The long-term co-occurrence of psychiatric illness and behavioral problems following child sexual abuse

Role of psychopathology on children credibility of sexual abuse testimony

When an alleged victim has a pre-existing psychopathological diagnosis, this can affect the rating of their version of the abuse in terms of credibility. The objective of this work is to analyze the relationship between the assessment of the credibility of the testimony of a CSA victim, the psychological problems that the child may have presented prior to sexual abuse and the possible psychological sequelae that she may present as a result of the abuse. 109 cases were selected in which the credibility of the testimony could be determined. Through forensic interviews and the study of the corresponding professional reports, the following were obtained: sociodemographic data, data on their previous psychological state and data on their psychological state after the reported events. The psychological state of the child after the reported events shows no relation to the forensic evaluation of the credibility of her testimony. The existence of a relationship between the absence of previous psychopathology and the fact that the victim's testimony is valued as a credible account is confirmed. This study reveals that children who presented psychological manifestations prior to their experience of abuse receive a lower credibility rating than those without previous psychopathological symptoms or diagnoses.

Gender Differences in the Characterization of Child Sexual Abuse

Research on child sexual abuse (CSA) has increased in recent decades. However, the study of gender differences in this field is still scarce. The aim of this study was to analyze the differences in the characterization of CSA between Spanish adult men and women. The Juvenile Victimization Questionnaire was administered to 162 cisgender victims of CSA aged 18-63. Most of the abuses involved physical contact and were committed by a known person. Twenty percent of the victims indicated that they had developed a mental health problem that they believed was due to the CSA experience. Women suffered more CSA with physical contact and penetration, more types of abuse and more abuse by men, and were abused more frequently by a family member. Compared to women, men suffered more sexual abuse by women. Exploring gender differences in CSA could help to improve preventive strategies and interventions aimed at reducing the occurrence of this type of abuse and sequelae resulting from it.

The self-perceived impact of sexual abuse on daily life and general health - an issue to consider in dental care

BACKGROUND/AIM

To analyse, from the perspective of adults with a history of sexual abuse, the impact of the experience on their general health and well-being.

MATERIAL AND METHODS

The participants comprised 12 strategically selected informants (10 women), aged 19-56; all sexually abused during child- and/or adulthood. They were interviewed in-depth and encouraged to describe the impact of the sexual abuse on their daily lives. The consequences of sexual abuse on oral health have previously been reported. The interviews were recorded digitally, transcribed verbatim and analysed according to qualitative content analysis with an inductive approach.

RESULTS

The overall theme illustrating the latent content was Sexual abuse experience-limiting long-term consequences, always present in body and mind. The first category covering the manifest content was 'A lost foothold', with two subcategories: (i) emotional repercussions and (ii) physical health repercussions. The second category was 'The significance of distance to trauma', with two subcategories (i) keeping a distance and tending to escape and (ii) processing the trauma experience-a struggle towards balance.

CONCLUSIONS

A history of sexual abuse cannot be understood in isolation: the long-term repercussions pervade daily life. However, after disclosure of the abuse and processing the trauma, it is possible to ameliorate some of the negative effects. In this context, the dental setting emerges as a potentially important venue for disclosure as almost every person, sooner or later, visits the dentist.

Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study

The aim of this study was to use longitudinal population-based data to examine the associations between childhood sexual abuse (CSA) and risk for adverse outcomes in multiple life domains across adulthood. In 937 individuals followed from birth to age 45y, we assessed associations between CSA (retrospectively reported at age 26y) and the experience of 22 adverse outcomes in seven domains (physical, mental, sexual, interpersonal, economic, antisocial, multi-domain) from young adulthood to midlife (26 to 45y). Analyses controlled for sex, socioeconomic status, prospectively reported child harm and household dysfunction adverse childhood experiences, and adult sexual assault, and considered different definitions of CSA. After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.

Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study

BACKGROUND

Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations.

METHODS

Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations.

RESULTS

Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics.

