Sexual abuse and associations with psychosocial aspects of health. A population-based study with Swedish adolescents

Sexual violence affects adolescents' health and prosocial behaviour beyond other violence exposure

Background: Sexual violence is a public health issue among adolescents globally but remains understudied in Sub-Saharan Africa.Objective: The present study focused on the association of cumulative exposure to different types of sexual violence with mental and physical health problems and prosocial behaviour.Method: We conducted a survey with a regionally representative sample of both in-school and out-of-school adolescents, aged 13-17 years, living in south-western Nigeria. Self-reported exposure to sexual violence, behavioural problems, physical complaints, and prosocial behaviour were assessed.Results: About three quarters of the participants reported the experience of sexual violence (74.6%). Multiple regression models revealed that the more types of sexual violence an individual reported, the more mental and physical health problems, and the fewer prosocial behaviours they reported when controlling for other forms of violence exposure. Latent class analysis revealed three severity classes of sexual violence. Symptoms of mental and physical health indicators were significantly higher as exposure increased by group whereas prosocial behaviours were non-significantly fewer in the opposite direction.Conclusion: This study revealed a consistent and unique relation between sexual violence exposure and negative health outcomes among adolescents. Further research on sexual violence in Sub-Saharan Africa and its associations is needed.

Young Adults Victimized as Children or Adolescents: Relationships Between Perpetrator Patterns, Poly-Victimization, and Mental Health Problems

Child and adolescent victims of violence are often exposed to more than one kind of physical, sexual, or emotional maltreatment. Both individually and cumulatively, such victimizations have significant ramifications on mental health. Yet little is known about the relationships in which these different kinds of victimizations occur and how the relationship between the victim and perpetrators may influence later mental health. This retrospective, self-report study of a nationally representative sample of 2,500 young adults in Sweden examines associations between different types of victimization (including poly-victimization), the victim's relationship to the perpetrator, and how these factors are related to current mental health. Results indicate differential patterns of abuse based on the perpetrator; parents were most likely to use physical aggression, whereas siblings typically perpetrated property crimes and partners committed sexual assault. Peers were the most likely perpetrator of both physical and verbal victimizations and also most often committed poly-victimization by subjecting youth to multiple forms of violence. While males were more likely to be victimized by peers, females were more likely to be victimized by parents, siblings, and partners. Significant positive relations were found for the amount of victimization by peers and mental health problems among both males and females. In addition, for females, higher amounts of youth victimization by parents and partners related to higher levels of mental health problems during young adulthood. Taken together, these results suggest that peer victimization presents the greatest risk for males, whereas dysfunctional family relationships are most detrimental to victimized females.

Gender Differences in Child Abuse, Emotional Processing Difficulties, Alexithymia, Psychological Symptoms and Behavioural Problems among Chinese Adolescents

Child abuse among adolescents in China has been documented and can lead to a whole range of psychological and behavioural problems. This study examined whether male and female adolescents would differ in level of child abuse, emotional processing difficulties, alexithymia, psychological symptoms and behavioural problems, and whether the pattern of association between these variables would vary depending on gender. Eight hundred adolescents were recruited from China and completed the Childhood Trauma Questionnaire, Emotional Processing Scale, Toronto Alexithymia Scale, General Health Questionnaire, and Prediction Test of Problem Children. Male adolescents reported significantly higher levels of emotional and physical neglect, and external oriented thinking style than female adolescents. Females reported significantly more anxiety symptoms and problems with learning than males. For males, child abuse was associated with emotional processing difficulties which were associated with alexithymia. In turn, alexithymia was associated with both psychological and behavioural problems. For females, the same association was established for predicting behavioural problems but not psychological symptoms. Male and female adolescents differed in level of child abuse, alexithymia, psychological symptoms and behavioural problems. These psychological constructs were connected in a specific pattern to trigger psychological and behavioural problems for male adolescents whereas for females, different patterns were involved.

Perceived social support and self-esteem in sexual violence victims

Background: Sexual violence can lead to serious consequences. Few studies have simultaneously evaluated Perceived Social Support and Self-Esteem of sexual violence victims. This study aims to investigate the relationship between self-esteem and perceived social support among sexual violence victims.

Methods: This study was a cross-sectional study which was conducted in forensic medical centers and all health centers affiliated to Shahid Beheshti University of Medical Sciences of Tehran. This study included 66 women in the sexual violence group (Women were considered sexual violence victims if vaginal or anal penetration had occurred) and 147 subjects in the non- sexual violence group (Women with no experience of sexual violence). Rosenberg Self-esteem Scale and Social support Multidimensional Scale of Perceived Social Support were used. Data were analyzed using IBM SPSS statistical software version 22. The significance level for all tests was considered as p<0.05.

Results: There were significant differences in the levels of perceived social support in all subscales between the two groups and it was higher in non-sexual violence group (p<0.001). There was no statistically significant difference in the self-esteem level between the two groups. There was a minor significant positive correlation between self-esteem level of the sexually abused victims and perceived social support level (r=0.274, p=0.026). Others relationships were not found to be statistically significant.

