Sexual assault disclosure in relation to adolescent mental health: results from the National Survey of Adolescents

Differences Between Girls and Boys in the Disclosure of Sexual Violence

This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 (N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.

Adolescents and sexual assault: A critical integrative review

Adolescents are sexually assaulted at remarkably high rates. Adolescents are also unique given the specific dynamics of adolescent sexual assault, their current stage in human development, their limited legal standing and rights, and their experiences navigating postassault services and resources. While literature exists within each of these domains, it is somewhat disconnected and overlooks how adolescents are often relegated to the margins in research and practice. The purpose of this integrative review is to (1) provide a more complete understanding of adolescent sexual assault and survivors' nuanced needs; (2) frame adolescent survivors as a too-often-overlooked oppressed group that researchers and responders must consider and center in their work, lest contribute to their further marginalization; and (3) inspire and orient social justice-minded scholar activists to various action steps to take to center and prioritize adolescents in research and practice. Through our intersectional feminist approach, we offer specific action steps for social justice-minded scholar activists to recenter adolescents in their research and practice.

(Un)safe Spaces: The Relationship Between Slavery and Sexual Victimization of Black Women

Research exploring the correlates of sexual victimization has found sexual victimization to be associated with both individual- and contextual-level factors, including age, gender, poverty, and size of the female population. However, to date, research has been limited in exploring how historical factors, such as slavery, may be associated with the contemporary prevalence of sexual victimization of women. Historical accounts have often suggested that enslaved women often experienced sexual victimization during their enslavement. Despite these accounts, research has been limited in empirically exploring the relationship between slavery and the sexual victimization of Black women. Using the 1860 U.S. Census and the 2019 National Incidence-Based Reporting System, multilevel logistic regression analyses are employed to explore whether slavery is consequential for contemporary instances of Black female sexual victimization. In line with the "legacy effect" framework, the findings from the current study suggest that Black women are significantly more likely to be sexually victimized in counties characterized by larger enslaved populations in 1860. These findings illuminate how historical institutions, despite being outlawed, have contemporary consequences, particularly for Black women. These findings, discussions, avenues for future research, and policy implications are discussed below.

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.

Prolonged school closure during the pandemic time in successive waves of COVID-19- vulnerability of children to sexual abuses - A case study in Tamil Nadu, India

Objectives

The Tamil Nadu government mandated several stay-at-home orders, with restrictions of varying intensities, to contain the first two waves of the COVID-19 pandemic. This research investigates how such orders impacted child sexual abuse (CSA) by using counterfactual prediction to compare CSA statistics with those of other crimes. After adjusting for mobility, we investigate the relationship between situational factors and recorded levels of cases registered under the Protection of Children from Sexual Offences Act (POCSO). The situational factors include the victims' living environment, their access to relief agencies, and the competence and responsiveness of the police.

Methods

We adopt an auto-regressive neural network method to make a counterfactual forecast of CSA cases that represents a scenario without stay-at-home orders, relying on the eight-year daily count data of POCSO cases in Tamil Nadu. Using the insights from Google's COVID-19 Community Mobility Reports, we measure changes in mobility across various community spaces during the various phases of stay-at-home orders in both waves in 2020 and 2021.

Results

The steep falls in POCSO cases during strict stay-at-home periods, compared with the counterfactual estimates, were -72% (Cliff's delta -0.99) and -36% (Cliff's delta -0.65) during the first and second waves, respectively. However, in the post-lockdown phases, there were sharp increases of 68% (Cliff's delta 0.65) and 36% (Cliff's delta 0.56) in CSA cases during the first and second waves, with concomitantly quicker reporting of case registration.

Conclusions

Considering that the median delay in filing CSA complaints was above 30 days in the mild and post-intervention periods, the upsurge of cases in the more relaxed phases indicates increased occurrences of CSA during strict lockdowns. Overall, higher victimization numbers were observed during the prolonged lockdown-induced school closures. Our findings highlight the time gap between the incidents and their registration during the strict lockdown phases.

Mandatory Reporting and Adolescent Sexual Assault

Adolescents experience alarmingly high rates of sexual violence, higher than any other age-group. This is concerning as sexual violence can have detrimental effects on teens' personal and relational well-being, causing long-term consequences for the survivor. Still, adolescents are hesitant to report the assault or seek out services and resources. When an adolescent survivor does seek out services, they may interact with a provider who is a mandatory reporter. This scoping review sought to synthesize the current U.S.-based research on the role, challenges, and impact of mandatory reporting (MR) in the context of adolescent sexual assault. Database searches using key words related to MR, sexual assault, and adolescence identified 29 peer-reviewed articles. However, none of these articles reported on empirical investigations of the phenomenon of interest and instead consisted of case studies, commentaries, and position papers. The scoping review was expanded to provide a lay of the land of what we know about the intersection of adolescent sexual assault and MR. Results of the review indicate that though implemented broadly, MR policies vary between individuals, organizations, and states and have historically been challenging to implement due to this variation, conflicts with other laws, tension between these policies and providers' values, and other factors. Based on the available literature, the impact of MR in the context of adolescent sexual assault is unknown. There is a critical need for research and evaluation on the implementation and impact of MR policies, especially in the context of adolescents and sexual violence.

