Factors that prevent, prompt, and delay disclosures in female victims of child sexual abuse

Risk and Protective Factors for the Sexual and Reproductive Health of Young Adolescents: Lessons Learnt in the Past Decade and Research Priorities Moving Forward

PURPOSE

To review the published literature on what has been reported on risk and protective factors for early adolescent sexual and reproductive health (SRH) in the recent decade.

METHODS

A scoping review of English language, peer-reviewed literature on risk and protective factors for early adolescent (aged 10-14 years) SRH published between January 2010 and January 2023 using Medline, Web of Science, PsycInfo, CINAHL, and Google Scholar. Articles reporting only on nonmodifiable demographic factors, or on the effect of interventions, were beyond the scope of this review.

RESULTS

Of 11,956 screened records, 118 were included of which half (49.2%) were published since 2018. Most articles (44.9%) presented research conducted in North America, followed by sub-Saharan Africa (20.3%) and East Asia and Pacific (16.1%). Five percent were based on multicountry studies or reported on pooled global data. Two-thirds (61.0%) reported on quantitative cross-sectional research designs, and 78.8% included both females and males. The most common SRH outcomes were sexual behaviors (34.7%); sexual and dating violence (28.8%); and sexual attitudes, beliefs, and intentions (19.5%). Most (83.0%) articles reported on risk/protective factors at the individual level, followed by interpersonal (family 58.5%, peers 33.0%, partners 11.9%), school (21.2%), and community (15.2%) factors. None of the included articles reported on macro/structural-level factors.

DISCUSSION

While there has been growing attention to risk/protective factors for early adolescent SRH, gaps remain with regards to study contexts (mainly North America), focus (mostly individual factors), and conceptualizations (generally risk-oriented). We offer recommendations for research priorities over the coming decade.

Orofacial manifestations of child maltreatment: A review

The recognition and reporting of child abuse and neglect continues to be a challenge in the healthcare setting. All healthcare providers, including dentists, should be aware of the high prevalence of orofacial injuries and conditions that are concerning for abuse and neglect. Sentinel injuries may appear trivial and do not require medical attention, but are unlikely caused by accidental mechanisms and, if not properly identified, often precede more severe abusive injuries. Concerning orofacial findings can manifest as bruising, eye injuries, intraoral injuries, pharyngeal perforations, facial bone fractures, and sexually transmitted infections. Abusive caregivers are likely to give inadequate explanations or no history at all to explain concerning findings. Medical providers' failure to make mandated reports about their concerns to the appropriate agencies can have significant long-term impacts on the physical and psychological well-being of children.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Longitudinal predictors of children's self-blame appraisals among military families reported for family violence

BACKGROUND

Although children's self-blame appraisals are recognized as important sequelae of child victimization that contribute to subsequent adjustment problems, little is known about the factors that predict their development and longitudinal course.

OBJECTIVE

The current study examines the stability and longitudinal predictors of children's self-blame appraisals among a sample of children reported for family violence.

PARTICIPANTS AND SETTING

Children (N = 195; 63 % female) aged 7 to 17 years (Mage = 12.17) were recruited as part of a longitudinal assessment of families referred to the United States Navy's Family Advocacy Program due to allegations of child physical abuse, sexual abuse, or intimate partner violence.

METHODS

Children completed assessments on self-blame at 3 time points (baseline, 9-12 months, and 18-24 months) and baseline measures of their victimization experience, caregiver-child conflict, and depression.

RESULTS

In univariate analyses, victimization that involved injury (r = 0.29, p < .001), the number of perpetrators (r = 0.23, p = .001), the number of victimization types (r = 0.32, p < .001), caregiver-child conflict (r = 0.36, p < .001), and depression (r = 0.39, p < .001) were each positively associated with baseline self-blame. When examined in a single longitudinal multilevel model, results indicated only caregiver-child conflict (b = 0.08, p = .007) and baseline depression (b = 0.06, p = .013) predicted increases in self-blame.

CONCLUSION

Findings suggest clinicians and researchers may consider assessment of victimization characteristics, caregiver-child relationships, and depression symptoms to identify children most at risk for developing self-blame appraisals.

