Child sexual abuse: consequences and implications

Interpersonal Difficulties Arising from Child Sexual Abuse: Differences Between Intra-familial and Extra-familial Abuse Victims

Child sexual abuse (CSA) often has serious implications for the victims. The scientific literature reflects a diversity of sequelae that may appear in the short and long term. Interpersonal difficulties have been shown to be one of the most common consequences. However, studies comparing these sequelae between victims of intra-familial (IF) and extra-familial (EF) CSA are scarce. The aim of this research was to analyze differences in dyadic satisfaction, sexual satisfaction, and attachment patterns in adulthood between Spanish IF victims, EF victims, and non-victims of CSA. The Sexual Victimization Subscale of the Juvenile Victimization Questionnaire, the Relationship Assessment Scale, the New Sexual Satisfaction Scale, and the Adult Attachment Questionnaire were administered to 140 adults (94 CSA victims and 46 non-victims) aged 18 to 54 years. CSA victims scored lower than the non-victims on the personal sexual satisfaction factor and attachment factors characterized by the need for approval, hostile resolution of conflicts, and emotional self-sufficiency. Statistically significant differences were also found between the victim groups in the factors characterized by the need for approval and communication of feelings and comfort with relationships showing the IF group to have more impairment in these areas than the EF group. In conclusion, CSA may have serious implications for the development of victims' interpersonal relationships. The context of sexual abuse and the relationship between victim and offender appears to play a role in the development of relational problems. These findings highlight the need to implement specific strategies in the psychological treatment of victims depending on their relationship with the offender and the environment in which the abuse occurred.

Child Sexual Abuse in Nigeria: A Systematic Review

Child sexual abuse (CSA) is a major social and public health issue that creates short- and long-lasting impacts on victims, families, and society. While global researchers have considered the topic of CSA since the 19th century, the Nigerian context has been largely ignored. Yet, without sufficient evidence and understanding, making changes to practices and policies becomes almost impossible. The review aimed to gain insights into the nature and extent of CSA and identify areas for improvement in practice and research in Nigeria. This article presents the findings of a systematic review of 31 empirical articles related to CSA in Nigeria. Using key search terms along Boolean operators and truncation, PubMed, PsycINFO, CINAHL, ASSIA, PILOTS, African Journals Online, and Google Scholar were searched. A total of 1,325 studies were found, and 31 empirical studies, including 20 quantitative, 9 qualitative, and 2 mixed methods studies, were included. The review findings reveal the discourse on CSA and delve into various aspects such as its prevalence, manifestation patterns, root causes, management, and consequential impact on victims and societal domains. The gaps in the existing literature are identified and explored to identify areas for improvement in victim services, societal awareness, and healthcare practices and relevant policies. The sociocultural norms not only heightened children's vulnerability to sexual abuse but also posed significant barriers to them disclosing such abuse. Survivors of CSA often receive inadequate care, indicating a pressing need for improvements in this area. Implications for research, policy, and conclusion were discussed.

Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy

Introduction

Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom.

Methods

The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample.

Results

Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life.

Discussion

Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology.

Ethics and dissemination

The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.

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.

Nonconsensual Sexual Experience Histories of Incarcerated Men: A Mixed Methods Approach

Nonconsensual sexual experiences (NSEs) may contribute to mental health concerns among incarcerated individuals, yet NSEs are understudied in this population. This study takes a novel approach in examining the prevalence of NSEs among incarcerated males by utilizing both quantitative and qualitative measures. The sample consisted of 189 men from three provincial maximum-security prisons in Ontario, Canada. Based on quantitative findings, 44.2% of the sample experienced NSEs before the age of 18, and 41.7% of the sample endorsed an experience that fit the legal definition of a NSEs as adults. Participants also responded to a qualitative open-ended question about their history of NSEs. Based on qualitative findings, a total of 23% of the men reported at least one incident of a NSE (e.g., child and adult). Based Findings highlight the high prevalence of NSEs among incarcerated men with quantitative responses demonstrating how the use of a behavioral questionnaire may, to some extent, correct for underreporting of NSEs. Qualitative responses illustrate the lived experience of incarcerated men and provide a deeper understanding of their NSEs. Responses also speak to the lack of resources and support available to these men. Findings underscore the need for proactive approaches in meeting mental health needs of incarcerated men in general and with regard to NSEs in particular. Results may inform the development of future correctional procedures (i.e., intake protocols that account for men with NSEs) and resources to support incarcerated men in navigating the psychological impact of non-consensual sexual experiences.

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

BACKGROUND AND OBJECTIVE

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

METHODS AND RESULTS

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

CONCLUSIONS

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

A Longitudinal Study in Worrisome Sexual Behavior Following Sexual Abuse in Infancy or Early Childhood: The Amsterdam Sexual Abuse Case

Worrisome sexual behavior (WSB) is often described as an outcome specific to child sexual abuse (CSA). Therefore, it is highly relevant to study WSB in relation to sexual abuse, especially in very young children, as it is hard to recognize sexual abuse in children who have limited verbal capacities of disclosing. Over time, literature describing WSB following CSA has gradually broadened. However, a gap remains regarding the long-term development of WSB in children who were sexually abused during infancy or very early childhood. To our knowledge, our study is the first to examine developmentally-related sexual behavior versus sexual abuse-specific behavior longitudinally in children who were sexually abused at a very young age. In total, we examined the sexual behavior, as reported by parents of 45 children who experienced early-age sexual abuse for a period of more than five years. Overall, we found that WSB is likely to be a CSA-specific and potentially long-term outcome for children who were sexually abused at a very young age. Despite the decrease in sexual abuse-specific behavior over time, the level of this behavior was still significantly high 8 years after the sexual abuse. This finding supports long-term monitoring and assessment and intervention for WSB over time. Despite these findings, it is important to note that WSB does not serve as proof of sexual abuse in children; likewise, when a child does not present with WSB, it does not indicate the absence of a substantiated history of sexual abuse.