CONCLUSIONS

Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

Access to therapy for child sexual abuse survivors: Preliminary dialogue of barriers and facilitators between caregivers

BACKGROUND

Difficulties in access to therapy were highlighted by COVID-19 measures restricting in-person gatherings. Additional challenges arise when focusing on caregivers of child sexual abuse (CSA) survivors in particular, which are a population that has been historically difficult to engage with due to issues of stigma and confidentiality.

OBJECTIVES

To present preliminary qualitative results from caregivers of CSA survivors.

METHODS

This study was conducted with caregivers of CSA survivors. Two hybrid webinar/focus groups were conducted using a video conferencing platform in fall of 2021 with two groups of stakeholders (11 caregivers and 5 moderators/clinical staff at Little Warriors, an intensive episodic treatment facility). Sessions were recorded, transcribed, and thematically-analyzed using standard qualitative methodology.

RESULTS

A total of 11 caregivers contributed to the data. Themes include: (1) Challenges of starting and maintaining treatment (i.e., emotional impact of intake day, challenges of enrolling), (2) Therapeutic benefits of specialized treatment (i.e., feeling safe and supported and the importance of trauma-informed care), and (3) Barriers and facilitators of treatment (i.e., avenues to scale-up and self-care).

CONCLUSION

The importance of a strong therapeutic alliance was highlighted by both caregivers/clinical staff and further support is needed for families post-treatment. The present hybrid webinar/focus group also achieved engagement goals in a population that is typically difficult to reach. Overall, the response rate (12%) was equivalent to reported registrant attendance rates for general business to consumer webinars and the recommended focus group size. This preliminary approach warrants replication in other populations outside our clinical context.

The Potential for Anti-Stigma Interventions to Change Public Attitudes Toward Minor-Attracted Persons: A Replication and Extension of Jara and Jeglic's Study

From a public health perspective, ensuring access to, and uptake of, support services for people concerned about their sexual thoughts and behavior is essential to the prevention of child sexual abuse. However, public and fiscal support for these services can be adversely affected by negative preconceptions regarding minor-attracted persons (MAPs); negative stigma may also limit MAPs' engagement with such services. Using a randomized-control design, the present study replicated and extended a recent US study to test effects of different modes of educational messaging to reduce negative attitudes toward MAPs in Australia. Participants were recruited nationally via a Qualtrics XM online survey platform. The final sample (n = 178) were aged 18-84 (M = 47.57 years, SD = 17.34; 49% male). Participants completed the Attitudes Toward Minor Attracted Persons (ATMAP) scale prior to being randomly assigned to one of four conditions (written text [facts only]; written text [myth and facts]; info-video [myths and facts]; and control). Following intervention (or control) the ATMAP was readministered; those in experimental groups also completed a comprehension test. Mixed between-within subjects analysis of covariance revealed significant reductions in pre-post scores on the ATMAP scale, but no significant differences were found across intervention types, or the control. Scores indicated that older participants were less negative in their attitudes compared to younger participants, both before and after intervention. Findings suggest that educating the public may improve attitudes toward MAPs, but more knowledge is required on how to best disseminate messages to maximize impact.

Surviving Child Abuse in People With Mental Illness: A Grounded Theory Approach

The aim of this qualitative study was to examine the process of surviving child abuse in people with a mental illness in order to develop an explanatory theory. The study utilized the grounded theory approach. Seventeen community-dwelling adults with a mental illness who had experienced child abuse were interviewed. For the in-depth interview, the lifeline interview method was used. Data were collected from July 14, 2019, to February 28, 2020. The constant comparative method was used for analysis, to identify similarities and differences between different statements, and similar phenomena or theories were compared and analyzed continuously. The central phenomena were "losing oneself" and "in a precarious state." Participants used "expressing," "standing on one's own feet," and "avoiding" as coping strategies. Observed outcomes were "making life work for them" and "living with others." The core category was "losing myself, embracing myself as someone in a precarious state, and being reborn as the master of my life." Positive religious coping, having a supportive network, and emotional or physical distance from difficult situations played a major role in surviving participants' experiences of child abuse and being victimized because of their mental illness. Our findings provide a theoretical basis for understanding people with mental illness who have survived child abuse, and suggest that opportunities for sharing their stories, facilitating self-reliance, and avoiding the causes of their difficulties all play a role in their healing process. Based on this study, it is expected that clinical experts and policy developers will be able to formulate evidence-based interventions and policies.

Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence

OBJECTIVE

The aim of this study was to characterize child sexual abuse and investigate the factors related to its repetition in the state of Santa Catarina, Brazil.

METHODS

This is a descriptive and analytical study, with data from 2009-2019 SINAN. Sociodemographic variables related to the circumstances of violence were analyzed. Multivariate logistic regression was used to test factors related to repetitive violence.

RESULTS

A total of 3489 cases of child sexual abuse were reported: 73.3% were girls, the most prevalent age ranged from 6 to 10 years, and 51% reported repetitive violence. The majority was perpetrated by one (85.6%) person, and in cases in which two or more perpetrators were involved, the proportion of occurrence was higher for boys (17%) versus girls (13%). Among the risk factors for the repetition of sexual violence are the place of occurrence being the residence, the perpetrator (the stepfather, the brother, and the father) being under the influence of alcohol, and the age of the child between 6 and 10 years.

CONCLUSION

The profile and factors that help in the identification of repetitive child sexual abuse were presented, such as the authorship being related to stepfathers, parents, and siblings, the perpetrator being under the influence of alcohol, and the victim's age between 6 and 10 years.

Help-seeking behaviour in primary care of men and women with a history of abuse: A Dutch cohort study

BACKGROUND

Previous studies show an association between a history of abuse and higher care demand. However, studies in general practice regarding help-seeking behaviour by patients (mainly male patients) with a history of abuse are scarce.

OBJECTIVES

To analyse help-seeking behaviour in general practice of men and women with a history of abuse.

METHODS

A cohort study using data from a Dutch primary care registration network from 2015 to 2019. We included all patients aged ≥ 18 years who indicated on a questionnaire that they did or did not have a history of abuse. We analysed differences in contact frequency, types of contact, reason for encounter and diagnoses between men and women with or without a history of abuse.

RESULTS

The questionnaire had a response rate of 59% and resulted in 11,140 patients, of which 1271 indicated a history of abuse. Men and women with a history of abuse contact the general practitioner (GP) 1.5 times (95% CI 1.42-1.60) more often than men and women without a history of abuse, especially for psychological (rate ratio 1.97, 95% CI 1.79-2.17) and social (rate ratio 1.93, 95% CI 1.68-2.22) problems. Moreover, when diagnosed with a psychological or social problem, patients with a history of abuse contact the GP twice more often for these problems.

CONCLUSION

Compared to men and women without a history of abuse, men and women with a history of abuse visit their GP more often, particularly for psychological and social problems.

Knowledge hardly translates to reality-A randomized controlled trial on sexual abuse prevention for girls with intellectual disabilities

Objective

People with intellectual disabilities (ID) are at higher risk of being sexually abused and developing psychiatric disorders in consequence. The effects of behavior prevention programs for children with ID have rarely been investigated. Previous studies suffer from methodical weaknesses, such as the lack of a control group, small sample size, or invalid outcome measures. This study aimed at demonstrating the efficacy of a prevention program by overcoming these flaws.

Methods

A group prevention program was developed and evaluated. One hundred and six girls aged from 8 to 12 years with mild ID were enrolled in a randomized controlled study, comparing the training to a sham intervention. Effects were examined in a three-time follow-up design as individual changes in preventive knowledge (board game, verbal reports) and preventive behavior (role-play, in situ tests). Participants' behaviors were videotaped and rated by three blinded raters.

Results

Girls from the intervention group (n = 64) showed significant improvements in preventive knowledge compared with the control group (n = 39) but showed non-significant improvements for preventive behavior. In situ tests with realistic seduction situations revealed no improvement. The intervention proved to be safe, but several risks need to be considered.

Discussion

This is the first study that evaluates a behavioral prevention program on sexual abuse for children with ID on a high level of evidence. Group interventions empowering girls with ID to recognize abuse situations are suitable to enhance sexual preventive knowledge but are less suitable to enhance preventive behavior. Naturalistic settings are indispensable for providing evidence for preventive interventions in children with ID.