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

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

Youth voices from an informal settlement of Nairobi, Kenya: Engaging adolescent perspectives on violence to inform prevention

We examined the experiences of violence and self-reported behavioural and community changes as a result of participation in a sexual assault prevention intervention in an informal settlement in Nairobi, Kenya. We conducted longitudinal qualitative in-depth interviews with 20 adolescent girls and 11 adolescent boys at baseline, 12, and 24 months. Analysis was thematic with two investigators coding and reaching consensus about the themes. Participants' ages ranged from 10 to 13 at baseline; girls' mean age was 11.9, boys' mean age was 11.6. Participants reported experiencing high levels of violence at all stages of the study. Most reported feeling more empowered to protect themselves and others from sexual assault because of the intervention. While participants had mixed responses about change in sexual assault incidence, most perceived an improvement in inter-gender relationships after the intervention. Participants at midline and endline cited acquaintances and friends as potential perpetrators of sexual violence more often than at baseline and were more open to reporting violent incidents. The very young adolescents in this setting perceived that this sexual assault prevention intervention led to improvements in gender relations, adolescent girls' empowerment and, recognition of harmful rape myths.Trial registration: ClinicalTrials.gov identifier: NCT02771132.

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.

How Does that Make You Feel? Development and Pilot Testing of Two New Instruments Measuring Emotional Attributions to Experiences of Childhood Sexual Abuse

Though prior research has demonstrated that survivors of childhood sexual abuse may experience a range of negative emotions following the abuse, studies have failed to consider the conflicting, ambivalent, or positive emotions being attributed to the experiences by survivors. The current study describes the development and piloting of two new scales to capture the positive and negative emotions that youth may attribute to experiences of childhood sexual abuse. A sample of youth (N = 136) were recruited and surveyed from community corrections and residential treatment centers in a Midwestern state. Item Response Theory was used to test the performance of the measures and their individual items with the subsample of youth who reported a history of childhood sexual abuse (n = 40). Both new measures demonstrated high internal consistency reliability and appropriately captured the range of positive and negative emotions youth may experience following childhood sexual abuse. Findings indicate that youth who have experienced childhood sexual abuse may have conflicting positive and negative emotions associated with the experiences. Implications for measurement refinement, future research directions, and clinical practice are discussed.

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.

Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care

OBJECTIVE

Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents.

METHODS

Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5.

RESULTS

PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type.

CONCLUSIONS

Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.

Sexual aggression against males: Differences between acts by males and females - Results from the German Health and Sexuality Survey (GeSiD)

BACKGROUND

Current research examining sexual aggression against males is rare and representative studies often do not sufficiently differentiate between male and female affected persons, male and female offending person, as well as between different types of sexual aggression.

OBJECTIVE

We investigated the prevalence of sexual aggression against males perpetrated by males and females distinguished by the type of sexual aggression and examined differences between sexual aggression against males committed by males and females in characteristics of the sexual aggression.

PARTICIPANTS AND SETTING

We examined representative self-report data collected in the German Health and Sexuality Survey (GeSiD; n = 4,955). A total of 305 male participants (12.3 % of all male participants) experienced at least one incident of sexual aggression.

METHOD

We investigated differences between characteristics of male- and female-perpetrated sexual aggression against males in cases of (1) sexual aggression against minors by adults, (2) sexual aggression among minors/peers, and (3) sexual aggression among adults. Characteristics of sexual aggression included were frequency, relation of accused person, disclosure, participant's age at first incident, and accused person's age at first incident.

RESULTS

Our results revealed that the proportion of sexual aggression by females against males is rather low in cases of sexual aggression against minors by adults (9 %) compared with sexual aggression among minors/peers (56 %) and among adults (52 %). Although the majority of characteristics of sexual aggression were similar, some differences between male- and female-perpetrated sexual aggression were found.

CONCLUSIONS

Sexual aggression against males appears to be an under-researched phenomenon, especially when it is perpetrated by a female person. More research on sexual aggression against males as well as on the differences between male- and female-perpetrated sexual aggression is therefore considered necessary.

Child Sexual Abuse in Mexican Women: Type of Experience, Age, Perpetrator, and Disclosure

Child sexual abuse (CSA) is a type of maltreatment that occurs in practically all countries and social statuses. Due to the taboo and shame that surrounds it, CSA is a problem universally silenced despite the important consequences (both physical and psychological) that it has for the victim and their family. This work aimed to study the correlates of CSA in Mexican women. Our sample comprised 1058 women ranged from 18 to 73 years (M = 40.19; SD = 10.24). They completed an anonymous online survey including questions about all the different types of abuse, questions about who perpetrated it, at what age it happened, and whether the victim disclosed the abuse. Our results showed that, depending on the type of abuse, from 13.9% to 65.8% of the participants had suffered at least one episode of CSA throughout their childhood. The first episode typically occurred between 6 and 12 years old, with the perpetrator being a male. The youngest women reported higher rates of being shown pornography by a family member, whereas the oldest ones reported higher rates of exhibitionism by a stranger. Only 31.3% of the sample disclosed the abuse, usually to their mother or a peer. Differences among the correlates of the different types of abuse, the age of the victims, and the relationship with the perpetrator are discussed as well as the victims’ feelings of being believed when they disclosed the abuse.