Effectiveness of child sexual abuse prevention programs on knowledge acquisition: A meta-analytical study

BACKGROUND

Child sexual abuse (CSA) is a type of maltreatment considered a global health problem. CSA is a traumatic experience with important consequences for the victim's health. It is essential to report the effectiveness of CSA prevention programs to offer society useful tools to combat this abuse.

OBJECTIVE

We aimed to study the effectiveness of CSA prevention programs on the knowledge acquisition based on comparing pre- and post-treatment changes, and also if their effectiveness is related to program-related and methodological variables.

PARTICIPANTS AND SETTINGS

Standardised mean change (with studies that report pre-post program measures) of the effectiveness of CSA prevention programs published between 2014 and 2021 was carried out.

METHODS

The general effectiveness of these programs and whether the results were influenced by program-related variables (the duration, the target population, participants' age, or the type of intervention) or by methodology-related factors (the agent who taught them, the geographical area where they were carried out or the way the programs were evaluated) were analysed. A total of 43 samples analysing knowledge about CSA as a dependent variable were included.

RESULTS

The results reported a combined effect size considered large (dMR = -0.96, 95 % CI [-1.10, -0.82], p < .001). High inter-study heterogeneity was observed in the meta-analysis, although only the geographic area where the studies were conducted appears as a significant moderator.

CONCLUSIONS

In conclusion, the prevention programs included in this analysis significantly improved the participants' knowledge acquisition.

Knowledge, Skills, and Self-Disclosure Following a Sexual Abuse Prevention Program Among Iranian Preschoolers: A Cluster Quasi-Experimental Controlled Study

Standard empirical studies are needed despite three decades of research on child sexual abuse prevention programs (CSAPPs). This study aimed to investigate the effects of CSAPP on the child's sexual safety. A multicenter, random cluster, quasi-experimental controlled survey was conducted in a 1:1 ratio in Tehran, Iran, from May to December 2019 in seventy 5- to 6-years-old children from 10 kindergartens. In groups of 7 to 8, the intervention group participated in four sessions of 45 minutes of face-to-face sexual self-care training, 3 to 4 days apart. The control groups received one session on accident safety. Knowledge, self-protective skills, fear, and self-disclosure were assessed respectively by the "Personal Safety Questionnaire (PSQ)," "What If Situation Test (WIST)," "Fear Assessment Thermometer Scale (FATS)," and researcher-made questions before and 8 weeks after the intervention. At the baseline, children obtained 70% of knowledge and 45% of protective skills scores. After the intervention, knowledge, protective skills, and detection of "appropriate requests" were significantly promoted (p < .001). Detecting "inappropriate requests" did not differ; however, all quadruple skills (Say, Do, Tell, and Report) improved significantly. "Girl sex" and "parents' education" were related factors promoting children's protective skills. Sexual abuse self-disclosure was 4.2% (n = 3), and one child reported child sexual abuse (CSA) only after the intervention. Despite the lack of formal education, children's basic knowledge reflects the importance of parents in preventing CSA. However, the CSAPP significantly improved children's skills and revealed one CSA case. CSAPP should not focus solely on risky scenarios because if children cannot distinguish between safe and unsafe situations, they will experience unnecessary anxiety. Even after recognizing the dangerous conditions, CSA prevention will practically fail without appropriate reactions such as escaping and reporting. CSAPP should emphasize individual rights such as body ownership and assertiveness skills and explain the "danger of known people" with detailed scenarios, especially in collectivistic and traditional societies.

Association of Dissociation with Suicide Attempt and Non-Suicidal Self Injury in Adolescents with a History of Sexual Abuse

Objective: Dissociative symptoms are considered risk factors for suicide and non-suicidal self-injury (NSSI). In this study, the relationship between suicidal behaviors and NSSI with dissociative symptoms in adolescents with a history of Child Sexual Abuse (CSA) was investigated. Methods: A total of 100 adolescents with a history of CSA were evaluated with a detailed forensic psychiatric interview. Dissociative symptoms were measured with the self-report Adolescent Dissociative Experiences Scale (A-DES) and the parent-reported Child Dissociative Checklist (CDC). Results: While dissociative symptoms did not differ between adolescents with and without suicide attempts (CDC; p = .068 and A-DES; p = .060), they were significantly higher in adolescents with non-suicidal self-harming behavior (CDC; p < .001 and A-DES; p = .001). Suicide attempts and NSSI were more common in those who reported genital touching as a type of sexual abuse (respectively, p = .003; p = .048). In regression analysis; history of psychiatric treatment (OR = 9.09 [95% CI = 1.52, 54.29]) and NSSI (OR = 8.18 [95% CI = 2.01, 33.23]) were independently associated with suicide attempts. In addition, parent-reported dissociative symptoms (CDC scores) (OR = 1.27 [95% CI = 1.06, 1.53] and suicide attempt (OR = 8.09 [95%CI = 1.96,33.42] showed independent association with NSSI. Conclusions: Dissociative symptoms may be predictive factors for NSSI and should be considered in risk assessment of adolescents with a history of CSA.

One-year Cohort Follow-up on the Diagnosis and Posttraumatic Symptoms in Child Sexual Assault Victims in Korea

OBJECTIVE

The victims and their families of child sexual abuse (CSA) may confront persistent psychological sequela. We aimed to investigate the psychological symptoms, diagnosis, and family functions in children and adolescents with CSA.

