) and electronic cigarette (EC) users exposed to CSA and 2) to compare the differences manifested in two network structures between EC and CC users with CSA experiences.

Methods

This cross-sectional study covers all 63 universities and colleges in Jilin province, China, from October 26 to November 18, 2021. A total of 117 769 students participated in this study, while 3479 young adults were exposed to CSA (3.62%, 95% CI = 3.50%-3.73%). Childhood sexual abuse, PTSD, and smoking symptoms were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), 10-item Trauma Screening Questionnaire (TSQ-10), and the 6-item Fagerstrom Test for Nicotine Dependence (FTND-6), respectively. In addition, network analysis was applied to analyse psychopathological symptoms between EC and CC users with CSA experiences. Both the edges and centralities were computed, and the network properties were compared among the two groups.

Results

Four symptoms of PTSD (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were both central and bridge symptoms between PTSD and smoking among EC and CC users with CSA experiences. Moreover, compared with CC users with CSA, there were significantly stronger associations between "nightmares" - "difficulty with restrictions" and "irritability / anger" - "more during wake up" among young EC users with CSA.

Conclusions

The four symptoms (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were keystones for treatments or interventions targeting these CSA victims with PTSD and smoking symptoms. Increasing efforts should be taken to restrict morning smoking among EC users with CSA. In addition, target interventions and strategies founded on these core symptoms and associations should be implemented to relieve the comorbid PTSD and smoking in EC and CC users with CSA experiences.

The Role of Second Step Child Protection Unit Online Teacher Training in Explaining Teacher and Student Outcomes: Multilevel SEM Analysis

Child sexual abuse (CSA) is a concern given its prevalence and harmful consequences such as depression, anxiety, substance misuse, and low academic performance, which pose great threats to children's sustainable development. In response, teachers must be empowered to play crucial roles in preventing CSA and intervening to avert CSA-related harm. We therefore explored the potential for online teacher training to improve teachers' preventive outcomes of CSA (awareness, commitment, and confidence in reporting) and student outcomes (CSA knowledge and ability to recognize, refuse, and report CSA). To assess the immediate effect of online teaching training, we analyzed pre-and post-test data from the implementation of the Second Step Child Protection Unit (CPU) on 131 teachers and 2,172 students using a multilevel structural equation modeling approach. We found a significant direct effect of online teacher training on improving teachers' preventive outcomes. Furthermore, we detected a significant indirect effect of online teacher training on children's preventive outcomes of CSA knowledge and ability to recognize, refuse, and report CSA via teachers' preventive outcomes of CSA awareness.

What Can We Learn About the Others Present During Incidents of Child Abuse?: Key Lessons and Future Directions Based on a Scoping Review

Child abuse (CA) is a global problem that has received attention from policymakers, researchers, and practitioners. The majority of studies have focused on the phenomenon's epidemiology and consequences, alongside groundbreaking writing on victims and perpetrators. The concept of others who are present during the abuse is understudied and underdeveloped, despite its vital importance in better understanding children's experiences as well as their disclosure. The current study was designed to spotlight the phenomenon of others' presence, beyond the victims and perpetrators, during child abuse incidents. The current literature review was guided by a scoping review strategy. The results revealed scant empirical data, with only 15 studies meeting the inclusion criteria of the study. The articles that met the inclusion criteria addressed other people's presence during CA incidents, were published in peer-reviewed journals, and were written in the English language. These articles' analyses addressed the relations of the survivors with these others, pointing mainly to two identities: accidental bystanders who are not familiar with the child and family members of the child. The results provided a glance into the process that accidental bystanders go through during the abuse and the meaning of their presence for those who are family members. The perceptions and experiences of the children themselves with respect to the presence of the others during the abuse are noticeably lacking. The key conclusion from the current scoping review pinpoints the urgent need to advance the empirical knowledge on the presence of others during incidents of child abuse, especially others who are familiar to the children and are a significant part of their lives. The conceptualization of this phenomenon has the potential to better adapt prevention and intervention efforts in the field of child abuse.