Conclusion: Our results indicate that the female victims of sexual violence had low social support from their family, friends in their life, However friend's support had a minor positive effect on their self-esteem.

A systematic review of adolescents' sense of coherence and health

The aim of this systematic review was to describe the association between adolescent sense of coherence (SOC) and health and identify the future direction for research in this area. Systematic searches were conducted (2007-2014) in the PubMed, CINAHL, PsycINFO and Cochrane electronic databases and carried out manual searches in three scientific journals. A total of 827 original papers were found and 23 were selected. Based on the results, adolescents' sense of coherence (SOC) was related to health in terms of the adolescents' quality of life, health behaviour, mental health and family relationships by using 31 different health-related instruments. In conclusion, the use of the SOC approach for adolescents can provide a useful view of their health during this transition phase to adulthood. Due to the large variation in the additional instruments used, combining and comparing the results proved challenging. More comparative and longitudinal research is needed to increase understanding of adolescents' health in relation to SOC and develop services that support both elements.

Online or off-line victimisation and psychological well-being: a comparison of sexual-minority and heterosexual youth

The purpose of this study was to compare sexual-minority and heterosexual youths' exposure to sexual abuse off-line, problematic sexual meetings off-line with person/s met online and online harassment with regard to prevalence, psychological well-being and support seeking. A nationally representative sample of 3,432 Swedish high school seniors completed an anonymous school-based survey about sexuality, health, sexual abuse and online-related sexual victimisation or harassment. Sexual-minority adolescents reported a greater rate of sexual abuse, problematic sexual meetings off-line with person/s met online and online harassment, compared to heterosexual youth. When compared to non-victimised heterosexual adolescents, victimised heterosexual adolescents and non-victimised and victimised sexual-minority adolescents reported more psychiatric symptoms, lower self-esteem and a weaker sense of coherence. Same-sex sexual orientation was related to more psychiatric symptoms, lower self-esteem and a weaker sense of coherence even when controlled for victimisation and gender. Compared to victimised heterosexual adolescents, victimised sexual-minority adolescents were more likely to seek support because of sexual abuse (females) or Internet-related problems (males and females). Results for sexual-minority youth were basically the same whether sexual orientation was assessed as sexual identity or as sexual or emotional attraction. Health care providers are challenged to not only provide the same care to sexual-minority youth who seek counselling or psychiatric treatment for mental health problems or problems related to victimisation that all adolescents should receive but also to find ways to address topics like prevention of sexual abuse and risk-taking behaviour online or off-line.

Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life

OBJECTIVES

The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression.

METHOD

We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization's QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression.

RESULTS

We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5-19.7% of variance). Good quality of parental relationship seemed protective.

CONCLUSION

The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Low Sense of Coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls - a cross-sectional study of a clinical and a non-clinical cohort

Background

The Sense of Coherence (SOC) scale is assumed to measure a distinct salutogenic construct separated from measures of anxiety and depression. Our aim was to challenge this concept.

Methods

The SOC-scale, Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI) , the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ-em) and self-assessed health-related and physiological parameters were collected from a sample of non-clinical adolescent females (n = 66, mean age 16.5 years with a range of 15.9-17.7 years) and from female psychiatric patients (n = 73), mean age 16.8 years with a range of 14.5-18.4 years), with diagnoses of major depressive disorders (MDD) and anxiety disorders.

Results

The SOC scores showed high inverse correlations to BDI, BAI and SDQ-em. In the non-clinical sample the correlation coefficient was -0.86 to -0.73 and in the clinical samples -0.74 to -0.53 (p < 0.001). Multiple regression models showed that BDI was the strongest predictor of SOC in the non-clinical (beta coefficient -0.47) and clinical sample (beta coefficient -0.52). The total degree of explanation of self assessed anxiety and depression on the SOC variance estimated by multiple R² = 0.74, adjusted R² = 0.73 in the non-clinical sample and multiple R² = 0.66, adjusted R² = 0.65 in the clinical sample.

Multivariate analyses failed to isolate SOC as a separate construct and the SOC-scale, BDI, BAI and SDQ-em showed similar patterns of correlations to self-reported and physiological health parameters in both samples. The SOC-scale was the most stable measure over six months.

Conclusions

The SOC-scale did not appear to be a measure of a distinct salutogenic construct, but an inverse measure of persistent depressive symptoms and generalized social anxiety similar to the diagnostic criteria for major depressive disorder (MDD), dysthymic disorder, generalized anxiety disorder (GAD) or generalized social anxiety disorder (SAD) according to DSM-IV. These symptoms were better captured with SOC than by the specialized scales for anxiety and depression. Self-assessment scales that adequately identify MDD, dysthymic disorder, GAD and SAD need to be implemented. Comorbidity of these disorders is common in adolescent females and corresponds to a more severe symptomatology and impaired global function.