METHODS

We assessed the symptom scales at 6-month intervals, and conducted diagnostic re-assessments at 1-year intervals. Trauma Symptom Checklist for Children (TSCC), Trauma Symptom Checklist for Young Children (TSCYC), Family Adaptability and Cohesion Evaluation Scales IV (FACES-IV), and Family Communication Scale (FCS) scores were reported by children or parents.

RESULTS

We found in parent-reported TSCYC, that posttraumatic stress symptoms domain scores significantly decreased with time progression. The scores decreased more in the evidence-based treatment group over time in anxiety and posttraumatic stress symptom domains of TSCC. In FACES-IV and FCS scores, indices of family function have been gradually increasing both after 6 months and after 1 year compared to the initial evaluation. Further, about 64% of the children diagnosed with psychiatric diseases, including posttraumatic stress disorder (PTSD) at the initial assessment maintained the same diagnosis at follow-up.

CONCLUSION

We observed changes in psychological symptoms and family functioning in sexually abused children with time progression during 1 year. It is postulated that PTSD may be a persistent major mental illness in the victims of CSA.

Digital games and virtual reality applications in child abuse: A scoping review and conceptual framework

Child abuse refers to any form of maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect that occurs to children under 18 years of age. Digital games and virtual reality (VR) can be used as beneficial solutions for dealing with child maltreatment concerns. This study aimed to present a conceptual framework for showing the applications of these technologies in managing child abuse. The framework is developed in two stages: (1) a scoping review to gather digital games and VR applications for child abuse issues through the search in PubMed, Ovid (APA PsycInfo), Scopus, Web of Science, ProQuest, Institute of Electrical and Electronics Engineers (IEEE), Cochrane Database of Systematic Reviews, and grey literature and (2) developing a conceptual framework based on the review results and validating it by 12 experts. The proposed conceptual framework shows that digital games and VR have been used for six main topics: (1) medical education, (2) prevention, (3) screening, (4) diagnosis, (5) treatment, and (6) forensic medicine in response to child abuse issues. Studies have more focused on child sexual abuse prevention, behavioral monitoring of sexual offenders in forensic medicine, and knowledge or performance assessment of students in medical education. Serious games (SGs), computer simulation, and immersive VR were common technologies for children, students, and forensic medicine, respectively. The experts believe the combination of immersive features of VR with SGs can further encourage user engagement. It appears that digital games and VR can play a positive role in child abuse management. Given the extensive capabilities of these technologies, further studies are needed to show all their potential applications for child abuse problems.

Prevalence of Child Sexual Abuse in Spain: A Representative Sample Study

The prevalence of child sexual abuse (CSA) is difficult to assess, and rates vary widely across studies due to methodological and sample differences. In Spain, prevalence data from representative samples are lacking. The objective of this study was to determine the prevalence of different CSA experiences in a sample that was representative of the Spanish population in terms of gender, age, and region. The sample comprised 1,071 (539 male and 532 female) Spanish adults (M_age = 45.37; SD = 14.84). Participants completed an anonymous online survey about different types of CSA and were asked whether they had disclosed the experience at the time. Prevalence was analyzed as a function of gender and generation. Results indicated prevalence rates ranging from 2.8% to 18.5%, depending on the type of experience. The most common experience suffered during childhood was being shown pornographic material, while that with the lowest prevalence was being forced to perform a sexual act involving penetration. Prevalence was higher in females than males for eight of the ten experiences considered. Young adults from Generation Z were the most likely to report having suffered three of the CSA experiences, two of them related to technology. Only 27.5% of respondents said that they had told someone about the abuse at the time, mainly their mother (more common among females) or a friend/peer (more frequent among males). The results suggest that CSA is prevalent in Spain, with considerable rates for several types of abusive experience, especially among females and the youngest generation. The implications of the results are discussed. The findings may inform social policy and the development of effective prevention programs.

Prevalence of Child Contact Sexual Abuse in the Spanish Region of Andalusia

The aim of this study was to analyze the prevalence and characteristics of child sexual abuse (CSA) in Andalusia, Spain's most populated region. A sample of 817 adults (281 male; M age = 34.7; SD = 13.86) completed the Child Sexual Abuse Experiences Questionnaire. Because the sample was unbalanced, we performed post-stratification by gender, resulting in 562 participants (50% male). Overall, 38.8% of the sample reported at least one type of contact abuse experience, with prevalence ranging from 22% for being fondled to 3.9% for being forced to perform a sexual act involving penetration. The first episode of CSA most commonly occurred between age 6 and 11 years, except for penetration. The majority of reported experiences were repeated and perpetrated by a male. More than half of the victims did not label their experience as sexual abuse, and this apparent lack of awareness about what constitutes abuse was particularly evident among male victims. The prevalence of CSA in Andalusia is higher than for Spain as a whole, highlighting the need to raise public awareness through prevention programs.

STAIR Plus Narrative Therapy-Adolescent Version (SNT-A) in An 11-Year-Old Girl With PTSD and Suicidal Behaviors Following Rape/Sexual Assault: A Case Report

Rape/sexual assault can profoundly affect the physical, mental, and social well-being of victims. Post-traumatic stress disorder (PTSD) and suicide in rape/sexual assault survivors are significantly more frequent than the national prevalence of the condition, indicating that existing treatments require improvement. In this case report, we presented an 11-year-old Iranian girl with PTSD and suicidal behaviors following rape/sexual assault. We specifically focused on the process of helping the victim to develop effective coping skills and overcome the trauma through 16 weekly sessions of Skill Training in Affective and Interpersonal Regulation (STAIR) plus Narrative Therapy-Adolescent Version (SNT-A). During this therapeutic approach, the patient regained emotional control over the traumatic experience and made sense of the experience. Our findings revealed that SNT-A might be an effective intervention to reduce suicidal ideation among adolescent victims of rape/sexual assault. Nonetheless, further investigations in this field need to be carried out through randomized controlled trials.

