Childhood sexual abuse, adult psychiatric morbidity, and criminal outcomes in women assessed by medium secure forensic service

The sexuality and sexual experiences of forensic mental health patients: An integrative review of the literature

Introduction

Sexuality is an integral aspect of the human experience that defines an individual. Robust research, substantiated by the World Health Organization, demonstrates that healthy sexuality improves mental health and quality of life. Despite this level of global advocacy and clinical evidence, sexuality and sexual health as determinants of health have been largely overlooked in the mental healthcare of patients being treated under the requirements of a forensic order (forensic patients). In this review, the authors have evaluated the literature related to the sexual development, sexual health, sexual knowledge and risks, sexual experiences, sexual behavior and sexual desires of forensic patients to inform policy and clinical practice. Furthermore, the review explored how forensic patients' sexual healthcare needs are managed within a forensic mental healthcare framework. The paper concludes with recommendations for service providers to ensure that sexual health and sexuality are components of mental health policy frameworks and clinical care.

Methods

An integrative review was utilized to summarize empirical and theoretical literature to provide a greater comprehensive understanding of the sexuality and sexual experiences of forensic patients. This included identifying original qualitative, quantitative, or mixed-method research, case reports, case series and published doctoral thesis pertaining to the research topic.

Results

Twenty-one articles were selected for review. We grouped the review findings into three main themes: 1) Forensic patient themes, 2) Forensic mental health staff themes and 3) Forensic mental health organization themes. The review demonstrated scant information on the sexual healthcare needs of forensic patients or how health services manage these needs while the patient is in a hospital or reintegrating into the community.

Conclusion

There is a dearth of evidence-based, individualized or group approaches which clinicians can utilize to assist forensic patients to achieve a healthy sexual life and it is recommended that such services be developed. Before that however, it is essential to have a clear understanding of the sexual healthcare needs of forensic patients to identify areas where this vulnerable population can be supported in achieving optimal sexual health. Urgent changes to clinical assessment are required to incorporate sexual healthcare as a component of routine mental healthcare.

Prevalence of adverse childhood experiences (ACE) in the Czech Republic

A cross-sectional survey was undertaken to estimate the prevalence of child maltreatment and adverse childhood experiences in the Czech Republic, as data on these is scarce. The survey was conducted among 1760 randomly selected students from five Czech universities. Participants filled in the adverse childhood experiences survey instrument. The results showed that the prevalence of child maltreatment and other adverse childhood experiences is high: emotional abuse was reported by 20.7%, physical abuse by 17.1%, sexual abuse by 6.4%, and physical neglect by 8.0%. Household dysfunction was also high, with household street drug use reported by 4.9%, alcohol misuse by 15.3%, mental disorder by 13.4%, parental violence by 22.1% and parental separation by 23%. Thirty-eight per cent had not experienced any adverse childhood experience, while 9.9% reported experiencing four or more types of adverse childhood experiences. There was a significant association between adverse childhood experiences and health-harming behaviours such as suicide attempt, drug use, risky sexual behaviour and tobacco use. The findings suggest that there is a need to invest in prevention programmes.

A Review of Child Sexual Abuse: Impact, Risk, and Resilience in the Context of Culture

Child sexual abuse is a problem with both a national and worldwide prevalence. In this review, the authors note that while empirical research has clearly shown the negative impact of child sexual abuse on social, psychological, and sexual functioning later in life, it has also been reported that some individuals remain asymptomatic despite a history of experiencing child sexual abuse. This implies that negative outcomes later in life are not inevitable and illustrates the critical need to elucidate how resilience may moderate the negative impacts of child sexual abuse. In addition to emphasising the role of resilience, this review also underscores the important role that cultural context plays in understanding child sexual abuse, as there are known risk factors and protective factors specific to different cultures. Similarly, one's culture may also influence whether abuse is reported and addressed, and the topic is given special attention in this paper because it is not widely discussed within the existing literature. The impact of child sexual abuse on mental health, sexual health, and social functioning is also discussed.

Trauma in relation to psychosis and hospital experiences: the role of past trauma and attachment

OBJECTIVES

We investigated rates of psychosis-related and hospital-related post-traumatic stress disorder (PTSD) in people with psychosis in secure settings. We also investigated relationships between PTSD symptoms and previous experiences of trauma and adult attachment.

METHOD

Using a cross-sectional design, 50 participants from medium-secure and low-secure settings were interviewed to identify distressing experiences related to psychosis and hospitalization. PTSD symptoms related to those experiences, past trauma and attachment were assessed using self-report measures.

RESULTS

The combined rate of psychosis-related and hospital-related PTSD was 30%. Twenty-four percent and 18% met criteria for psychosis-related and hospital-related PTSD, respectively. Severity of psychosis was associated with both psychosis-related and hospital-related PTSD symptoms. The prevalence of previous trauma was high, but previous trauma was not significantly correlated with psychosis-related or hospital-related PTSD symptoms. Anxiety in attachment relationships was significantly associated with both psychosis-related PTSD symptoms and hospital-related PTSD symptoms.

CONCLUSIONS

This study adds to the growing body of research highlighting the distressing nature of psychosis and the iatrogenic effects of treatments. It also highlights the potentially important role of attachment styles in PTSD in psychosis.

PRACTITIONER POINTS

30% of patients met criteria for psychosis- or hospital-related PTSD. Severity of psychosis was associated with PTSD symptoms. Anxiety in attachment relationships was positively correlated with PTSD symptoms.