"Our family sleeps deeply": The Presence of Others During Intrafamilial Child Sexual Abuse as Conveyed By Girls From Diverse Communities in Israel

Child sexual abuse (CSA) is generally perceived as a crime perpetrated out of sight, without witnesses. Nevertheless, several researchers have explored the presence of others during incidents of abuse in regards to two main aspects: bystanders in extrafamilial CSA and bystanders' decisions whether or not to get involved. However, there is a dearth of knowledge regarding how children who experience abuse perceive and experience the presence of others during abusive incidents. The current study was designed to examine the experiences and perceptions of girls who experienced intrafamilial CSA (IFCSA) with respect to the presence of others, as conveyed during their forensic interviews. A thematic analysis of 24 forensic interviews was conducted with secular Jewish, ultra-Orthodox Jewish, and Muslim Arab girls, aged 4-14. The analysis identified four main themes: (a) the girls' perceptions of others' awareness of them being abused, (b) the girl's experiences of loneliness, (c) the girls' experiences of disclosing to the others present during the abuse, and (d) family dynamics. The discussion highlights the unique, multifaceted and elusive dynamics of IFCSA, calling into question the commonly held view that it happens only in secret. The girls' narratives highlighted their distress and pointed to the abusive and unbearable daily routine in which they live. In spotlighting their encounters with IFCSA, the girls focused on the feelings of guilt, shame, and isolation they experienced.

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

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

Self-Reported Experience of Abuse During the Life Course Among Men Seeking General Psychiatric or Addiction Care-A Prevalence Study in a Swedish Context

A prevalence study was conducted using the NorVold Abuse Questionnaire for men (m-NorAQ) to estimate the prevalence of self-reported experience of life-course abuse and to identify the perpetrators of the abuse. This among men seeking general psychiatric and addiction care in a Swedish context. In total, 210 men completed the questionnaire, and were included in the study. The total prevalence of life-course abuse (i.e., any emotional, physical or sexual abuse during the life course) was 75% (n = 157). The results of this study indicate the importance of identifying experiences of life-course abuse among men in general psychiatric and addiction care settings.

The Longitudinal Effects of Second Step Child Protection Unit on Children: Gender as a Moderator

We investigated the longitudinal effects of the Second Step Child Protection Unit (CPU; Committee for Children) on student outcomes through a randomized controlled trial. Eight schools with a total sample including 2,031 students were assigned randomly to the CPU intervention or the wait-list control condition. We employed a multi-process latent growth model using a structural equation modeling framework which simultaneously analyzed student outcome growth via the effects of the intervention. The moderating effect of gender was also included. Over four data collection waves (pretest, posttest, follow-up [6 months] and follow-up [12-months]), the intervention group students were better able to recognize appropriate requests in CSA scenarios than control group students over time. Teacher-student relations improved for the students in the intervention schools but worsened for the students in the control schools over time. Despite concerns that CSA prevention programs may result in the unintended consequence of making children more fearful, children in both conditions did not show increased fears over time. The longitudinal effect on CSA recognition was more pronounced among girls, who suffer from higher CSA prevalence, compared with boys. Implications for prevention, policy, and directions for future research are discussed.

A One-Session Treatment of PTSD After Single Sexual Assault Trauma. A Pilot Study of the WONSA MLI Project: A Randomized Controlled Trial