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

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

An examination of the sociodemographic and psychiatric characteristics of children who have suffered penetrative and non-penetrative sexual abuse in Malatya, Eastern Turkey

Penetrative and nonpenetrative sexual abuse can cause short- and long-term psychiatric problems in victims. This study aimed to examine the sociodemographic characteristics and psychiatric diseases of children in Malatya, eastern Turkey, according to whether the abuse was penetrative or nonpenetrative. A retrospective examination was conducted on the records of 115 cases of sexual abuse that had been referred to judicial authorities from January 1, 2012-July 30, 2019. The subjects were evaluated by a committee formed of 5-7 separate specialized department faculty members. It was determined that 51.3% (n = 59) of the cases had suffered nonpenetrative sexual abuse, and 48.7% (n = 56) had suffered penetrative sexual abuse. The majority of the perpetrators were known to the child from their close environment. A psychiatric diagnosis was made by the committee in 20.3% (n = 12) of the nonpenetrative cases and in 42.9% (n = 24) of the penetrative cases. There was a significant difference between penetrative and nonpenetrative sexual abuse in terms of psychiatric diagnoses. Of the cases of penetrative sexual abuse, 87.5% (n = 14) had attempted suicide. As a result, early diagnosis of sexual abuse, which has devastating effects on mental health in the early and late periods before it penetrates, can reduce the devastating effects on the child. For this reason, it is crucial for doctors, psychologists, social workers, and teachers who work with children to be informed about this issue.

Knowledge and Myths About Child Sexual Abuse in Mexican Women

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

Psychological Intervention in Women Victims of Childhood Sexual Abuse: An Open Study-Protocol of a Randomized Controlled Clinical Trial Comparing EMDR Psychotherapy and Trauma-Based Cognitive Therapy

INTRODUCTION

Most victims of sexual abuse have symptoms that may lead to post-traumatic stress disorder. This study aims to offer evidence-based psychological treatment to women who have been sexually abused earlier in life and currently have sequelae from that trauma. With this treatment, each of the women in the study will hopefully improve their overall quality of life and, more specifically, it is expected that post-traumatic stress symptoms will decrease, as found in recent studies, as well as strengthening their security, confidence, and coping with the situations they have experienced.

METHODS AND ANALYSIS

The effect of two therapeutic approaches focused on the improvement of trauma will be evaluated in a sample of 30-50 women victims of childhood sexual abuse, with a randomized clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy. According to the literature reviewed, both approaches will considerably improve self-esteem when the appropriate number of sessions are conducted, significantly reducing general psychiatric symptoms and depression. Furthermore, the effects are sustained over time. It should be noted that this study will be carried out comparing both therapies, analyzing both the differential benefit of each and the cumulative effect of receiving both treatments and in which order. It is also intended to demonstrate that implementing the protocols presented in this study will help improve the quality of life of the women who benefit from them, and after this study, it will be possible to replicate this program in other people with the same problems. Each of the therapeutic benefits of each of them will be analyzed, and clinical and logistical guidance will be provided to implement both, including a session-by-session protocol.

Mothers Attitudes Toward Child Sexual Abuse Prevention in Schools: A Preliminary Examination

Providing school-based child sexual abuse (CSA) prevention programs ensures that the majority of children will participate in programming. Since many parents may feel ill equipped to have such discussions with their children, programs offered in education settings can bring awareness to this issue. A sample of mothers (N = 268) from across the United States completed an online survey related to their experiences with and attitudes toward school-based CSA prevention programs. Most mothers (70%) had no exposure to prevention programs during their childhood, but the majority (95%) had a positive attitude toward programming for their children. Most mothers believed that offering CSA prevention in schools was important and could provide a safety net. Mothers desired programming that was age appropriate, involved parents and was activity based. These results can help inform schools' prevention programming.

Disclosing the abuse: The effect of ethnoreligious identity on CSA disclosure in forensic interviews

Multiple studies have examined sexually abused children and their interactions with the legal system, as manifested in children's disclosures of sexual abuse during forensic interviews. Nevertheless, few have done so while referencing contextual variables, such as ethnoreligious identity. The current study was designed to examine how ethnoreligious identity affects children's disclosure in forensic interviews beyond the contribution of child characteristics and abuse characteristics. In addition, the moderating role of pre-interview disclosure was examined. An analysis of 1054 forensic interviews conducted in Israel indicated a relationship between a child's age, gender, and abuse characteristics (i.e., perpetrator identity and type of abuse) with the likelihood of disclosure during the forensic interview. The results indicated a relationship between ethnoreligious identity and forensic disclosure. Unexpectedly, Muslim Arab children were more likely to disclose than Jewish children. Predictably, pre-interview disclosure moderated the relationship between abuse characteristics and ethnoreligious identity (among Jews) and forensic disclosure. Conversely, it did not moderate the relationship between child characteristics and disclosure during the forensic interview. The findings demonstrate the importance of a context-informed examination of child abuse disclosure and its potential to advance the development of services adapted to children from diverse communities.