The Influence of Video-Modeled Sexual Assault Disclosure and Self-Efficacy Messages on Sexual Assault Disclosure Efficacy of Adolescent Girls

Adolescent female victims of sexual assault must often disclose their victimization to trusted adults to seek positive physical and mental health outcomes; however, adolescent girls face unique barriers to disclosure, and they are less likely to disclose compared to adult women. Media interventions could be useful in motivating adolescent girls to feel more efficacious about disclosing sexual assaults. Self-efficacious messages in media that model disclosure behavior could motivate adolescent girls to feel more confident disclosing information about an assault and seeking positive health outcomes. This study used quasi-experimental methods to test the effect of a YouTube vlog containing a self-efficacy message about sexual assault disclosure. Results indicate that exposure to the self-efficacious message leads to higher sexual assault disclosure efficacy among adolescent girls who identify with self-efficacious media characters (B = -.0867, SE = .059, 95% CI [-.2318, -.0033]), albeit indirectly through perceived discrimination of sexual assault victims and approach coping behaviors. Appropriate interventions targeting disclosure of sexual assault by adolescent girls could include a more holistic view of disclosure and use new mediums like YouTube vlogs to deliver self-efficacious messages.

Youth Response to Rape: Rape Myths and Social Support

Adolescents and young adults face the highest incidence of sexual assault, yet only limited research focuses on the experience of adolescent survivors, adolescent rape myth acceptance, or the ways youth respond to rape. Survivors tend to disclose to at least one person, typically peers, and the response, whether positive or negative, can impact well-being and help-seeking behaviors. Focus groups across Oregon, a leader in state-level comprehensive sexuality education policy, solicited high school-student reactions to an alcohol-involved rape scenario. These rich-case participants had taken comprehensive sexuality education classes and were affiliated with health and sexuality organizations. These youth were anticipated to showcase best possible outcomes resulting from current sexuality education practices. After hearing a hypothetical scenario involving a friend's experience with alcohol-involved sexual assault, participants were asked how they would respond. Participants spontaneously discussed whether the actions described constituted rape, often relying on victim-blaming rape myths as evidence. Alcohol use was a critical factor in interpretations. Female use increased her perceived culpability and male use decreased his. After assessing blame and whether the incident constituted rape, youth described three types of support (informational, instrumental or practical, and emotional support) they would offer as well as barriers when responding to the victim and intentions to hold victims accountable. These responses paint a concerning portrait of the ways youth make sense of sexual violence and consider responding to a friend's disclosure. Sexuality education policy mandates and intervention programs must target the problematic links between alcohol, rape, and rape myths while reinforcing non-victim-blaming support.

Releasing the Tide: How Has a Shock to the Acceptability of Gender-Based Sexual Violence Affected Rape Reporting to Police in India?

National household data suggest that more than four million women in India have experienced nonspousal rape. Fewer than 1.5% of victims of sexual violence in India report their assaults to police, though there is some indication of increased rape reporting to police following a very high-profile fatal gang rape in Delhi in December 2012. This study examines effects of the Delhi gang rape on rape reporting to police in India, and assesses the roles played by geography, media access, and women's status and protection factors in that reporting. Triangulated data from Indian crime, census, and police bureau records were used to assess trends in rape reporting to police at national and district levels from 2005 to 2016, using regressions, spatial mapping, and graphical trend analyses. Nationally, there was a 33% increase in annual rapes reported to police after 2012. Subnationally, there was substantial variation in trends; these district-level changes were particularly affected by distance from Delhi (0.2 fewer rapes reported to police/100,000 women for each 100 km from Delhi), literacy sex ratio (0.6 more rapes for every increase of 0.1 in male: female literacy ratio), and the presence of a women's police station (1.0 fewer rapes reported to police/100,000 women relative to districts with no women's police station). The 2012 Delhi gang rape significantly affected rape reporting to police in India, with greater increases seen closer to Delhi and in districts with compromised gender equity. Further work to support the rights and safety of women is needed, including bolstering an enabling environment for reporting, legal protections, and responsive criminal justice.

Recipients of children's and adolescents' disclosures of childhood sexual abuse: A systematic review

Disclosure of childhood sexual abuse (CSA) is a complex, multifaceted process with many barriers that are largely shaped by individual, familial, and systemic characteristics. Children and youth tend to withhold or delay disclosure for many years, such that most CSA goes unreported. This systematic review aimed to synthesize evidence regarding the pathways and recipients of CSA disclosures and to identify potential developmental and gender differences in the recipients of disclosures. Thirty-seven studies conducted between 1990 and 2017 were selected for review. Results indicated that children and youth follow a gradual pattern of disclosure, whereby they first disclose to peers before disclosing to a parent or trusted adult, who can then help the child report to a person of authority. Key developmental patterns in CSA disclosure were identified, whereby older children and adolescents are significantly more likely to turn to peers, keeping the abuse largely hidden from adults. Gender differences were also found, whereby girls are more likely to seek emotional support by disclosing to peers, whereas boys are significantly less likely to disclose the abuse all together; when boys do disclose, they tend to do so for practical reasons, such as protection or accessing services. This review contributes to our understanding of the various pathways of CSA disclosure and highlights the importance of further understanding youth-directed disclosures and how the reactions of informal recipients of disclosures may impact further disclosures to authorities and professionals. Research and clinical implications of the findings are discussed.

Forcible Rape and Adolescent Friendship Networks

Studies have found that sexual victimization can adversely affect an adolescent's psychological well-being, physical health, and behavior. Little is known, however, about how friendships are influenced by such victimization. Drawing on research on sexual violence and the salience of peers among adolescents, the current study extends prior work by examining the effects of forcible rape on adolescent social networks. Using a subsample of females from the National Longitudinal Study of Adolescent to Adult Health (N = 4,386), the study employs multivariate regression analyses to estimate the effects of youth forcible rape on the popularity, centrality, and density of adolescent friendship networks and to determine whether depression and attachment to others (e.g., to friends and to school) mediate these effects. The analyses indicated that forcible rape was associated with a decrease in the popularity and centrality of females within their friendship networks; however, no effect on the density of these networks was identified. In addition, forcible rape effects on popularity and centrality were partially mediated by depression and social attachments. The results suggest that forcible rape may adversely affect adolescent females' levels of popularity and centrality within their friendship networks. Combined with prior research, the results indicate that the harmful effects of rape have the potential to extend across diverse domains, including social relationships. This possibility suggests that services and assistance to female adolescents may be useful in navigating these relationships after victimization. It suggests, too, that potential benefits that may arise from interventions that educate adolescents-victims and nonvictims alike-about the challenges that victims of sexual violence experience.