Sexual abuse is a crime with devastating health consequences. Accessible, acceptable and affordable treatment of PTSD after sexual abuse is important. In this pilot study, a one-session PTSD treatment and a modified perspective to PTSD treatment is introduced. The aim of the study was to test the efficacy of one session of Modified Lifespan Integration (MLI) on reduction of symptoms of PTSD in individuals with PTSD after one sexual assault. This was a single-center, individually randomized waitlist-controlled treatment study with 1:1 allocation, with the intervention of one 90 - 140 minutes session of MLI and with post-treatment follow-up at 3 weeks (time point two). All participants were females, mean age 24, with PTSD symptoms after one sexual assault during the past 5 years. Exclusion criteria were poor understanding of Swedish, multiple traumas, active substance abuse, active psychosis, ADHD, or autism spectrum disorder. Of 135 interested participants, 38 were finally included, 36 completed baseline measures and were included in the intent to treat analyses and 33 were analyzed per protocol. The primary outcome was the difference between the two trial arms in mean PTSD symptoms as measured by the Impact of Event Scale Revised (IES-R) at time point two. In the intervention arm, 72% no longer scored PTSD in per-protocol analysis, compared to 6% in the waiting list arm. IES-R scores were on average halved in the intervention arm (F=21.37, P<0.001), but were essentially unchanged in the waiting list arm. No adverse effects or drop-outs were seen. One session of Modified Lifespan Integration was an effective treatment with a low drop-out rate for females aged 15-65 with PTSD after one sexual assault. Provided that this result can be replicated, MLI should be offered to these patients in clinical settings. Registration number NCT03141047 was given 03/25/2016 at ClinicalTrials.gov (https://register.clinicaltrials.gov/).

Interrelationship of Posttraumatic Stress, Hassles, Uplifts, and Coping in Women With a History of Severe Sexual Abuse: A Cross-Sectional Study

Experiencing trauma, such as sexual abuse, increases the risk of a negative health outcome. The aim of the present study was to compare two groups of female survivors of sexual abuse, one group with a lower indication of posttraumatic stress disorder (L-PTSD) and one with a higher indication of posttraumatic stress disorder (H-PTSD). We hypothesized that, with a history of sexual abuse, higher levels of PTSD symptoms would be associated with more daily hassles, fewer daily uplifts, and more maladaptive coping strategies, and that there would be more reporting of severe types of sexual victimization, less resourceful socioeconomic conditions and a lower level of emotional stability. A questionnaire, including measures of socioeconomic conditions, trauma experience, emotional stability (the Single-Item Measures of Personality), Posttraumatic Stress Disorder Checklist (PCL), daily hassles and uplifts (the Stress Profile), and coping strategies (the Brief Coping Orientation to Problems Experienced [COPE] questionnaire), was completed by 57 female users at nine support centers for survivors of incest and sexual abuse in Norway. The results show that the H-PTSD group reported significantly more daily hassles, fewer daily uplifts, and more use of maladaptive coping strategies. The L-PTSD group reported more emotional stability, fewer daily hassles, and more uplifts, and used more adaptive coping strategies. However, few differences were found between the H-PTSD and the L-PTSD groups with regard to severity of sexual abuse and socioeconomic conditions. The results on the hassle, uplift, and coping scales are potentially interesting from an interventional point of view. Major life events such as sexual abuse may be out of control for the afflicted victim. Appraisal of and coping with everyday events, however, can be affected and offer interesting possibilities for interventions directed at the survivor, her significant others, and professional helpers.

Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis

Background: Childhood sexual abuse (CSA) is one of the prevalent forms of trauma experienced during childhood and adolescence. Previous research underscores its associations with depression, anxiety, post-traumatic stress disorder (PTSD), and psychosis. Objective: This study examined symptom connections between depression, anxiety, PTSD, and psychosis while simultaneously investigating whether these connections differed by gender among CSA survivors. Methods: A large-scale, cross-sectional study among 96,218 college students was conducted in China. Participants' CSA was measured by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Participants' PTSD, psychosis, depression, and anxiety were measured by the Trauma Screening Questionnaire (TSQ), the Psychosis Screener (PS), the nine-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Network analysis was used to explore the potential associations between these symptoms and to compare the sex differences in the symptoms model. Results: Among participants who suffered from CSA, females were more likely from left-behind households, while males were more likely from households with a high annual income (P < .001, Cohen's W = 0.07). In addition, compared to male victims, female victims were more likely to report depression, anxiety, and PTSD (P < .001, Cohen's d≈0.2), while male victims were more likely to report psychosis (P < .001, Cohen's d = 0.36). Results from network estimation showed that psychosis, depression, anxiety, and PTSD symptoms were positively correlated. Moreover, psychosis had a stronger connection with PTSD symptoms, including hypervigilance, intrusive thoughts, and physiological and emotional reactivity. Conclusions: The current study explores the associations between PTSD symptoms and psychiatric symptoms among college students exposed to CSA using a network analysis approach. These crucial symptoms of PTSD may have potential connections to psychosis. Target intervention and strategy should be developed to improve mental health and quality of life among these CSA victims. Furthermore, longitudinal studies are warranted to advance our understanding of PTSD and psychosis.