What Do We Know About Child Sexual Abuse? Myths and Truths in Spain

Child sexual abuse (CSA) is a terrible type of maltreatment that can have serious physical and psychological consequences for victims. These consequences include shame and are often taboo in conversation, which makes CSA very difficult to see. Therefore, multiple myths exist about CSA that can lead to misperceptions regarding issues such as its context, prevalence, and consequences. What is unknown cannot be addressed; therefore, the aim of this work was to investigate Spanish participants' knowledge about CSA as well as examine gender and educational level differences. A 10-item questionnaire comprising myths and truths about CSA was developed, taking into account existing literature. Participants (N = 1,540) had to rate their level of agreement with the statements. Some important aspects of CSA remain unclear, particularly in terms of the background of the victims (e.g., gender, educational level, CSA prevalence). Significant differences in the perception of CSA between men and women and among those with various educational levels were found: Men and people with lower levels of education held more myths about CSA. In conclusion, better knowledge about CSA is needed to get people involved in its prevention. We must consider the myths and truths about CSA when designing prevention programs and tailor educational programs to the target population.

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.

Victims and Perpetrators of Child Sexual Abuse: Abusive Contact and Penetration Experiences

Child sexual abuse (CSA) includes abusive contact experiences, which habitually impact the victim's whole life. This study aims to analyze the characteristics of six CSA experiences with physical contact, including penetration, in a representative sample of the Spanish population. Participants were 1071 Spanish adults (53% males; M_age: 45.37) who completed the Child Sexual Abuse Experiences Questionnaire. The victim's age at the first episode, the perpetrator's characteristics, and the number of times that each experience occurred were analyzed, taking into account gender differences. Results were reported for every experience independently. The most prevalent age at the first experience was from 6 years old onwards, but with differences in some experiences. The abuses usually happened more than once, committed by the same person. The most prevalent perpetrator is a male, although a female perpetrator is more prevalent in male victims. Most of the abuses were committed by an adult acquaintance, a strange adult, and other minors, with some gender differences. The implications of the results concerning every CSA experience are discussed, highlighting their value for future research and practice, the design of preventive programs, and early detection of CSA.

Training non-mental health professionals to assess and manage suicide risk: Community level intervention for suicide prevention in Guatemala

BACKGROUND

Domestic violence, childhood physical and sexual abuse, and gang violence are prevalent and growing problems for Guatemalan youth, particularly in low socioeconomic (SES) areas. Resources in the community for psychosocial support are greatly lacking. Schools often serve as the main source of support for these highly vulnerable adolescents. Yet, many teachers lack the training to manage the psychological distress of their at-risk students and to properly engage, assess, and manage the psychological needs of their students. We developed a brief risk assessment and management training for teachers to address this gap.

AIMS

We present the acceptability and preliminary effectiveness of the training at increasing teacher's knowledge and understanding of how to engage and work with their at-risk students around their thoughts and feelings of suicide.

METHOD

Twenty-two teachers from a school in a low SES community in Guatemala participated in the training program. Mixed methods were used to explore effectiveness, acceptability, and satisfaction with the training. Primary outcomes assessed were changes in self-reported knowledge and understanding of engaging and working with students at risk of suicide.

RESULTS

Participants reported increased knowledge and understanding of all training targets (p < .05). Acceptability was high as no participants dropped out and all participants rated the training as useful for their professional development, meeting their expectations, and as highly satisfying.

CONCLUSION

Brief, focused training on suicidality can be effective and is acceptable to lay professionals. Further examination of the effectiveness of the training in a larger sample is required to assess the long-term impact of the training and its transportability to other communities.

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.

History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents

American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = -0.88, 95%CI [-1.55, -0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.

No way to run or hide: Children's perceptions of their responses during intrafamilial child sexual abuse

BACKGROUND

Child maltreatment (CM) has received much research attention in recent years, leading to substantial development of relevant child services worldwide. The literature on posttraumatic stress accentuates the long-term mental and physical ramifications of peritraumatic responses. However, although CM is considered a traumatic experience, examinations of child responses to CM have rarely been attempted.

OBJECTIVE

The current study spotlights children's responses during intrafamilial child sexual abuse (IFCSA), as conveyed by them during forensic interviews.

PARTICIPANTS AND SETTING

The sample is comprised of 40 transcripts of forensic interviews with children aged 4-14, who have been sexually abused by their fathers.

METHODS

The exploration of the children's responses to the abuse was guided by the grounded theory approach and their narratives were thematically analyzed.

RESULTS

Indicate that when children contend with ongoing and severe IFCSA, they tend to develop alternative survival strategies, understanding that fight, flight, or disclosure are not relevant options for them.

CONCLUSION

The discussion stresses the multifaceted nature of the way children respond during IFCSA, which should be understood through holistic observation of the children and various aspects of their lives. The children's responses profoundly shape their abuse experiences and require further exploration so as to promote both intervention and prevention efforts.

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.

Perspectives on Adolescent Sexual Relations With Older Persons: A Systematic Review of the Literature

Relations between minors under the age of consent and older persons are legally prohibited in many countries. However, the nature of these relationships, their impact on the lives of minors involved, and how they should be dealt by law enforcement and welfare systems are highly controversial. The differences between the way these relations are perceived by the minors involved and the public are also unclear. This literature review examines them as perceived by youths or young adults who had experienced sexual relations with a person at least 2 years older during their adolescence as well as by students and other adult members of the public. A systematic search of 977 studies initially identified as relevant yielded 16 studies that fit the inclusion criteria. Most (13) research samples were located in the United States, and the remainder were in the United Kingdom (2) and Australia (1). All were published in English. Four main themes emerged from the analysis of these studies: adolescent motives for sexual relations with older persons (two studies); characteristics of sexual relations between adolescents and older persons (6); contextual factors affecting the way such relations are perceived, including the partners' ages and genders (11); and perspectives on the legal framing of such relations (6). The studies' findings are discussed and implications for future research, policy, and practice are suggested, highlighting the complexity and ambiguity of the phenomenon and calling on intervention programs to focus on strengthening the family unit and social network of these youth and for policies to address teen sexuality as defined both normatively and legally.