Edutainment as A Strategy of Child Sexual Abuse Prevention: Literatur Review

BACKGROUND: Child sexual abuse is the most serious public health problem in all cultures and societies that will have an impact in the future on a lost generation. The United Nations Children's Fund (UNICEF) estimates that around 120 million girls under 20 y.o. have been sexually abused. AIM: This study aimed to determine the effectiveness of preventing sexual abuse in children by using an edutainment approach. METHODS: This study used an online journal database that provided free articles and journals in PDF such as Proquest, Google Scholar, Pubmed, Elsevier, and Scinapse. Literature was collected from the past 10 years, 2010–2020, using the following keywords: Edutainment, Child Sexual Abuse, Child Sexual Abuse Prevention, and Child Sexual Abuse Education Program. RESULTS: This study examining the effectiveness of edutainment in preventing child sexual abuse showed that edutainment in preventing child sexual abuse through children's play had succeeded in increasing awareness about sexual abuse in children and parents, as well as improving children's self-protection skills to recognize potential situations of abuse and resist inappropriate touch requests. CONCLUSIONS: Intervention model with edutainment approach effective for the prevention of child sexual abuse

"It's Complicated Because We're Only Sixteen": A Framework for Understanding Childhood Sexual Abuse Disclosures to Peers

The process of disclosing childhood sexual abuse (CSA) is very difficult for young people. Researchers have consistently found that young people disclose CSA to other youth at much higher rates than to familiar adults or authorities and indicate that CSA remains largely unknown to adults. However, no study to date has focused exclusively on understanding the process of youth-directed disclosures from young people's perspectives. Using grounded theory methodology, this qualitative study aimed to understand the process of CSA disclosures to peers based on interviews with 30 young people from Canada and Ireland who have experienced CSA. The findings reflect the iterative and dialogical nature of the peer disclosure process and provide a framework for youth-directed disclosures that is centered on the theme of uncertainty. An underlying sense of uncertainty permeated the entire disclosure experience as participants' narratives reflected six stages that were interrelated in a cyclical process: experiencing internal conflict, needing to tell and choosing to confide in peers, expecting emotional support from peers, gradual telling and making sense of the abuse, burden on peers, and assessing peer responses and further disclosures. In addition, this model was not static, as with time, participants reinterpreted their peers' responses. The presented framework is consistent with previous conceptualizations of CSA disclosures, but the focus on youth-directed disclosures from the perspective of young people also allowed for a model that explains processes that are unique to peer disclosures. Practice and policy implications as well as limitations and future research directions are discussed.

Comparison Between Male and Female Survivors of Sexual Abuse and Assault in Relation to Age at Admission to Therapy, Age of Onset, and Age at Last Sexual Assault: Retrospective Observational Study

BACKGROUND

Sexual abuse and sexual assault are complex phenomena that involve many factors (or correlates) and have many health and financial implications for individuals, families, and society. Every correlate needs to be studied in detail, individually and in relation to other correlates. Only with a thorough understanding of these correlates can more efficient and targeted prevention and intervention programs be designed.

OBJECTIVE

The purpose of this study was to examine the differences between male and female survivors of sexual abuse and sexual assault regarding the correlates of the survivors' age of onset of assault, age at the last assault, and age at which they entered therapy.

METHODS

Therapists at eight sexual assault centers in the province of Alberta, Canada, completed a questionnaire on each of their clients over a period of 7 years. A total of 3302 participants, of whom 2901 (87.86%) were female and 401 (12.1%) were male survivors of sexual abuse and assault, were included in this study. Mostly descriptive analyses were carried out on the 4 variables of concern in this study.