The mediating role of transmembrane protein 132D methylation in predicting the occurrence of panic disorder in physical abuse

OBJECTIVE

Genome Wide Association study (GWAS) has revealed that the transmembrane protein 132D (TMEM132D) is a gene of sensitive for panic disorder (PD). As the main type of childhood trauma experience, childhood abuse has become a public health issue attracting much attention at home and abroad, and has been proved to be a risk factor for the onset of PD. However, how it affects the occurrence and development of panic disorder has not yet been revealed. We examined the relationship between TMEM132D methylation, childhood abuse and symptoms based on this finding.

MATERIALS AND METHODS

Thirty-two patients with PD and 22 healthy controls (HCs) were recruited after age, gender, and the education level were matched. The DNA methylation levels of CpG sites across the genome were examined with genomic DNA samples (PD, N = 32, controls, N = 22) extracted from subjects' elbow venous blood. A mediation model was used to explore the relationship between the methylation degree of different CpG sites and childhood maltreatment and clinical symptoms.

RESULTS

We found that the PD group had significantly lower methylation at CpG1, CpG2, CpG3, CpG4, CpG5, CpG6, CpG7, CpG8, CpG11, CpG14, and CpG18 than did the HCs (p < 0.05). The CpG2 (r = 0.5953, p = 0.0117) site in the priming region of TEME132D gene were positively associated with PDSS score. The CpG2 (r = 0.4889, p = 0.046) site in the priming region of TEME132D gene were positively associated with physical abuse. Furthermore, path analyses showed that the methylation of CpG2 of TMEM132D played a fully mediating role in the relationship between physical abuse and PD symptom severity (95.

CONCLUSION

Childhood abuse experiences, especially physical abuse, are significantly related to PD. The methylation of CpG2 of TMEM132D was shown to have a fully mediating effect between panic disorder and physical abuse. The interaction between TMEM132D methylation and physical abuse can predict panic disorder.

Dyadic Reports Using the Parental Support after Child Sexual Abuse Measure: Psychometrics and Associations with Post-Traumatic Stress Disorder Symptoms

This study assessed the psychometric properties of a new measure, the Parental Support after Child Sexual Abuse (PSCSA) survey, and tested the association between parents' and children's parental support reports and children's post-traumatic stress disorder (PTSD) symptoms. A total of 99 Icelandic children (86.5% girls, 6-18 years old, M = 13.9 years) starting therapy for child sexual abuse (CSA) and 98 non-offending parents (90.6% mothers, 23-58 years old, M = 41.2 years) participated in the study. Participants completed questionnaires on parental support (PSCSA) and children's PTSD symptom severity (University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition). A total of 18 items were considered for the PSCSA parent version and nine for the PSCSA child version. Five reliable factors emerged for the parent version (Emotional support, Instrumental support, Self-blame, Child blame and Disbelief) using 16 items and one factor (combined Emotional and instrumental support) emerged for the child's version using eight items. On average, ratings for both Emotional and Instrumental support were higher for parents than their children. Emotional support reported by both parents and children was negatively associated with PTSD symptom severity. The PSCSA survey is a promising dyadic measure for future research and clinical use in children's advocacy centres.

Boys should not be overlooked: Sexual violence victimization and associated factors among school-going adolescents in urban Ghana

BACKGROUND

Adolescent sexual violence victimization is still less researched in countries within sub-Saharan Africa, including Ghana.

OBJECTIVES

To estimate the 12-month prevalence of sexual violence victimization and describe the differences and commonalities in the associated factors between school-going boys and girls in urban Ghana.

PARTICIPANTS AND SETTING

Students (n = 1692) aged 13-19 years attending Second Cycle Schools in the Greater Accra Region of Ghana participated in this study.