Twitter as a tool for social movement: An analysis of feminist activism on social media communities

In recent years, social media has been widely used as a tool for feminist social movements, addressing social problems such as sexual assault traumatization. This research aims at understanding how social media users utilized Twitter to describe traumatic sexual assault experiences and reasons victims chose not to disclose their experiences (Study 1), and how users became a part of the digital activism (i.e., social media movement against sexual assault) to increase social actions (Study 2). Tweets using the hashtag #WhyIDidntReport and #MeToo were extracted. Thematic analyses were used to analyze tweets across the two studies. Results from Study 1 revealed that social media victims who self-disclosed their victimization stories often reported having serious psychological impacts, a sense of helplessness, and issues with the police. Study 2 further uncovered that social media users engaged in hashtag activism through discussing views on relevant political and social issues, sharing resources to help sexual assault victims, and promoting social actions (e.g., protests, voting).

The role of stigmatization in developing post-traumatic symptoms after experiencing child sexual abuse by a female perpetrator

BACKGROUND

The context in which individuals are exposed to child sexual abuse (CSA) and reactions to the disclosure of such abuse experiences play a major role in post-traumatic mental health. Female-perpetrated CSA is an under-recognized issue in society and mental health care, and is therefore supposed to be a breeding ground for stigmatization.

OBJECTIVE

The aim of the current study was to examine the mediating role of internalized and anticipated stigma on the effects of so-called victim-blaming experiences and the perception of abuse in the childhood of survivors of female-perpetrated CSA on their post-traumatic symptom severity.

METHOD

A total of 212 individuals who reported experiences of female-perpetrated CSA were assessed in an anonymous online survey. The International Trauma Questionnaire (ITQ) served as the primary outcome parameter for detecting differences in post-traumatic symptom severity within mediation analyses, where victim-blaming and abuse awareness served as predictors and anticipated as well as internalized stigma served as mediator variables.

RESULTS

Internalized stigma fully mediated the deteriorating effect of victim-blaming on post-traumatic symptom severity, while abuse awareness and anticipated stigma showed no statistically significant effects as predictor and mediator variables. Yet, victim-blaming had a significant increasing effect on anticipated stigma.

CONCLUSIONS

Efforts to enhance awareness of female-perpetrated CSA in society are needed and mental health care professionals should pay attention to the adverse effects of victim-blaming and internalized stigma on post-traumatic symptoms in individuals affected by female-perpetrated CSA.

Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure

Disclosure rates of child sexual abuse (CSA) to both social supports and law enforcement are concerningly low, although more research is needed to understand factors that impact disclosure. Thus, the present study examined rates of informal (i.e., to a social support) and formal (i.e., to law enforcement) disclosure of CSA, as well as victims' self-reported experiences with telling others about their own abuse and their perceptions of the overall advantages and disadvantages of disclosure. In all, 76 undergraduate women (who collectively experienced 105 instances of abuse) participated in a semi-structured interview regarding their history of CSA. Results revealed that approximately 50% of cases involved the victim informally disclosing, and only 10% of cases being formally disclosed to authorities. The quantitative and qualitative data shed light on a number of factors that lead victims to not disclose, as well as the identification of factors that may promote a victim to share their abuse with others. The implications for improved prevention and responses to CSA disclosure are discussed.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma

BACKGROUND

Depression is often reported as co-occurring with post-traumatic stress disorder in children and adolescents, but its prevalence within trauma-exposed child and adolescent samples is not well understood.

METHODS

Our meta-analyses addressed two questions: I. What is the prevalence of depression (either based on structured interview or cut-off on a self-report measure) in children and adolescents after exposure to trauma? II. Does trauma exposure increase the severity or rates of depression comparative to another comparison group of children and adolescents with milder exposure or no exposure to trauma?

RESULTS

Fifty-six studies reported depression prevalence. A random effects meta-analysis suggested that 24.2% [95% CI 20.6-28.0] of children and adolescents exposed to a traumatic event met criteria for depression. Our second meta-analysis across 30 studies found that the effect of trauma exposure (relative to unexposed or less exposed children and adolescents) on depression scores was medium in size (d = 0.51, 95% CI 0.41-0.61). The odds of a diagnosis of depression were 2.6 times greater [95% CI 2.0-3.3] for children and adolescents exposed to trauma as compared to those unexposed or less exposed. Participants exposed to interpersonal violence (IPV) had a higher prevalence and level of depression compared with those exposed to non-IPV trauma.

LIMITATIONS

Results should be interpreted with caution due to high levels of heterogeneity.

CONCLUSION

Depression in trauma-exposed children and adolescents is a common response to trauma that is not solely reflective of pre-traumatic difficulties. Post-traumatic depression merits serious consideration in trauma-exposed children and adolescents.

Forensic medical results and law enforcement actions following sexual assault: A comparison of child, adolescent and adult cases

BACKGROUND

In sexual assault cases, little research has examined differences in forensic medical findings and law enforcement response by victim age across the entire age range.