Differences in Abuse, Neglect, and Exposure to Community Violence in Adolescents With and Without PTSD and Depression

South African adolescents are exposed to high levels of violence and trauma, including community violence, abuse, and neglect. Violence and trauma are associated with negative mental health outcomes, including posttraumatic stress disorder (PTSD) and depression. Demographic characteristics, additional exposure to trauma, community violence, and types of childhood abuse and neglect may place adolescents at greater risk of developing PTSD. This study aimed to first assess the weighted contribution of demographic factors, trauma load, community violence, and types of abuse and neglect in predicting PTSD symptom severity. Second, we aimed to determine group differences in demographic factors, trauma load, community violence, and types of abuse and neglect among participants with no disorder, PTSD only, PTSD and depression, and depression only. Participants were 215 adolescents identified with emotional and/or behavioral problems and referred to an adolescent trauma clinic from schools in the Western Cape region of South Africa. Clinical assessments were undertaken to assess community violence exposure; physical, sexual, and emotional abuse; physical and emotional neglect; and a clinical diagnosis of PTSD and comorbidity. Trauma-exposed adolescents with PTSD and depression reported significantly higher levels of emotional abuse and community violence exposure in comparison with trauma-exposed adolescents without a disorder. Emotional abuse, community violence exposure, and female gender were significant predictors of PTSD in regression analysis. These findings underscore the contribution of different types of trauma in the development of PTSD. Interventions focused on preventing trauma, PTSD, and depression should be multifaceted and be targeted at various levels, for example, individual/interpersonal level (reduce abuse in the household and immediate environment) and community/societal level (reduce crime rates in communities and strengthen conviction policies). Traumatized youth should routinely be screened for a history of abuse and particularly exposure to community violence, given their strong association with PTSD.

A Parent-focused Child Sexual Abuse Prevention Program: Development, Acceptability, and Feasibility

OBJECTIVES

Child sexual abuse (CSA) affects nearly 60,000 children in the U.S. annually. Although prevention efforts targeting adults in the community and school-aged children have been somewhat successful, there is a clear gap in the current prevention efforts: parents. Generalized parent-education (PE) programs have effectively reduced the rates of physical abuse and neglect; however, currently no PE program targets risk factors for CSA specifically. We sought to develop a brief module to be added onto existing PE programs thereby leveraging the skills and implementation infrastructure to ensure sustainability.

METHODS

In three phases, we developed the curriculum, refined content and presentation while simultaneously developing and psychometrically evaluating a measurement tool, and conducted an acceptability and feasibility pilot. These phases are described in detail such that intervention scientists wishing to develop a module to be added onto existing programs can follow our procedures.

RESULTS

The results of each phase are described so that the reader can see how information gleaned in one part of a phase informed subsequent phases of research. This was an iterative process of development, refinement, and piloting.

CONCLUSIONS

The resultant module is designed to be added onto extant evidence-based PE programs. The module, and the additive approach of the intervention, will be evaluated in a future randomized controlled trial.

A Bayesian Decision-Support Tool for Child Sexual Abuse Assessment and Investigation

In assessments of child sexual abuse (CSA) allegations, informative background information is often overlooked or not used properly. We therefore created and tested an instrument that uses accessible background information to calculate the probability of a child being a CSA victim that can be used as a starting point in the following investigation. Studying 903 demographic and socioeconomic variables from over 11,000 Finnish children, we identified 42 features related to CSA. Using Bayesian logic to calculate the probability of abuse, our instrument-the Finnish Investigative Instrument of Child Sexual Abuse (FICSA)-has two separate profiles for boys and girls. A cross-validation procedure suggested excellent diagnostic utility (area under the curve [AUC] = 0.97 for boys and AUC = 0.88 for girls). We conclude that the presented method can be useful in forensic assessments of CSA allegations by adding a reliable statistical approach to considering background information, and to support clinical decision making and guide investigative efforts.

Increasing Child Serving Professionals' Awareness and Understanding of the Commercial Sexual Exploitation of Children

Child serving professionals need increased understanding of the identification and therapeutic needs of child victims of commercial sexual exploitation. This study evaluated the effectiveness of a training program aimed to increase awareness of commercial sexual exploitation of children (CSEC) among professionals likely to encounter victims in their work. Professionals' (N = 227) knowledge level was examined prior to the training, immediately thereafter, and in a 6-12 month follow-up. Despite professional position or years of experience, participants had similar levels of CSEC knowledge before the training and all showed a significant improvement in their knowledge after the training. However, follow-up testing on a smaller subsample demonstrated that knowledge gains were not maintained. The analysis of the participants' responses to how their behavior would change subsequent to the training revealed important themes including: (1) greater ability to identify/assess or recognize CSEC victims, (2) greater understanding and knowledge of CSEC, (3) increased ability to communicate, interact, and engage with CSEC victims, and (4) heightened desire to educate others and raise awareness about CSEC. Results also indicated that participants were very satisfied with the training and found it highly relevant to their work.

"I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault

The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.