METHODS

This is a cross-sectional survey involving the use of a self-report anonymous questionnaire. Items measuring sexual violence victimization and correlates were adopted from the 2012 WHO-Global School-based Student Health Survey. Data analysis involved bivariable and multivariable approaches.

RESULTS

Overall, 17.6% (95% confidence interval [CI] 15.7, 19.4) adolescents (males = 10.4% [95% CI 8.3, 13.6]; females = 24.3% [95% CI 21.5, 27.3]) reported sexual violence victimization during the previous 12 months. Girls (compared to boys) were nearly three times more likely to report sexual violence victimization (aOR = 2.74, 95% CI 2.01, 3.74, p < 0.001). Breakup, sexual minority status, and conflict with parents were uniquely associated with sexual violence victimization among females. Regardless of gender, adolescents who were in a romantic relationship (aOR = 1.63, 95% CI 1.19, 2.24, p = 0.002) and reported physical abuse victimization (aOR = 1.84, 95% CI 1.36, 2.49, p < 0.001) were more likely to report sexual violence victimization.

CONCLUSIONS

The prevalence of sexual violence victimization among school-going adolescents in urban Ghana compares with estimates from sub-Saharan Africa, but also warrants the need for universal and targeted prevention regimes against the offence in both boys and girls.

The longitudinal effects of maltreatment class membership on post-traumatic stress & depression

BACKGROUND

While the link between maltreatment and mental illness has been largely established, there is a need to better understand how certain types or profiles of maltreatment place youth at heightened risk for depression and traumatic stress, and when the risk of developing symptoms may be greatest.

OBJECTIVE

We examined the extent to which youth experiences of maltreatment co-occur and how certain combinations of maltreatment work to influence the subsequent development of depression and post-traumatic stress over time.

PARTICIPANTS & SETTING

Data were drawn from NSCAW-II, a nationally representative longitudinal sample of 5872 child welfare involved youth, aged 0-18.

METHODS

Latent Class Analysis was used to investigate profiles of child maltreatment. We then used a longitudinal three-wave panel design to examine whether membership in various maltreatment classes predicted development of depression and post-traumatic stress measured at two future time points.

RESULTS

Three classes emerged: Class 1 (68 %) the "Neglect and Adverse Parental Behaviors Class", Class 2 (20 %) the "Physical Abuse Class", and Class 3 (12 %) the "Sexual Abuse Class". Membership in Class 2 increased depression and trauma symptoms at Wave 2, compared to Class 1 (b = 1.8 and 1.4, respectively; p < 0.05). Membership in Class 3 increased trauma symptoms at Wave 3, compared to Class 1 and Class 2 (b = 2.3 and 2.7, respectively; p < 0.01).

IMPLICATIONS

Child welfare involved youth need to be appropriately screened for psychiatric health annually and provided with services that correspond with their level of need.

Delayed healthcare access among victims of sexual abuse, understood through internal and external gatekeeping mechanisms

BACKGROUND

Sexual abuse is associated with severe health consequences, and the European Union has, through the Istanbul Convention, urged its member countries to provide specialist care for victims of sexual abuse.

AIM

This aim of this study was to investigate patient- and abuse-related characteristics among patients seeking help at a specialist clinic in Sweden, with focus on disclosure, mental health and appropriate healthcare access.

METHODS

This is a descriptive study where journal data from 100 consecutive patients January 2017 to February 2018 were analyzed. All adult individuals (women n = 80, men n = 8) who had taken part in the standardized semi-structured intake interview at the clinic were included (n = 88).

RESULTS

At admission, mean age was 40.3 (SD 11.9), mean number of psychiatric diagnoses 6.3 (2.6), and 93% of the patients scored above cut-off (≥34) on IES-R for PTSD. A majority of the patients (87%) had been exposed to childhood sexual abuse (CSA), and mean time to first disclosure was 15.9 (SD 15.3) years. In total, 82% of the patients had, despite disclosure, experienced difficulties accessing appropriate healthcare before coming to the specialist clinic.