RESULTS

Regarding the number of survivors who sought therapy, female survivors outnumbered male survivors by a ratio of 7:1, with different ratios for different age groups. As children age, their risk of being sexually assaulted for the first time decreases. Male children are more likely to be sexually abused at a younger age, whereas female children are more vulnerable to being assaulted at all ages, particularly in adolescence. The mean age of onset of sexual abuse was found to be 6.71 (SD 2.86) years, and the odds of experiencing the first sexual assault during childhood, as opposed to adolescence, were 4:1 for females and 9:1 for males. Male survivors were two times more likely than female survivors to experience their first sexual assault in childhood. The vast majority of survivors sought help many years after being sexually assaulted, and male survivors waited an average of 3 years longer from the last sexual assault before seeking therapy.

CONCLUSIONS

The majority of survivors of sexual abuse and sexual assault live with the consequences for many years before they seek help, and a large proportion of male survivors are not likely to seek help.

Factors associated with psychiatric admission and subsequent self-harm repetition: a cohort study of high-risk hospital-presenting self-harm

BACKGROUND

Individuals presenting to hospital with self-harm of high lethality or high suicidal intent are at high risk of subsequent suicide.

AIM

To examine factors associated with psychiatric admission and self-harm repetition following high-risk self-harm (HRSH).

METHOD

A cohort study of 324 consecutive HRSH patients was conducted across three urban hospitals (December 2014-February 2018). Information on self-harm repetition was extracted from the National Self-harm Registry Ireland. Logistic regression models examined predictors of psychiatric admission and self-harm repetition. Propensity score (PS) methods were used to address confounding.

RESULTS

Forty percent of the cohort were admitted to a psychiatric inpatient setting. Factors associated with admission were living alone, depression, previous psychiatric admission, suicide note and uncommon self-harm methods. History of emotional, physical or sexual abuse was associated with not being admitted. Twelve-month self-harm repetition occurred in 17.3% of cases. Following inverse probability weighting according to the PS, psychiatric admission following HRSH was not associated with repetition. Predictors of repetition were recent self-harm history, young age (18-24 years) and previous psychiatric admission.

CONCLUSION(S)

Findings indicate that psychiatric admission following HRSH is not associated with repeated self-harm and reaffirms the consistent finding that history of self-harm and psychiatric treatment are strong predictors of repetition.

Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study

BACKGROUND

Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited.

AIMS

We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm.

METHOD

A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition.

RESULTS

Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94-9.94, P = 0.00). Three themes emerged when exploring participants' CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm.

CONCLUSIONS

CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.

Psychological intervention with adult victims of sexual abuse: A comprehensive review

Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short- and long-term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult CSA survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA and demonstrates the need to conduct further research on the effectiveness of intervention.

Childhood maltreatment, psychiatric symptoms, and suicidal thoughts among adolescents receiving substance use treatment services

INTRODUCTION

Childhood maltreatment experiences are associated with future suicidal thoughts and suicide attempts, yet the roles of specific psychiatric symptoms mediating this relation remain to be clarified. To clarify these relations, we tested a model incorporating multiple forms of childhood maltreatment (sexual abuse, physical punishment, emotional neglect), past year psychiatric disorder symptoms during adolescence (anxiety, mood, and conduct disorders) and recent suicidal thoughts.

METHODS

We administered structured interviews to 394 adolescents receiving outpatient substance use treatment services in the Southeastern United States (280 males; Mage = 16.33; SDage = 1.15). Structural equation models (SEMs) were used to evaluate the degree to which relations between childhood maltreatment and suicidal thoughts were mediated by specific past-year psychiatric symptoms.

RESULTS

Mood disorder symptoms significantly mediated the relation between neglect/negative home environment and suicidal thoughts. This path of influence did not vary by gender.

CONCLUSIONS

Childhood maltreatment and subsequent psychopathology influence suicidal thoughts among adolescents receiving substance use treatment services. The findings of the present study have implications for the adaptation and delivery of substance use treatment services to adolescents to enhance treatment engagement and outcomes.

Child sexual abuse knowledge/attitude scale for parents: Reliability and validity of the Turkish version

PURPOSE

The aim of this study was to determine the validity and reliability of the Turkish version of the child sexual abuse knowledge/attitude scale for parents (CSAKAS).

DESIGN AND METHODS

This methodological study was carried out with 193 parents in between February and May 2018.