Advancing Child Sexual Abuse Prevention in Schools: An Exploration of the Effectiveness of the Enough! Online Training Program for K-12 Teachers

Child sexual abuse (CSA) in schools and educator misconduct represents a threat to the safety and well-being of our children. The Enough! Preventing Child Sexual Abuse in My School program is a 1-hour online training course developed to address the problem of sexual misconduct and CSA in K-12 education via the use of two avatars/teachers who are navigating CSA and misconduct in their schools. One hundred and thirty-four teachers from three school districts participated in a study to examine the effectiveness of the program in terms of knowledge awareness, including prevalence rates, types of CSA behaviors, impact of CSA on children, signs and symptoms, reporting responsibilities and responses to suspected abuse. Participants were randomly assigned to intervention and control groups: the intervention group (A) received the Enough! training and completed a pre-/posttest and an evaluation of the training (n = 61), Group B (control) completed the posttest only (n = 55), and Group C (control) completed both the pre- and posttests (n = 18). Results indicated that the intervention group's knowledge was significantly higher than that of the control group's at posttest. Group A participants reported a high level of satisfaction in the training, as well as increased knowledge, awareness and willingness to take action in the future. This study points to the need to further test the effectiveness of the Enough! program (and programs like it) on a wider-basis in an effort for educators to be better prepared to protect from the threat of CSA and sexual misconduct.

Child sexual offenders show prenatal and epigenetic alterations of the androgen system

Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.

Diminished fronto-limbic functional connectivity in child sexual offenders

BACKGROUND

Child sexual abuse and neglect have been related to an increased risk for the development of a wide range of behavioral, psychological, and sexual problems and increased rates of suicidal behavior. Contrary to the large amount of research focusing on the negative mental health consequences of child sexual abuse, very little is known about the characteristics of child sexual offenders and the neuronal underpinnings contributing to child sexual offending.

METHODS AND SAMPLE

This study investigates differences in resting state functional connectivity (rs-FC) between non-pedophilic child sexual offenders (N = 20; CSO-P) and matched healthy controls (N = 20; HC) using a seed-based approach. The focus of this investigation of rs-FC in CSO-P was put on prefrontal and limbic regions highly relevant for emotional and behavioral processing.

RESULTS

Results revealed a significant reduction of rs-FC between the right centromedial amygdala and the left dorsolateral prefrontal cortex in child sexual offenders compared to controls.

CONCLUSION & RECOMMENDATIONS

Given that, in the healthy brain, there is a strong top-down inhibitory control of prefrontal over limbic structures, these results suggest that diminished rs-FC between the amygdala and the dorsolateral prefrontal cortex and may foster sexual deviance and sexual offending. A profound understanding of these concepts should contribute to a better understanding of the occurrence of child sexual offending, as well as further development of more differentiated and effective interventions.

Childhood abuse, intimate partner violence, and placental abruption among Peruvian women

PURPOSE

Experiencing childhood abuse (CA) or intimate partner violence (IPV) has been linked to adverse pregnancy outcomes. We examined whether CA history and current IPV are independently and jointly associated with placental abruption (PA).

METHODS

We recruited 662 PA cases and 665 controls in Lima, Peru. We used multivariate logistic regression to calculate odds ratios (OR), adjusting for age, education, and parity.

RESULTS

Approximately 42% of cases and controls reported CA; 50% of cases and 49% of controls reported IPV. History of any CA was not associated with PA, but history of severe CA was associated with 38% increased odds of PA (adjusted OR [aOR], 1.38; 95% confidence interval (CI), 1.07-1.80), adjusting for IPV. There was a statistically nonsignificant association between severe IPV and odds of PA (aOR, 1.22; 95% CI, 0.92-1.62), adjusting for CA. Women who experienced severe CA and severe IPV had 2.06-fold (95% CI, 1.25-3.40) increased odds of PA compared with women who did not experience severe abuse. The joint effect of CA and IPV was positive but statistically nonsignificant on the multiplicative (aOR, 1.48; 95% CI, 0.79-2.80) and additive scale (relative excess risk due to interaction, 0.70; 95% CI, -0.39 to 1.78).

CONCLUSIONS

Preventing exposure to violence may improve maternal outcomes.

Comparing the Central Eight Risk Factors: Do They Differ Across Age Groups of Sex Offenders?

Following the risk-need-responsivity (RNR) model, cognitive-behavioral therapy is considered most effective in reducing recidivism when based on dynamic risk factors. As studies have found differences of these factors across age, exploring this seems beneficial. The current study investigates the Central Eight (C8) risk factors across six age groups of outpatient sex offenders ( N = 650). Results showed that recidivism rates and age were inversely related from 19 years and up. Half of the C8 did not predict general recidivism at all, substance abuse, antisocial cognition, antisocial associates, and history of antisocial behavior in only one or several age groups. However, factors differed between age groups, with the youngest group demonstrating the most dysfunction in several areas and the oldest group the least. It is concluded that the C8 risk factors seem to lose significance in the older age groups. Results may benefit targeting treatment goals.

Treatment of a Commercially Sexually Abused Girl Using Trauma-Focused Cognitive Behavioral Therapy and Legal Interventions

This case study describes the use of trauma-focused cognitive behavioral therapy (TF-CBT) and legal interventions for a 16-year-old girl who was the victim of commercial sexual exploitation (CSE) and suffered from substance abuse, anxiety, and body image issues. Over the course of 1 year, the client was able to discontinue involvement in sexual exploitation, cease substance use, decrease her anxiety level, improve her self-concept, and reduce posttrauma symptoms. The case calls attention to the need for extended rapport building, flexibility in treatment, and tailoring manualized treatments. It highlights the path to CSE for one teenager as well as the resultant emotional and behavioral consequences. Given the extensive nature of her past traumas, case management was continued following the clients’ discharge from treatment to support her adjustment. These follow-up sessions were conducted about once a month and assisted with maintenance of treatment goals.