CONCLUSION

Adult victims of sexual abuse have difficulties accessing appropriate healthcare. This constitutes a gender-based equality problem. A model of gatekeeping mechanisms with two dimensions (external and internal) and three categories (Competence related, Organizational and Emotional) is proposed to understand these difficulties.

Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice

BACKGROUND

Child protection is and will be drastically impacted by the COVID-19 pandemic. Comprehending this new reality and identifying research, practice and policy paths are urgent needs.

OBJECTIVE

The current paper aims to suggest a framework for risk and protective factors that need to be considered in child protection in its various domains of research, policy, and practice during and after the COVID-19 pandemic.

STRATEGY

From an international collaboration involving researchers and child protection professionals from eight countries, the current paper examines various factors that were identified as playing an important role in the child protection system.

THE INITIAL SUGGESTED FRAMEWORK

Through the use of an ecological framework, the current paper points to risk and protective factors that need further exploration. Key conclusions point to the urgent need to address the protection of children in this time of a worldwide pandemic. Discussion of risk and protective factors is significantly influenced by the societal context of various countries, which emphasizes the importance of international collaboration in protecting children, especially in the time of a worldwide pandemic.

CONCLUSION

The COVID-19 pandemic has stressed the urgent need to advance both theory and practice in order to ensure children's rights to safety and security during any pandemic. The suggested framework has the potential to advance these efforts so that children will be better protected from maltreatment amidst a pandemic in the future.

Self-Harm Among School-Going Adolescent Survivors of Sexual Violence Victimisation: A Cross-Sectional Study

Background: A growing body of evidence from high-income contexts suggests a strong association between sexual violence victimisation and self-harm and eventual suicide. However, both sexual violence and self-harm among adolescents are still less researched in sub-Saharan African countries, including Ghana. Objectives: To estimate the 12-month prevalence of self-harm, and to describe the associated factors and reported reasons for self-harm among school-going adolescent survivors of sexual violence victimisation during the previous 12 months in urban Ghana. Methods: Analytic data came from a regional-based representative cross-sectional survey including in-school youth (N = 1,723) conducted in 2017 within the Greater Accra Region of Ghana. Of these, 297 (17.2%) self-reported sexual violence victimisation in the previous 12 months; this proportion of the participants (n = 297) was the focus of the current study. Items measuring sexual violence victimisation, self-harm, and correlates were adopted from the 2012 Ghana WHO-Global School-based Student Health Survey and the Child and Adolescent Self-harm in Europe Study. Data analysis involved multivariable logistic regression models. Results: The estimate of self-harm ideation during the previous 12 months was 45.8% (95% CI: 40-52), whereas the estimate of self-harm behaviour was 38.7% (95% CI: 33-44). About two in five of the participants who reported self-harm wanted to die by their last episode of the behaviour. While bullying victimisation was associated with increased odds of self-harm ideation (aOR = 1.97, 95% CI 1.17, 3.31, p = 0.010) and behaviour (aOR = 2.76, 95% CI 1.59, 4.80, p < 0.001), weekly alcohol use (aOR = 2.56, 95% CI 1.32, 4.93, p = 0.005), conflict with parents (aOR = 2.30, 95% CI 1.28, 4.12, p = 0.005), and physical abuse victimisation (aOR = 1.80, 95% CI 1.03, 3.15, p = 0.037) showed strong associations with increased odds of self-harm behaviour in the past 12 months. Conclusions: The evidence underscores the need for both universal and targeted multi-level intervention and prevention programmes to mitigate the offence of sexual violence and reduce the chances of self-harm among adolescent survivors of sexual violence in urban Ghana.