OBJECTIVE

This study addressed this gap by comparing four victim age groups: adults, adolescents over the age of consent, adolescents under the age of consent, and children under 12.

PARTICIPANTS AND SETTING

Cases were randomly sampled from a statewide database of medical reports on sexual assault examinations conducted in hospital emergency departments, including only cases reported to law enforcement (N = 563).

METHODS

Data were combined from a medical report database, from coding of medical documentation and crime laboratory reports, and from case data provided by law enforcement.

RESULTS

Rates for both younger and older adolescent victims and adult victims were comparable, with no statistically significant differences on most variables: penetration, perpetrator use of force, non-genital and genital injuries, presence of biological evidence, generating assailant DNA profiles, DNA match to suspect, hits in the FBI's DNA database, and law enforcement unfounding (i.e., determining allegations to be false or baseless). Child victims were significantly less likely to have a non-genital injury, and their cases were significantly more likely to be founded by law enforcement. Arrests were significantly more likely when victims were under the age of consent.

CONCLUSIONS

Despite significant differences by victim age, similarity between adolescent and adult cases was substantial. Both younger and older adolescents may be at higher risk of physical violence during sexual assault than previously recognized, and need greater attention in response systems.

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

BACKGROUND

Child sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology.

OBJECTIVE

To conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD.

PARTICIPANTS AND SETTING

Studies included clinical, college and community-based samples of adults' and children's experiences of CSA.

METHODS

We conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors.

RESULTS

Twenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables.

CONCLUSION

The relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally.

Trauma-informed care and practice for eating disorders: personal and professional perspectives of lived experiences

BACKGROUND

Learning about the life stories of patients who have experienced a severe eating disorder (ED), but also traumas that led to PTSD, dissociative disorders, and other comorbidities, has great value to clinicians in their efforts to deliver trauma-informed care (TIC). Many investigators have been researching and writing about these issues for years, and strong scientific evidence has emerged, indicating that trauma is a significant risk factor for the development of EDs, particularly in its bulimic forms.

PURPOSE

Peer-reviewed literature contains scarce input from people with "lived experiences". Hearing and "sitting with" such individuals are extremely useful in clinical practice and research. Further, encouraging patients to put words to their pain has recognized therapeutic effects. These lived experiences are often demonstrative of key elements of what professionals need to know about evaluating and treating patients with EDs and co-occurring trauma-related disorders.

METHOD/RESULTS

The principal author invited two courageous recovered ED advocates and writers (June Alexander and Jenni Schaefer), who have gone public about their ED-PTSD experiences, to recount their life stories and treatment experiences (both positive and negative). Dr. Brewerton then offers his professional perspectives on the course of their treatment experiences put in the context of ongoing relevant clinical research.

CONCLUSION

Their and other patients' experiences have great power to guide professionals toward trauma-informed care, more integrated practice, and theoretically improved outcomes.

LEVEL OF EVIDENCE

Level V.

Men with childhood sexual abuse histories: Disclosure experiences and links with mental health

BACKGROUND

There is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes.

OBJECTIVE

The current study described men's disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience).

PARTICIPANTS AND SETTING

Men (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18-59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes.

RESULTS

Findings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p <  .05), although this was a small effect (Cohen's f² = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors.

CONCLUSIONS

These results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.

Barriers and facilitators affecting self-disclosure among male survivors of child sexual abuse: The service providers' perspective

Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates, with males less likely to disclose their abuse compared to females. CSA can have lasting impact on a children's emotional, physical, and psychological wellbeing. While service providers play an instrumental role in providing care and support for male CSA survivors, little is known about their perceptions and experiences related to disclosure among these men. The aim of this qualitative study was to explore service providers' perceptions and awareness of disclosure-related barriers and facilitators amongst male CSA survivors. Individual interviews were conducted with eleven service providers. Study findings reveal four key themes related to the disclosure process among male CSA survivors: (a) personal characteristics, (b) interpersonal relations, (c) institutional elements, and (d) societal norms. Findings indicate that service providers understand and respond to complex challenges associated with disclosure of CSA among this marginalized population. Study findings demonstrate the need for additional research on the specific issues of gender bias and stigma associated with male sexual abuse. Along with their empirical significance, these findings can be used to develop more tailored public health and social service-related programming for male CSA survivors, their families, and the broader community to promote a safer and more supportive environment in which to discuss these sensitive and important issues. Recommendations to service providers are discussed.

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.].

Sexual violence in the college population: a systematic review of disclosure and campus resources and services

AIMS AND OBJECTIVES

To synthesise research examining college student sexual violence disclosure and campus sexual violence resources and services.

BACKGROUND

Recently, the issue of sexual violence within the college population has garnered attention worldwide. The prevalence of sexual violence within college students is alarmingly high. Survivors often experience negative outcomes (e.g. health-related consequences, impact on education). Efforts have been made to address this significant public health concern.

DESIGN

Systematic review of published literature.

METHODS

Studies were identified through systematic searches of PubMed, CINAHL and PsycInfo of articles published between January 2010-February 2015. A total of 672 articles were identified. After screening, 16 articles were included in this review.

RESULTS

A lack of consistency in how sexual violence was referred to and measured was identified. Research on college student sexual violence disclosure has primarily been conducted in six areas: (1) informal disclosure, (2) formal disclosure, (3) friends' perceptions of disclosure, (4) process/effects of disclosure on the survivor, (5) barriers to disclosure and (6) social support in the disclosure process. Research related to campus sexual violence resources and services has primarily focused on: (1) students' knowledge, (2) students' utilization and (3) students' suggestions. Synthesised findings are presented.