Victims' Attitudes Toward Sex Offenders and Sex Offender Legislation

It is commonly assumed that victims of sexual abuse feel more negatively toward sex offenders and advocate for harsher punishments than individuals who have not been victimized. This belief was examined by comparing attitudes toward sex offenders and their treatment, support of registration, notification, and residence restriction policies, as well as general knowledge about sex offenders between a sample of 129 individuals who reported sexual victimization and a sample of 841 individuals who did not report sexual victimization. Overall, we found that victims of sexual abuse reported more positive attitudes toward sex offenders and were more supportive of mandated treatment compared with nonvictims. However, while victims showed decreased support for the community notification laws, there were no differences in support of residence restrictions laws compared with those who reported no victimization. Finally, knowledge about sex offenders predicted attitudes regardless of victim status. These findings are discussed as they pertain to sex offender treatment and legislation.

Marihuana y drogas ilícitas en jóvenes mexicanos: Factores de riesgo y protección asociados a la edad de inicio del consumo

Objetivo: Determinar factores de riesgo y protección asociados a la edad de inicio del consumo de mariguana y drogas ilícitas en jóvenes mexicanos. Método: Se analizaron datos de 40,366 jóvenes participantes de la Encuesta de Cohesión Social para la Prevención de la Violencia y la Delincuencia (ECOPRED). Las variables asociadas con la edad de inicio del consumo de mariguana y otras drogas ilícitas fueron determinadas mediante dos modelos de riesgos proporcionales. Resultados: La edad mediana de inicio en consumo de drogas ilícitas osciló entre los 15 y 18 años, mientras que en consumo de marihuana fue de 17 años. En ambos modelos, tener un par consumidor de marihuana fue el factor más fuertemente asociado al inicio de consumo. Discusión: La edad de inicio de consumo revelada en el presente estudio resultó similar a aquella propuesta en investigaciones previas. A pesar de las diferencias de factores en cada modelo, tener un par consumidor de marihuana y el consumo previo de tabaco (variable moderadora) resultaron los factores más fuertemente asociados en ambos modelos.

Emotionally Abusive Behavior in Italian Middle School Teachers as Identified by Students

The aim of this article was to estimate the prevalence of psychological maltreatment in Italian middle school students by their teachers, and to test the applicability of surveying instruments for this phenomenon in Italian educational settings. The sample consisted of 105 teachers and 128 middle school students, who were asked about their experiences with emotionally abusive behaviors (i.e., demeaning, discriminating, dominating, destabilizing, distancing, and diverse) in the Italian school system. Teachers did not tend to perceive their behavior as abusive, while the students showed a very high perception of abuse (98%). Males were more likely to be victims of abuse, and they also reported lower scores in the Achievement scale. Emotional child abuse is highly present in Italian educational settings, and there is a strong need for interventions aimed at supporting teacher education, in the hopes of increasing the general well-being in schools.

TSCC and TSCYC Screening Forms in a Clinical Sample: Reliability, Validity, and Creating Local Clinical Norms

Clinical norms were developed for two screening tools recently developed by Briere and published by Psychological Assessment Resources. The screening measures were derived from the most predictive items of the Trauma Symptom Checklist for Children (TSCC) and the Trauma Symptom Checklist for Young Children (TSCYC). Both screening measures (TSCC-Screening Form and TSCYC-Screening Form) have a total of 20 items measuring general trauma (12 items) and sexual concerns (8 items). Briere and Wherry report on the reliability and validity of the instrument when used with a normative group of children who are not identified as abused. This clinical sample of abused children seeking services from a child advocacy center was comprised of 86.1% females and 55.4% Hispanic children. Data were collected for 177 TSCYCs and 261 TSCCs. Internal consistencies ranged from an α of .74 to .85, and correlation coefficients indicating validity with the longer scales ranging from an r = .563 to .807. T score norms were calculated for this clinical sample. The measure has promise as a tool for screening multiple domains with child and caregiver informants; and in addition to its psychometric properties, it assesses sexualized behavior, suicidal thoughts, and trauma.

Emotional and Psychosocial Problems Encountered by Children Who Have Been Sexually Abused

The current descriptive analysis sought to identify the emotional and psychosocial problems experienced by children who have been sexually abused. Of 518 children with a history of sexual abuse who applied to the Child Protection Center, 443 were included in the study. Approximately 71.6% of children were subject to sexual abuse entailing penetration, whereas 69% were subject to sexual abuse not entailing penetration. After-effects reported included despair (46.5%), fear of reoccurrence of the incident (52.8%), distrust of others (36.8%), difficulty sleeping (32.7%), negative expectations about the future (32.1%), and self-blame (31.1%). Nurses have crucial roles and functions in the protection, improvement, treatment, and rehabilitation of the health of children who have been sexually abused. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 37-43.].

Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students

The aim of the current study was to examine whether early maladaptive schemas (EMSs) mediate the association between different kinds of childhood maltreatment and later psychopathology and the effect of different kinds of childhood maltreatment on psychological distress in later life. A total of 1102 college students from two local universities participated in the study; their average age was 20.46 ± 1.13 years. The participants completed the Childhood Trauma Questionnaire (CTQ), the Early Maladaptive Schemas Scale (EMSs), the Zung Self-Rating Depression Scale (SDS), and the Zung Self-Rating Anxiety Scale (SAS). Later psychological distress had a significant positive correlation with childhood EMSs, and almost all of the variables measuring childhood maltreatment had a significant positive correlation with EMSs. Structural equation modeling and mediation analyses were conducted based on Bootstrap estimations; the mediation analyses demonstrated the utility of EMSs as the mechanism through which childhood maltreatment has an indirect effect on later psychological distress. Moreover, the study found that emotional abuse had the strongest overall effect of all five types of child maltreatment on later psychological distress, followed in order of magnitude by emotional neglect, physical neglect, sexual abuse, and physical abuse.