FINDINGS

The validity and reliability of the six-factors structure scale were confirmed. The Cronbach's alpha coefficient of the whole scale is 0.793, the item-total score correlations ranged between 0.341 and 0.719 and the test-retest coefficient was 0.841.

PRACTICE IMPLICATIONS

The CSAKAS Turkish scale was found to be a valid and reliable tool that can be used to evaluate the knowledge and attitudes of parents about child sexual abuse.

The Amsterdam Sexual Abuse Case: What Scars did it Leave? Long-Term Course of Psychological Problems for Children Who have been Sexually Abused at a Very Young Age, and their Parents

Longitudinal research of CSA in infancy and early childhood is scarce. The current study examined the long-term course of psychological outcomes (PTSD, dissociation and internalizing and externalizing behavioral problems) in children who were sexually abused in the early childhood. Additionally, we looked into the outcomes for their parents by assessing PTSD symptoms and negative emotional reactions towards the sexual abuse of their child. We examined the outcomes for five consecutive years in a sample of children (n = 45) who were sexually abused at a very young age (0-3) and their parents (n = 42), included in the Amsterdam Sexual Abuse Case-study. We found that outcomes following CSA in early childhood go beyond PTSD symptoms and can manifest in atypical symptoms such as behavioral problems. Parents experienced persistent PTSD in the years following CSA disclosure. CSA in very young children warrants long-term monitoring, as negative outcomes still present 8 years later.

Examining the Use of Police and Ambulance Data in Suicide Research

Background: Police and paramedics are often the first to respond to individuals in suicide crisis and have an important role to play in facilitating optimal care pathways. Yet, little evidence exists to inform these responses. Data linkage provides one approach to examining this knowledge gap. Aim: We identified studies that examined suicide behaviors and linked to police or ambulance data. Method: A systematic search of PubMed and Scopus was undertaken to identify data linkage studies that: (1) examined suicide behaviors, and (2) included police or ambulance data. Studies were reviewed to identify: aims; suicide behaviors examined; how these were measured; how the cohort was defined; topic area; and what datasets were linked. Results: Eight studies met the inclusion criteria. Six studies included police data, and two studies included ambulance data. No study included both. Two topic areas were identified: (1) suicide-related contact with police or ambulance services; and (2) associations between suicidal behaviors and violence, victimization, and criminality. Limitations: Limitations to the review include the potential to have missed studies that investigated or reported on suicidality under the guise of mental health problems; complexities and nuances arising from the role of police data in coronial investigations; and limitations in the number of databases searched. Conclusion: Police and ambulance data represent a currently underutilized source of valuable information relevant to suicide crises, and further research should aim to address this gap.

The influence of pre and postnatal adversity on depression and anxiety over two decades

INTRODUCTION

Perinatal and later postnatal adversity (e.g., child sexual abuse) are predictors of psychopathology across the lifespan. However, little is known about the impact of the joint effects of perinatal and postnatal adversity on the longitudinal trajectories of mental health problems from adolescence through adulthood.

METHOD

We utilized data from a prospective, longitudinal birth cohort of extremely low birth weight (ELBW; < 1000 g) survivors and normal birth weight (NBW; > 2500 g) control participants. Self-report data on internalizing (depression, anxiety) and externalizing (antisocial) problems were collected at 12-16, 22-26, and 30-35 years of age.

RESULTS

A birth weight by child sexual abuse (CSA) interaction was observed such that ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than NBW participants exposed to CSA. Differences remained significant after adjustment for covariates. Likewise, ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than ELBW participants who were not exposed to CSA.

LIMITATIONS

Findings are limited by sample attrition due to the longitudinal nature of the study spanning over 30 years as well as the retrospective nature of child sexual abuse reporting.

CONCLUSIONS

Exposure to both perinatal and later postnatal adversity leads to persistently higher internalizing problems than exposure to either adversity alone over more than two decades. These findings suggest that individuals exposed to perinatal adversity may be especially vulnerable to, and persistently affected by, childhood adversity, particularly in the form of depression and anxiety.