Timing of Sexual Assault Disclosure: A Study of College Women

The present study examined correlates of immediate (within 48 h) and delayed (after 48 h) sexual assault disclosure among a sample of 83 college women who experienced sexual victimization since age 14. The use of physical resistance and experiencing a "freeze response" was positively associated with delayed disclosure. Identifying the perpetrator as a friend/acquaintance, compared to a was a romantic partner, increased the likelihood of immediate disclosure. Other individual characteristics (i.e., assault characteristics, a history of childhood sexual abuse, attitudes towards seeking help, and sexual assertiveness) and microsystem-level characteristics (i.e., perceived social support) did not impact the timing of disclosure.

Child sexual abuse in Kaduna State, Northwestern Nigeria: A review of 420 police-reported cases

Child sexual abuse affects millions of children globally but in Nigeria, hospital-based studies continue to report few cases, making it difficult to assess the magnitude and quality of care. This study aimed to overcome this challenge by reviewing police medical reports instead of hospital records. A total of 420 reports were retrieved from one police area command in Kaduna State, Northwestern Nigeria, between 2018 and 2021. The majority of the victims were females (65.5%), 5-14 years (70.2%), and familiar with their assailants (71.4%). Most of the assailants were men (99.0%), 20-40 years (29.1%), who acted alone (86.7%). Most of the reports contained history (79.3%), physical examination (49.6%), and laboratory results (>90%). Among female victims, the commonest genital findings were absent hymen (25.6%) and normal findings (17.6%). Among male victims, the commonest anal findings were normal findings (41.7%) and anal dilatation (23.6%). The victims tested positive for HIV (0.5%), hepatitis B (4.7%), hepatitis C (1.0%), and syphilis (0.8%). Higher positivity rates were noted among assailants. Treatments offered to the victims included antibiotics (30.2%), analgesics (11.9%), emergency contraception (6.7%), and psychotherapy (67.4%). The review calls for improved reporting, use of comprehensive treatment guideline, and training of service providers to improve the quality of care.

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.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

"The most shocking thing was that I didn't respond to the abuse": The peritraumatic responses and transitions as conveyed by survivors of continuous child sexual abuse

BACKGROUND

Child sexual abuse (CSA) is a worldwide phenomenon with ongoing and far-reaching consequences for millions of children worldwide. It is a consensus among researchers that continuous CSA represents a unique challenge.

OBJECTIVE

The current study aimed to explore the peritraumatic responses of survivors of continuous CSA as described in their written narratives of abuse. The transitions between the peritraumatic responses will also be examined, highlighting the unique context of continuous CSA.

PARTICIPANTS AND SETTING

Written narratives of CSA were recruited via an advertisement in the media inviting CSA survivors to share their stories of abuse on an anonymous online platform. The data collection was carried out under the Israeli Independent Public Inquiry on CSA.

METHODS

A qualitative thematic analysis was applied to 32 richly written accounts of abuse.

RESULTS

Three peritraumatic responses were identified: the adaptive response, hinting, and attempts to fight and flight. Transitions between these responses were described by the survivors and addressed the heavy load of the abuse, realization of the abuse, fear of consequences and the central role of the survivor's environment.

CONCLUSIONS

The current study provides a unique platform for the exploration of peritraumatic responses in continuous CSA. Alongside the identification of three peritraumatic responses described by the survivors, the current study provides an initial glance into transitions between peritraumatic responses. This insight strengthens the developing notion that peritraumatic responses in the unique context of CSA are a top-down process, often shaped by various contexts and multidimensional dynamics in the children's lives.

The Centrality of Child Maltreatment to Criminology

Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.

Bullying, Psychological, and Physical Trauma During Early Life Increase Risk of Major Depressive Disorder in Adulthood: A Nationwide Community Sample of Korean Adults

BACKGROUND

There is an association between early life traumas and the development of depression in adults. Few studies have used nationwide population-based samples to investigate whether the type of early life trauma differentially influences the risk of developing depression.