Child Sexual Abuse and Adult Sexual Assault among Emerging Adults: Exploring the Roles of Posttraumatic Stress Symptoms, Emotion Regulation, and Anger

Child sexual abuse (CSA) has been previously linked with a risk for adult sexual assault (ASA) and posttraumatic stress symptoms (PTSS). Yet, the relations between CSA, ASA, and other psychological outcomes that may contribute to increased risk for ASA are less clear. This study aims to: 1) examine the links between CSA and ASA and potential risk factors (i.e., PTSS, emotion dysregulation, anger), 2) determine whether there are indirect effects between CSA and ASA through each factor, and 3) investigate whether there are indirect effects between CSA and ASA through the DSM-5 posttraumatic stress disorder (PTSD) symptom clusters. The sample included 567 undergraduates (M_age = 20.84, SD = 4.10; 81.1% women; 56.6% white) from two universities. Both CSA and ASA were related to PTSS, emotion dysregulation, and anger. There were indirect effects of CSA on ASA through PTSS and anger (B = .04, B = .01, respectively). CSA was associated with each of the PTSD symptom clusters, but only marked alterations in arousal and reactivity were linked with ASA (B = .01). The clusters had no indirect effects on the relation between CSA and ASA. These findings revealed several factors that may be linked with increased risk for sexual victimization.

Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed.

Prediction of the development of depression and post-traumatic stress disorder in sexually abused children using a random forest classifier

BACKGROUND

Depression and post-traumatic stress disorder (PTSD) are among the most common psychiatric disorders observed in children and adolescents exposed to sexual abuse.

OBJECTIVE

The present study aimed to investigate the effects of many factors such as the characteristics of a child, abuse, and the abuser, family type of the child, and the role of social support in the development of psychiatric disorders using machine learning techniques.

PARTICIPANTS AND SETTINGS

The records of 482 children and adolescents who were determined to have been sexually abused were examined to predict the development of depression and PTSD.

METHODS

Each child was evaluated by a child and adolescent psychiatrist in the psychiatric aspect according to the DSM-V. Through the data of both groups, a predictive model was established based on a random forest classifier.

RESULTS

The mean values and standard deviation of the 10-k cross-validated results were obtained as accuracy: 0.82% (+/- 0.19%), F1: 0.81% (+/- 0.19%), precision: 0.81% (+/- 0.19%), recall: 0.80% (+/- 0.19%) for children with depression; and accuracy: 0.72% (+/- 0.12%), F1: 0.71% (+/- 0.12%), precision: 0.72% (+/- 0.12%), recall: 0.71% (+/- 0.12%) for children with PTSD, respectively. ROC curves were drawn for both, and the AUC results were obtained as 0.88 for major depressive disorder and 0.76 for PTSD.

CONCLUSIONS

Machine learning techniques are powerful methods that can be used to predict disorders that may develop after sexual abuse. The results should be supported by studies with larger samples, which are repeated and applied to other risk groups.

Association of abuse-specific, familial, and post-incident factors with patterns of behavior problems in sexually abused preschoolers

BACKGROUND

The negative effects of child sexual abuse are well known; however, limited research has been conducted on the symptom patterns and their predictors in sexually abused preschoolers.

OBJECTIVE

The aim was to identify the subtypes of parent-reported behavior problems and sexual behaviors among sexually abused preschool-aged children using latent profile analysis (LPA) and investigate factors that can affect the identified subtypes.

PARTICIPANTS AND SETTING

Participants included 194 (28 males; 166 females) sexually abused children (age, 3-6 years) located in the Republic of Korea.

METHODS

LPA was performed using the seven syndrome scales of the Korean version of the Child Behavior Checklist for ages 1.5-5 and the Child Sexual Behavior Inventory as indicators. Demographic, sexual abuse characteristics, familial variables, and post-incident variables were compared between the derived classes. Multinomial regression analysis was performed to investigate the predictors for each class.

RESULTS

Four classes were obtained from LPA: "Mild" (29.9 %), "Moderate" (18.0 %), "High Internalizing" (21.6 %), and "High Internalizing/Externalizing" (29.9 %). The Mild group included more cases of a single episode of abuse or victimization by strangers and immediate disclosure. Marital conflict was significant in differentiating the High Internalizing/Externalizing group from the other groups.

CONCLUSIONS

Sexually abused preschoolers could be classified into three groups according to severity, and the severe group could be classified into two heterogeneous groups. Furthermore, relationship with the perpetrator may predict more serious internalizing behavior problems, and marital conflict may be associated with complex symptoms involving externalizing and sexual behavior problems.