Evaluating the legal assumptions of Victoria's Sex Offender Registration Act 2004 from a psychological perspective

The Sex Offender Registration Act 2004 was introduced in Victoria to decrease recidivism and aid in future investigations and prosecutions. This article reviews literature to evaluate four assumptions inherent to the Act: (a) sexual offenders are more dangerous than non-sexual offenders; (b) sexual offenders who target children are more dangerous than those who target adults; (c) recidivism risk can be accurately assessed for sexual offenders who target adults; and (d) the Act is a useful tool for investigations and prosecutions. The findings suggest that there is little evidence that supports the assumptions. Further, given the relatively narrow scope of the Act, it is unlikely to have a positive impact on the safety of the community.

Child Sexual Abuse and Depression in Late Life for Men: A Population-Based, Longitudinal Analysis

OBJECTIVE

Research investigating long-term effects of childhood sexual abuse (CSA) on mental health for men is vastly underdeveloped. This study strengthened the knowledge base by examining: (a) long-term trajectories of depressive symptoms for men with and without a history of CSA, and (b) moderating effects of social support over time.

METHOD

We analyzed multiple waves of data from the Wisconsin Longitudinal Study. The sample (N = 2,451) consisted of men with histories of CSA and a stratified, randomly sampled comparison group. Growth curve modeling was employed for analyses.

RESULTS

After controlling for demographic, parental, and health factors, men with CSA histories had greater depressive symptoms than those with no history of CSA. For both groups, depressive symptoms decreased over time; slope patterns did not differ. We found a significant moderating effect of social support on the relationship between CSA and depressive symptoms.

DISCUSSION

This innovative, population-based, longitudinal study demonstrated that CSA can undermine mental health for men across the life span and into old age. Social support appears to mitigate these deleterious effects. In early, middle, and late adulthood, practitioners should assess for CSA and strengthen support resources for male survivors.

The Prevalence of Sexual Abuse in Adolescence in Suriname

Studies conducted to ascertain the prevalence of child sexual abuse (CSA) in the Caribbean are poorly synthesized. Present study reports on the lifetime and year prevalence of unwanted sexual experiences, the risk of CSA at different ages within adolescence, and differences between the three largest ethnic groups in Suriname. One thousand one hundred and twenty (1,120) adolescents completed a questionnaire on child maltreatment, including CSA. The study's stratified sample consisted of students (ages 12 to 17) from five districts in Suriname. More than 16% of all boys and 15% of all girls indicated that they had been exposed to some form of CSA in the past 12 months. Girls reported significantly more intrafamilial CSA by a minor than boys. Boys reported significantly more experiences of being touched or forced by a minor outside the family to look at/touch the abuser's private parts than girls. Besides, 16 and 17-year olds were the most vulnerable. An increased risk of CSA (year prevalence) was found as adolescence progresses. A significant portion of CSA constituted peer-to-peer sexual victimization. Afro Surinamese adolescents were found to report the highest rates of CSA. Appropriate legislation, policies, and services for prevention and recovery are needed in Suriname.

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

An Exploration of Coping with Childhood Sexual Abuse in Arab American Women

This research used a descriptive qualitative approach to explore coping with childhood sexual abuse (CSA) and to identify long-term psychological outcomes among Arab American women. Ten Arab American women participated in the study. Data were collected by individual semi-structured interviews and analyzed using content analysis. Five categories emerged for CSA experience among the participants: CSA characteristics, social support, Arabic culture, coping, and long-term psychological outcomes. Most of the women had experienced familial and contact CSA . and had disclosed their CSA and received different reactions from family and friends. Arabic cultural values influenced the women's experience of CSA and their coping strategy, especially regarding the CSA disclosure and seeking mental health services. The women used a spectrum of strategies to cope with their abuse including seeking support, positive reappraisal,,, accepting responsibilities, avoidance and protective coping. All women experienced negative long-term psychological outcomes of CSA such as flashbacks and low self-esteem. Prior to this research, no known studies have explored coping with CSA experience among Arab American women. Thus, this study can be used to inform practice guidelines to minimize the stigma of CSA and to promote help-seeking behavior for Arab American female CSA survivors and their families.