CONCLUSIONS

Sexual violence impacts college student survivors and the campus community as a whole. To appropriately assist/address sexual violence, a thorough understanding of college student sexual violence disclosure and campus sexual violence resources/services is necessary. Suggestions for researchers, colleges and nurses are provided.

RELEVANCE TO CLINICAL PRACTICE

Nurses who serve students, especially those at on-campus student health centres, are opportunely placed to address sexual violence. Findings highlight the need for nurses to use consistent definitions of sexual violence when identifying survivors. Nurses should take measures to increase disclosure and promote sexual violence resources/services provided by their facility. Additional suggestions for nurses are provided.

[Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence]

Disclosure of Adolescents in Residential Care Institutions and Boarding Schools after Exposure to Sexual Violence In international research, many papers exist about the issue of disclosure after having experienced sexual violence. However, specific research regarding disclosure processes of children and adolescents in institutional care are missing, even though those are particularly often affected by sexual violence. In the Germany-wide study "Sprich mit!", adolescents from the age of 15 up (n = 322; average age 16,69 (SD = 1,3); 57,1 % males) who live in residential care or boarding schools were asked for experiences of sexual violence and their consequences by means of a self-report questionnaire. Results showed that the majority of the adolescents (82 %) entrusted themselves to someone, mostly towards peers (56 %) and less frequent towards adults (24 %). Boys and girls opened up equally often, regardless of the severity of the experienced violence. Adolescents who entrusted themselves towards their peers indicated retrospectively more satisfaction than those entrusting themselves towards adults, even if there were no consequences following the disclosure. Considering that the disclosure towards peers did not initiate a process of help, adolescents in institutional care should be better informed about relevant possibilities to entrust themselves and receive support.

Anogenital and Physical Injuries in Adolescent Sexual Assault Patients: The Role of Victim-Offender Relationship, Alcohol Use, and Memory Impairment

Prior research has documented high rates of anogenital and physical injuries among adolescent sexual assault patients. Although a number of factors related to rates of injury detection in adolescents have been identified, there may be additional features of the assault that are disclosed in the patient history that could be important indicators of injury risk. The purpose of the current study was to expand this literature by examining whether factors that are salient in sexual assaults committed against adolescents-victim-offender relationship, substance use, and memory impairment-are associated with documented anogenital and physical injury rates. Results indicated that victim-offender relationship, substance use, and assault memory are significantly related to the number of anogenital injuries and, particularly, the number of physical injuries detected in adolescent sexual assault patients. These results highlight the importance of a comprehensive patient history, including assessment of alcohol and drug use and memory impairment, to guide the medical forensic examination.

Community-level moderators of a school-based childhood sexual assault prevention program

Childhood sexual abuse (CSA) is highly prevalent and associated with a wide variety of negative mental and physical health outcomes. School-based CSA education and prevention programs have shown promise, but it is unclear to what extent community-level characteristics are related to their effectiveness. The present cluster randomized controlled trial evaluated community-level moderators of the Safe@Lastprogramcomparedtoawaitlistcontrolcondition.(*) Knowledge gains from pre- to post-intervention were assessed in 5 domains: safe versus unsafe people; safe choices; problem-solving; clear disclosure; and assertiveness. Participants were 1177 students (46% White, 26% African American, 15% Hispanic, 4% Asian American, 6% Other) in grades 1 through 6 from 14 public schools in Tennessee. Multilevel models accounting for the nesting of children within schools revealed large effect sizes for the intervention versus control across all knowledge domains (d's ranged from 1.56 to 2.13). The effectiveness of the program was moderated by mean per capita income and rates of substantiated cases of child abuse and neglect in the community. Intervention effects were stronger for youth living in lower as compared to higher income counties, and for youth attending schools in counties with lower as compared to higher abuse/neglect rates. Child characteristics (sex, race) did not moderate intervention effects. This research identified two community-level factors that predicted the effectiveness of a CSA education and prevention program designed to improve children's knowledge of personal safety skills. School-based CSA prevention programs may require modification for communities with higher rates of child abuse and neglect.

Female Sex Offenders: Public Awareness and Attributions

Traditional gender roles, sex scripts, and the way female sex offenders are portrayed in the media may lead to misconceptions about who can commit sexual offenses. Sexual crimes by women may go unnoticed or unreported if there is a general lack of awareness that females commit these crimes. Data from the 2012 Nebraska Annual Social Indicators Survey were used to determine whether the public perceives women as capable sex offenders and the perceived causes of female sex offending. The traditional focus on male sex offenders by researchers, media, and politicians, in addition to gender stereotypes, introduces the possibility of group differences (e.g., between men and women) in perceptions of female sex offenders. Consequently, two secondary analyses were conducted that tested for group differences in both the public's perception of whether females can commit sex offenses and the explanations selected for why females sexually offend. The findings suggest that the public does perceive women as capable sex offenders, although there were group differences in the causal attributions for female sex offending.

Acute Sexual Assault in the Pediatric and Adolescent Population

Children and adolescents are at high risk for sexual assault. Early medical and mental health evaluation by professionals with advanced training in sexual victimization is imperative to assure appropriate assessment, forensic evidence collection, and follow-up. Moreover, continued research and outreach programs are needed for the development of preventative strategies that focus on this vulnerable population. In this review we highlight key concepts for assessment and include a discussion of risk factors, disclosure, sequelae, follow-up, and prevention.

