Methodological considerations in research on child sexual abuse

Psychological functioning and family discord among African-American adolescent females with and without a history of childhood sexual abuse

OBJECTIVES

The aim was to examine the rate of childhood sexual abuse along with the factors (age of abuse onset, type of perpetrator, and duration of the abuse), as well as the relationship of these factors to psychological functioning among females with a history of childhood abuse. Second, to determine whether levels of psychological functioning and family discord differ among females with and without a history of childhood sexual abuse.

METHOD

A cross-sectional design was used. Two hundred and forty-nine adolescent females were recruited from a community-based health program. Two trained female interviewers administered an anonymous survey that assessed childhood sexual abuse, psychological functioning, and family environment.

RESULTS

Fifty-seven (22.9%) of those surveyed reported childhood sexual abuse, of which 44.3% were intrafamilial and 55.7% were interfamilial. Age at onset ranged from 3 years to 17 years; 62.5% reported that the sexual abuse occurred 1 to 4 times; 27.9% reported a duration ranging from 1 year to 13 years; and 9.6% reported a duration of 1 month to 7 months. Multiple regression analysis revealed that a greater duration predicted higher levels of depression and lower levels of self-esteem among females with a history of sexual abuse. Females with a history of childhood sexual abuse scored significantly lower on measures of self-esteem and mastery, and significantly higher on measures of physical and emotional abuse.

CONCLUSIONS

Results indicate that adolescent females with a history of childhood sexual abuse suffer an array of negative sequelae that include psychological and family distress.

A critical appraisal of the 1998 meta-analytic review of child sexual abuse outcomes reported by rind, tromovitch, and bauserman

The goal of this article is to present a methodological critique of the 1998 meta-analysis of child sexual abuse outcomes by Rind, Tromovitch, and Bauserman. Seven major concerns are addressed. Rind et al.'s view is, at best, extremely limited. By restricting a supposedly broad meta-analysis to only some of the population in question, the conclusions they drew regarding this complex topic, primarily that adult-child sex is not necessarily harmful, are invalid.

Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization

OBJECTIVE

The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence.

METHOD

A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years.

RESULTS

Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence.

CONCLUSIONS

The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.

Physical punishment/maltreatment during childhood and adjustment in young adulthood

OBJECTIVE

To study the relationships between retrospective reports of physical punishment/maltreatment and rates of adjustment difficulties at age 18 in a birth cohort of New Zealand subjects.

METHOD

Data were gathered over the course of an 18 year longitudinal study of a birth cohort of 1,265 New Zealand born children. At age 18 retrospective reports of exposure to physical punishment/maltreatment were obtained. At this time the cohort was also assessed on measures of psychosocial adjustment juvenile offending, substance abuse behaviors, and psychiatric disorder.

RESULTS

Young people reporting exposure to harsh or abusive treatment during childhood had elevated rates of juvenile offending, substance abuse, and mental health problems. However, subsequent analysis using logistic regression methods showed that much of the elevated risk shown by this group was explained by social and contextual factors that were associated with patterns of childhood punishment/maltreatment. Nonetheless, even after control for confounding factors those reporting harsh or abusive childhood experiences were at increased risks of violent offending, suicide attempts, being a victim of violence, and alcohol abuse.

CONCLUSION

This study leads to three major conclusions: (1) Those exposed to harsh or abusive treatment during childhood are an at-risk population for juvenile offending, substance abuse, and mental health problems; (2) Much of this elevated risk arises from the social context within which harsh or abusive treatment occurs; (3) Nonetheless, exposure to abuse appears to increase risks of involvement in violent behavior and alcohol abuse.

Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse

OBJECTIVE

To present accounts of the prevalence of childhood sexual abuse (CSA) and social, family, and related factors that are associated with increased risk of CSA, using data gathered during an 18-year longitudinal study of a New Zealand birth cohort.

METHOD

A birth cohort of more than 1,000 children born in Christchurch (New Zealand) was studied prospectively to the age of 16 years. At age 18, retrospective reports of CSA were obtained.

RESULTS

Of the cohort, 10.4% (17.3% of females and 3.4% of males) reported having experienced CSA before the age of 16 years. Rates of severe abusive experiences involving intercourse were lower: 5.6% of females and 1.4% of males reported abuse involving attempted or completed intercouse. Multivariate analyses that the risk of CSA was elevated among females (p < .0001), those exposed to high levels of marital conflict (p < .005), those reporting low parental attachment (p < .001), those reporting high levels of paternal overprotection (p < .005), and those with parents who reported alcoholism/alcohol problems (p < .05). The level of prediction of CSA from childhood and family factors was not sufficient to identify individuals at risk of CSA with any degree of accuracy.

CONCLUSIONS

CSA was not an uncommon experience in this cohort. Those most likely to be exposed to CSA were girls reared in families in families characterized by high levels of marital conflict and impaired parenting and in families having parents with adjustment problems.

Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse

OBJECTIVE

This is the second in a series of articles that describe the prevalence, correlates, and consequences of childhood sexual abuse (CSA) in a birth cohort of more than 1,000 New Zealand children studied to the age of 18 years. This article examines the associations between reports of CSA at age 18 and DSM-IV diagnostic classifications at age 18.

METHOD

A birth cohort of New Zealand children was studied at annual intervals from birth to age 16 years. At age 18 years retrospective reports of CSA prior to age 16 and concurrently measured psychiatric symptoms were obtained.

RESULTS

Those reporting CSA had higher rates of major depression, anxiety disorder, conduct disorder, substance use disorder, and suicidal behaviors than those not reporting CSA (p < .002). There were consistent relationships between the extent of CSA and risk of disorder, with those reporting CSA involving intercourse having the highest risk of disorder. These results persisted when findings were adjusted for prospectively measured childhood family and related factors. Similar but less marked relationships between CSA and nonconcurrently measured disorders were found.

CONCLUSIONS

The findings suggest that CSA, and particularly severe CSA, was associated with increased risk of psychiatric disorder in young adults even when due allowance was made for prospectively measured confounding factors.

Prevalence of child sexual abuse among adolescents in Geneva: results of a cross sectional survey

OBJECTIVE

To measure the cumulative prevalence of child sexual abuse in a representative sample of the adolescent population of Geneva.

DESIGN

Cross sectional survey with an anonymous self administered questionnaire centred on a factual description of sexual activities.

SETTING

68 classes (17 schools) randomly selected from the 201 ninth grade classes of the public school system in Geneva.

SUBJECTS

1193 adolescents aged 13-17 years, of whom 1116 (93.5%; 568 girls, 548 boys) consented to the study and returned completed questionnaires.

RESULTS

192 (33.8%) girls and 60 (10.9%) boys reported having experienced at least one sexually abusive event. The prevalence of abuse involving physical contact was 20.4% (116 cases) among girls and 3.3% (18) among boys. The prevalence of abuse involving some form of penetration was 5.6% (32 cases) among girls and 1.1% (six) among boys. One third of the abused adolescents had experienced more than one abusive event and 46.5% (92/198) had experienced the first event before age 12. Abuse by a family member was reported by 20.5% (36/176) of abused girls and 6.3% (3/48) of abused boys. Abusers were known to victims in two thirds of cases. Ninety per cent of abusers were male and 35.3% (71/201) came from the victim's peer group. Over 80% of participants found the questionnaire interesting, clearly formulated, and useful.

CONCLUSIONS

Child sexual abuse is a universal social phenomenon. Adolescents themselves can contribute to research and so help in the search for more efficient prevention and intervention strategies.