Domestic Violence Between Childhood Incest and Re-victimization: A Study Among Anti-violence Centers in Italy

The study focuses on a specific problem in the area of child sexual abuse (CSA), which is still under-researched: the relationship between incest and adult female re-victimization treatment within the ambit of domestic violence in Italian centers. About 112 anti-violence centers were contacted, but only 13 participated and only 16 psychologists were interviewed to reconstruct the biographies of 32 victims. The study aimed to examine if and how the service centers recognized and dealt with the problem of re-victimization among survivors based on psychologists' narrations. Findings showed that the description of perpetrators revealed not only sexual abuse was perpetrated, but also psychological and physical abuse. About half of mothers did not come to their daughters' aid and those who cooperated with the abusers had mostly suffered from CSA at a time in their life. Only three mothers did help their daughters in contacting the anti-violence centers. However, most of the service centers were not concerned with the relationship between incest and domestic re-victimization, while those who considered the problem, dealt with it only on the practitioner-patient level. In addition, despite the psychologists used professional and empathetic language, they disclosed their high emotional involvement and a genuine bewilderment. A discussion on the need to standardize the psychotherapeutic support given to these re-victimized women was presented, with a critique to the un-discriminated de-pathologization approach adopted by almost all anti-violence centers. In particular, we wanted to underline the fact that, although, this approach is useful in treating victims who were not abused during infancy, it could be insufficient for women who suffered from incest.

Child Sexual Abuse and Criminal Offending: Gender-Specific Effects and the Role of Abuse Characteristics and Other Adverse Outcomes

This study sought to enhance knowledge of the link between child sexual abuse (CSA) and long-term criminality by investigating gender-specific effects and the role of index sexual abuse characteristics, revictimization, and serious mental health problems. An Australian sample of 2,759 documented cases of sexual abuse and 2,677 community controls were linked to statewide police records and public mental health service databases, with a follow-up period of 13-44 years. Four key findings emerged from the analysis: (1) CSA victims were more likely than controls to engage in all types of criminal behaviors including violent, sexual, and other offending; (2) gender moderated the relationship between CSA and criminal offending, with stronger associations found among females for general and violent offending, and among males for sexual offending; (3) certain features of the index sexual abuse (i.e., developmental period, number of perpetrators, relation to perpetrator), further victimization experiences, and the development of serious mental health problems were all associated with an increased likelihood of criminal behavior among CSA victims; (4) CSA victims who engaged in criminal offending were more likely to present with cumulative risks than victims not engaging in criminal offending. Implications for future research and clinical practice are discussed.

The influence of self-reported childhood sexual abuse on psychological and behavioural risks in young adults at a university in Botswana

Globally, childhood sexual abuse is a public health problem that affects millions of people. Few studies have considered its long-term ramifications, especially among young adults in developing countries. This study assessed the influence of childhood sexual abuse on depression and behaviours in young adults. Data were obtained from 362 students enrolled at a university in Botswana (Age: M = 21.40, standard deviation = 2.48) using the Childhood Sexual Abuse Scale, the 21-item Beck’s Depression Inventory–II, Revised Sociosexual Orientation Inventory, and Alcohol Use Disorders Identification Test (AUDIT). The t test and chi-square test of independence were used to assess subgroup differences and regression analyses were used to assess the extent to which childhood sexual abuse predicted depression and risky behaviours. About 25% ( n = 90) reported childhood sexual abuse, 18% reported harmful alcohol use ( n = 66, 18.2%), 7.82% ( n = 28) reported severe depression, and 24% ( n = 101) reported failure to use contraceptives. Childhood sexual abuse significantly predicted depression and all the behavioural outcomes in the study. The effect sizes of the associations between childhood sexual abuse on the one hand and mental health and behavioural outcomes on the other were modest. Consequently, the current study is a precursor to further studies on the long-term outcomes of childhood sexual abuse in Botswana. Consequently, a history of childhood sexual abuse should be considered in planning interventions to mitigate depression and behavioural problems on university campuses.

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.].