METHODS

Major depressive disorder and early life trauma were assessed using the Korean version of the Composite International Diagnostic Interview (K-CIDI) for DSM-IV psychiatric disorder and a questionnaire for early life trauma in the Korean Epidemiological Catchment Area Study in 2016. A total of 4,652 participants were included in the final analysis. This study evaluated the effect of the type and frequency of reported early life trauma on the risk of developing MDD and the association between reported early life trauma and differential symptoms of MDD.

RESULTS

Individuals with reported early life trauma had a 3.7-fold increased risk of MDD. The risk of MDD was associated with bullying trauma (odds ratio (OR) = 1.847, p = 0.005) after adjusting for age, gender, marriage, job, and education years. The risk of MDD was increased as the types of reported early life traumas increased.

CONCLUSION

Bullying trauma during early life represents a risk factor for MDD, especially in individuals exposed to multiple traumas in early life.

Predicting disclosure latency in substantiated cases of child sexual abuse

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

An Italian single-centre retrospective analysis of 1106 consecutive cases of child and adolescent abuse: key elements of effective practices

BACKGROUND

Child and adolescent maltreatment refer to several forms of abuse and neglect, with negative and harmful consequences on children's and adolescents' physical and psychological health.

METHODS

This study aims to provide a wide perspective on child and adolescents maltreatment from a large, public, anti-violence centre located in a university hospital (SVSeD, Sexual and Domestic Violence Service) and to suggest models of tailored therapeutic interventions and proposals for effective clinical practice.

RESULTS

The sample study was obtained by analyzing 1106 medical records of victims aged 0 to 17 referring to SVSeD for all types of abuse. Our findings confirm that almost in one third (28,2%) of the cases children and adolescents are victims of multiple different types of violence. In our experience, sexual violence plays a leading role (66% of cases), being the most frequent type of child and adolescent abuse.

CONCLUSIONS

This study confirms that child and adolescent abuse could manifest in many different ways, which are often not so easily detected, as the violence usually occurs inside the family. Institutional educational programs should be implemented to increase the health practitioners' skills and competence for detecting and reporting children and adolescents who are victims of abuse.

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

BACKGROUND

Child sexual abuse (CSA) has been linked to a higher risk of sexual re-victimization, including sexual intimate partner violence (IPV). The aim of this study was to investigate whether borderline personality disorder (BPD) features, dissociation, and maladaptive cognitive emotion regulation mediate the link between self-reported CSA severity and sexual IPV. Specifically, we were interested in the unique effect of each mediator variable, when accounting for the effect of the other variables.

METHODS

Data was assessed in a cross-sectional anonymous online survey, posted on platforms for people affected by domestic violence, and research platforms of Leiden University. Overall, n = 633 participants completed the survey (including n = 100 participants with CSA and n = 345 reporting at least one incidence of sexual IPV). Multivariate regression analyses and path-analytical modelling were performed for hypothesis testing.

RESULTS

Adult sexual IPV was predicted by more severe CSA, more severe BPD features, higher dissociation, and more maladaptive emotion regulation. Each mediator variable showed a significant effect in the separate mediation models. In the overall model, only dissociation and maladaptive emotion regulation, but not BPD features, mediated the association between CSA and sexual IPV.

CONCLUSIONS

Findings add to the existing literature, suggesting that CSA severity, BPD features, dissociation, and maladaptive emotion regulation are important risk factors for sexual IPV. Given the cross-sectional correlational design of our study, prospective studies are needed to corroborate our findings regarding potential psychological mechanisms underlying sexual re-victimization. Ultimately, this can help developing interventions aimed at breaking the cycle of abuse.

What to do when a child reports sexual harassment and sexual assault to a medical professional

Global exposure of children to sexual abuse is widespread. Disclosure may be extremely upsetting for both families and medical professionals. This review provides medical practitioners with practical tips for a stepwise approach of the child who discloses sexual abuse. Having secured a private examination room, the physician should approach the child and caregivers separately to determine the level of concern for abuse and the urgency of the situation. The medical evaluation is based on the information gathered, including a complete physical examination, inspection of the genitalia, collection of forensic evidence, and testing for sexually transmitted diseases. On a case-by-case basis, the need for surgical intervention, prophylactic treatment, and immunization is discussed. Finally, important questions for the medical team to address are outlined with the goal of supporting the child and his/her family and ultimately stopping the abuse.