Sexual Assault Disclosure and Sexual Functioning: The Role of Trauma Symptomatology

INTRODUCTION

Previous research has demonstrated that a history of adult sexual assault (ASA) is associated with negative outcomes, including trauma symptomatology and fear of sexual intimacy. Disclosing sexual assault might be protective against such negative outcomes.

AIM

To examine the indirect effect of trauma symptomatology on the association between disclosing ASA and current sexual functioning.

METHODS

Participants included 652 women 21 to 30 years old with a history of ASA recruited from the community. Participants completed self-report measurements on a computer.

MAIN OUTCOME MEASURES

Separate models were performed, with sexual functioning divided into sexual desire, orgasm, and pain during sex.

RESULTS

ASA disclosure was indirectly associated with sexual orgasm and pain during sex by trauma symptomatology. However, there was no indirect effect of trauma symptomatology on the relation between ASA disclosure and sexual desire.

CONCLUSION

Disclosing experiences of ASA could serve a protective function by lessening trauma symptomatology, thereby mitigating impacts on aspects of sexual functioning, such as orgasm and pain.

Pathways to Help

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors’ disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged—and assisted—the survivors in seeking help. Throughout this process, the survivors’ disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors’ wishes; the adults made the victims seek help, which was also against the survivors’ preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims’ continued engagement with these systems.

The parent ratings of traumatized children with or without PTSD

Two clinical and 2 structured clinical interviews were used to identify children with posttraumatic stress disorder (PTSD), traumatized children without PTSD, and nontraumatized controls. Parents evaluated child conduct by marking the Conners' Parent Rating Scale-48 (CPRS-48; Conners, 1989). Data analysis indicated that the CPRS-48 Total scores and the Anxiety and Psychosomatic subscales scores of the PTSD group significantly exceeded the scores of the comparison groups. Children with PTSD and traumatized children without PTSD did not significantly differ on the Hyperactivity Index. The Hyperactivity Index scores of traumatized children without PTSD and nontraumatized controls were not significantly different. Nonsignificant differences were observed between groups on the CPRS-48 Impulsivity-Hyperactivity, Conduct Problems, and Learning subscales. Overall, PTSD was marked by higher internalizing scores and trauma exposure without PTSD was not associated with increased psychological morbidity.

Predictors of delayed disclosure of rape in female adolescents and young adults

BACKGROUND

Delayed disclosure of rape has been associated with impaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency. The purpose of this study was to compare various demographics, post-rape characteristics, and psychological functioning of early and delayed disclosers (i.e., more than 1-week post-rape) among rape victims, and to determine predictors for delayed disclosure.

METHODS

Data were collected using a structured interview and validated questionnaires in a sample of 323 help-seeking female adolescents and young adults (12-25 years), who were victimized by rape, but had no reported prior chronic child sexual abuse.

RESULTS

In 59% of the cases, disclosure occurred within 1 week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12-17 years [odds ratio (OR) 2.05, confidence intervals (CI) 1.13-3.73], penetration (OR 2.36, CI 1.25-4.46), and closeness to assailant (OR 2.64, CI 1.52-4.60) contributed significantly to the prediction of delayed disclosure.

CONCLUSION

The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services.

Rape prevention through empowerment of adolescent girls

BACKGROUND AND OBJECTIVE

Sexual assault is a major cause of injury, unplanned pregnancy, HIV infection, and mental health problems worldwide. In parts of sub-Saharan Africa, sexual assault has reached epidemic proportions. This study evaluated the efficacy of an empowerment and self-defense intervention for adolescent girls to decrease the incidence of sexual assault and harassment in Nairobi's large informal settlements.

METHODS

A prospective cohort of 1978 adolescents from 4 neighborhoods near Nairobi were taught empowerment, deescalation, and self-defense skills in six 2-hour sessions. The standard-of-care (SOC) group (n = 428) received a life skills class. Self-reported, anonymous survey data were collected at baseline and 10.5 months after intervention.

RESULTS

Annual sexual assault rates decreased from 17.9/100 person-years at baseline to 11.1 at follow-up (rate ratio = 1.61; 95% confidence interval [CI], 1.26-1.86; P < .001); there was no significant change in the SOC group (14.3 to 14.0, rate ratio = 1.02; 95% CI, 0.67-1.57, P = .92). Sexual assault disclosure in the intervention group increased from 56% to 75% (P = .006), compared with a constant incidence of disclosure (53%) in the SOC group. The majority (52.3%) of adolescents in the intervention group reported using skills learned to stop an assault.

CONCLUSIONS

This intervention decreased sexual assault rates among adolescent girls in Kenya. The intervention was also associated with an increase in the disclosure of assaults, thereby enabling survivors to seek care and support and possibly leading to the identification and prosecution of perpetrators. This model should be adaptable to other settings both in Africa and globally.

Cold or caring? Adolescent sexual assault victims' perceptions of their interactions with the police

One-third of sexual assault cases that are reported to the police involve adolescent victims (Snyder, 2000), yet little is known about adolescent victims' interactions with law enforcement. Through semistructured interviews with 20 adolescent sexual assault victims, this study sought to understand--from the perspectives of the adolescents--how the police interacted with them on an interpersonal level and the impact this had on the adolescents' emotional well-being and engagement in the criminal justice system. Findings revealed that when the police engaged in behaviors that the victims perceived as caring, compassionate, and personable (vs. behaviors that were perceived as uncaring, insensitive, and intimidating), there was a positive impact on victims' emotional well-being and criminal justice system engagement. Implications for improving adolescents' help-seeking experiences are discussed.

