The lasting consequences of childhood sexual abuse on human capital and economic well-being

Genital lichen sclerosus misdiagnosis: Forensic insights

In this case study, we present an instance of genital lichen sclerosus et atrophicus that was initially misdiagnosed as child sexual abuse. A 6-year-old female presented to the emergency department with complaints of vaginal bleeding accompanied by pruritus. The initial suspicion of child abuse was prompted by the presence of blood. However, a thorough physical examination conducted by the forensic department ruled out any traumatic injuries and instead suggested an underlying pathology, ultimately diagnosed as lichen sclerosus et atrophicus. This case report underscores the vital role of forensics in excluding abuse as a cause in similar presentations, guiding the case towards a more accurate diagnosis. Additionally, it emphasizes the significance of possessing a comprehensive understanding of pathologies that can mimic abusive injuries, thereby preventing the potential consequences of an incorrect abuse diagnosis.

Abuse and neglect as indicators of unhealthy behaviours among 15-year-old schoolchildren in Albania

OBJECTIVE

We assessed the independent associations of lifetime child abuse and neglect indices with behavioural characteristics of children.

STUDY DESIGN

A cross-sectional study was conducted in Albania in 2022.

METHODS

Participants consisted of a nationwide representative sample of 1877 schoolchildren aged 15 years (55 % girls; response: 96 %). Data on lifetime child abuse and neglect were collected, along with behavioural factors and sociodemographic characteristics. Binary logistic regression was used to assess the independent associations of child abuse and neglect with behavioural factors of schoolchildren.

RESULTS

Irrespective of sociodemographic characteristics, lifetime physical abuse was positively related to lifetime smoking (OR = 1.8, 95%CI = 1.4-2.3), lifetime alcohol consumption (OR = 2.4, 95%CI = 1.9-2.9), and breakfast skipping (OR = 1.3, 95%CI = 1.0-1.6). Furthermore, positive independent factors associated with emotional abuse included lifetime alcohol intake (OR = 1.7, 95%CI = 1.3-2.1) and breakfast skipping (OR = 1.4, 95%CI = 1.0-1.8). Additionally, positive factors associated with lifetime emotional neglect consisted of lifetime smoking (OR = 2.2, 95%CI = 1.6-3.0) and alcohol intake (OR = 2.0, 95%CI = 1.5-2.6), and a lower fruit consumption (OR = 1.7, 95%CI = 1.3-2.3). Positive factors associated with lifetime sexual abuse included lifetime alcohol consumption (OR = 2.4, 95%CI = 1.4-4.1) and especially smoking (OR = 4.3, 95%CI = 2.6-7.3). Also, lifetime witnessing of family violence was positively related to lifetime smoking (OR = 2.7, 95%CI = 1.8-4.1) and alcohol intake (OR = 1.7, 95%CI = 1.2-2.6).

CONCLUSIONS

We evidenced strong and consistent links between child maltreatment indices and unhealthy behavioural practices among 15-year-old children in Albania. These findings underscore the potential impact of early trauma on developmental trajectories. The association between child abuse and the adoption of detrimental behaviours highlights the urgent need for comprehensive support and intervention strategies to break the cycle of harm.

Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis

Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.

Child Sexual Abuse in Pakistan: A Phenomenological Study on Parental Understanding and Prevention Strategies for Child Protection

Child Sexual Abuse (CSA) is widespread and pervasive in Pakistan, presenting a significant threat to a child's physical health, psychological well-being, and overall development. This study aimed to empirically substantiate the understanding of parents regarding CSA and their utilized preventive strategies. The study utilized Social Ecological Theory to gain a deeper comprehension of the phenomenon. Data was collected through in-depth semi-structured interviews with 18 parents from Islamabad capital city, using a qualitative phenomenological research approach along with thematic analysis. Results reveal that most of the parents were highly aware of the most common aspects of sexual assault and molestation, but they were unaware of the more manipulative subtle forms such as "grooming." Additionally, they had a limited understanding of the long-term consequences of sexual abuse. While many parents knew about the option of involving the police in cases of abuse, they were unaware of helpline services and the availability of psychological support. In terms of prevention, most parents employed an integrated approach involving various preventive measures, such as educating their children about appropriate and inappropriate touch. These findings underscore the importance of implementing public-focused initiatives and community-based programs to enhance parental awareness, knowledge, and capabilities in preventing CSA in Pakistan.