Factors associated with adolescents' disclosure of sexual abuse experiences in Hong Kong

This research project is the first study conducted in Hong Kong using adolescent subjects to explore predictors of child sexual abuse disclosure. Eight-hundred male and female adolescents aged 13 to 16 years were recruited from the community while another 30 adolescents joined the study from a clinical setting. One hundred and seventy-seven adolescents acknowledged having a child sexual abuse experience. Results showed that the severity of sexual abuse activities and parent attachment were associated with disclosure in the clinical setting, while abuser's gender and the adolescents' disclosure tendency were associated with disclosure among participants in the community setting. Among the 104 participants who had disclosed their childhood sexual abuse, 70% of them had disclosed it within one month and 63% of them had disclosed to 2 to 5 people. The majority of the disclosers (81%) shared their child sexual abuse experience(s) with their friends. Participants from the clinical setting tended to reveal the experience more to adults than those from the community. The study suggested that when choosing a potential confidant, adolescents paid more attention to confidant characteristics than to anticipated confidant responses to their disclosure. Limitations and practical implications for increasing child sexual abuse disclosure rates are discussed.

Factors from Durkheim's family integration related to suicidal ideation among men with histories of child sexual abuse

Men who were sexually abused during childhood represent a highly stigmatized, marginalized population at risk for a variety of long-term mental health problems. Using the family integration dimension of Durkheim's theory of suicide, factors associated with suicidal ideation among a purposive sample of 487 men with histories of child sexual abuse were examined. Four variables--length of cohabitation, maternal support after disclosure, parental divorce, and older age--were negatively related to suicidal ideation. The analysis provides partial support for Durkheim's model. Implications for education, clinical practice, and future research are presented.

Symptoms of ADHD and depression in a large adolescent population: co-occurring symptoms and associations to experiences of sexual abuse

BACKGROUND

Symptoms of either attention-deficit hyperactivity disorder (ADHD) or depression constitute the most common reasons for contact with child and adolescent psychiatry. The development of psychiatric symptoms can be explained by a combination of environmental stress events and genetic vulnerability. One common form of environmental stress with high impact on health is sexual abuse.

AIMS

To investigate the prevalence and co-occurrence of symptoms of ADHD and depression in relation to experiences of sexual abuse in a large adolescent general population.

METHOD

All 15- and 18-year-old students (n = 4910) in the Swedish county of Vestmanland answered a school-based screening instrument including the six-question ADHD self-rating scale (ASRS), the Depression Self-Rating Scale (DSRS) and questions relating to experiences of sexual abuse.

RESULTS

The prevalence of co-occurring symptoms of ADHD and depression was 2.4% (boys 1.0%, girls 3.9%). The prevalence of experience of any sexual abuse was 20.9% (boys 13.3%, girls 28.7%). Of those with co-occurring symptoms, 48% of the boys and 47% of the girls reported a history of sexual abuse.

CONCLUSIONS

School-based screening for co-occurring symptoms of ADHD and depression might be a method that identifies students at psychiatric and psychosocial risk.

Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women

A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low-income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peritrauma variable of abuse severity and the posttrauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African-American and Latina women with histories of CSA. After controlling for nonsexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African-American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.

The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity

Disclosure is a critical aspect of the experience of people who live with concealable stigmatized identities. This article presents the disclosure processes model (DPM)-a framework with which to examine when and why interpersonal disclosure may be beneficial. The DPM suggests that antecedent goals representing approach and avoidance motivational systems moderate the effect of disclosure on numerous individual, dyadic, and social contextual outcomes and that these effects are mediated by three distinct processes: (a) alleviation of inhibition, (b) social support, and (c) changes in social information. Ultimately, the DPM provides a framework that advances disclosure theory and identifies strategies that can assist disclosers in maximizing the likelihood that disclosure will benefit well-being.

Disclosure of sexual assault: characteristics and implications for posttraumatic stress symptoms among African American and caucasian survivors

Although the general trauma literature links disclosure of abuse to positive psychological and physical health outcomes, findings for sexual assault survivors are mixed. Supportive responses can reaffirm self-worth; however, negative responses can increase feelings of shame and isolation. This study examined the effects of disclosure in a community sample of Caucasian and African American sexual assault survivors who completed computer-assisted self-interviews. Among the 58.6% of survivors who had disclosed to someone (n = 136), 96% had disclosed to at least 1 informal and 24% at least 1 formal support provider. The experiences of African American and Caucasian survivors were similar in many ways. Participants received more positive than negative responses from others, although only negative responses were related to posttraumatic stress disorder symptoms, and particularly so for African American participants. Regretting disclosure and disclosure to formal providers were also related to posttraumatic stress disorder symptoms. Suggestions are made for programs to decrease negative responses to disclosure.

From the margins to the center: ethnic minority women and the mental health effects of sexual assault

The trauma of sexual assault is heightened for many women by the interlocking experience of societal traumas such as racism, sexism, and poverty. The mental health effects of sexual assault are mediated by race and ethnicity. The investigators explore the experiences of African American, Asian American, Latina, and Native American female survivors of sexual assault. The sociohistorical context of intergenerational trauma in the lives of ethnic minorities is a part of the context for the contemporary experience of sexualized violence. Racial and ethnic dynamics related to sexual assault prevalence, mental health effects, and disclosure are examined. Literature related to cultural beliefs, community attitudes, and perceived social support in relation to sexualized violence are also reviewed. Finally, practice, research, and policy implications are discussed.