Attachment and mentalization among survivors of sexual abuse: A questionnaire survey

Knowledge of the long-term consequences of child sexual abuse (CSA) is crucial to further develop preventive strategies and treatment programs. The aim of this study is to investigate attachment and mentalizing ability in people who have experienced CSA. Attachment style, measured with the Experiences in Close Relationships-Relationship Structures Questionnaire (ECR-RS), and mentalization, measured with the Reflective Functioning Questionnaire (RFQ), were examined through a quantitative questionnaire survey in a sample of 49 individuals who had experienced CSA, and a control group of 612 with no history of CSA. The CSA group was, to a greater extent, identified with insecure attachment style. In addition, participants with insecure attachment were more likely to use hypomentalizing compared to individuals identified with a secure attachment. No significant association was found between attachment style and the relationship between the victim and the offender or the length of traumatic episodes.

Associations between exposure to sexual abuse, substance use, adverse health outcomes, and use of youth health services among Norwegian adolescents

BACKGROUND

A strong association between sexual abuse and adverse health outcomes has been reported among adolescents. The present study aimed to provide more information about adverse health outcomes associated with sexual abuse and substance use, and to examine the use of youth health services among Norwegian adolescents.

METHODS

National representative cross-sectional study among 16-19-year-old Norwegian adolescents (n = 9784). Multivariable regression analyses, adjusted for socioeconomic status and age, were used to examine the association between exposure to sexual abuse, substance use and health risk factors, and the use of youth health services.

RESULTS

Adolescents exposed to sexual abuse had higher odds of depressive symptoms (males: OR:3.8; 95% CI:2.5-5.8, females: 2.9;2.4-3.5), daily headache (males: 5.3;2.8-10.1, females:1.9; 1.5-2.4), high medication use (males: 3.2;1.7-6.0, females: 2.0;1.6-2.6), self-harm (males: 3.8;2.4-6.0, females:3.2; 2.6-3.9), suicidal thoughts (males: 3.3; 2.2-5.0, females:3.0; 2.5-3.6) and suicide attempts (males: 9.5;5.6-16.0, females:3.6;2.7-4.9). Furthermore, exposure to sexual abuse was associated with higher odds of using school health services (males: 3.9;2.6-5.9, females: 1.6;1.3-1.9) and health services for youth (males: 4.8;3.1-7.6, females: 2.1;1.7-2.5). In general, substance use was associated with increased odds of adverse health related outcomes and use of youth health services, but the strength of the relationships varied according to sex. Finally, results indicated a significant interaction between sexual abuse and smoking that was associated with increased odds of having suicidal thoughts for males (2.6;1.1-6.5) but a decreased odds of having suicidal thoughts and have conducted suicide attempts once or more for females (0.6;0.4-1.0 and 0.5;0.3-0.9, respectively).

CONCLUSIONS

The present study confirmed a strong relationship between exposure to sexual abuse and health risks, especially among males. Moreover, males exposed to sexual abuse were much more likely to use youth health services compared to sexually abused females. Substance use was also associated with adverse health outcomes and use of youth health services, and interactions between sexual abuse and smoking seemed to influence risk of suicidal thoughts and attempts differently according to sex. Results from this study increase knowledge about possible health related effects of sexual abuse which should be used to identify victims and provide targeted treatment by youth health services.

Child Sexual Abuse and Employment Earnings in Adulthood: A Prospective Canadian Cohort Study

INTRODUCTION

Child sexual abuse remains a worldwide concern with devastating consequences on an individual's life. This longitudinal study investigates the associations between child sexual abuse (official reports versus retrospective self-reports) and subgroups by perpetrator identity (intrafamilial and extrafamilial), severity (penetration/attempted penetration, fondling/touching, noncontact), and chronicity (single, multiple episodes) and employment earnings in adulthood in a cohort followed for over 30 years.

METHODS

The Quebec Longitudinal Study of Kindergarten Children database was linked to child protection services (official reports of sexual abuse) and to Canadian government tax returns (earned income). The sample included 3,020 individuals in Quebec French-language school kindergartens in 1986/1988, followed until 2017, and assessed with retrospective self-reports at age 22 years. Tobit regressions were used for associations with earnings (ages 33-37 years), adjusting for sex and family socioeconomic characteristics in 2021-2022.

RESULTS

Individuals who experienced child sexual abuse had lower annual earnings. Those with retrospective self-reported sexual abuse (n=340) earned $4,031 (95% CI= -7,134, -931) less annually at ages 33-37 years than nonabused individuals (n=1,320), with pronounced differences for those with official reports (n=20), earning $16,042 (95% CI= -27,465, -4,618) less. Individuals self-reporting intrafamilial sexual abuse earned $4,696 (95% CI= -9,316, -75) less than those who experienced extrafamilial sexual abuse, whereas those self-reporting penetration/attempted penetration earned $6,188 (95% CI= -12,248, -129) less than those who experienced noncontact sexual abuse.

CONCLUSIONS

Earnings gaps were highest for severest child sexual abuse (official reports, intrafamilial, penetrative). Future studies should investigate the underlying mechanisms. Improving support for victims of child sexual abuse could yield socioeconomic returns.