Adult Coping with Childhood Sexual Abuse: A Theoretical and Empirical Review

Childhood sexual abuse, adult sexual assault, revictimization, and coping among sexual minority women

BACKGROUND

Compared with heterosexual women, sexual minority women experience higher rates and greater severity of sexual victimization. Little is known about how childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization impact coping in this population. Few studies have examined the effects of recency, developmental stage, and revictimization on coping.

OBJECTIVE

To improve psychosocial outcomes following sexual victimization, it is important to understand whether different patterns of exposure differentially impact coping over time. To do so, we investigated associations between CSA, ASA, and revictimization (both CSA and ASA) and adult sexual minority women's coping strategies.

PARTICIPANTS AND SETTING

Data are from a longitudinal community-based sample of 513 sexual minority women of diverse ages and races/ethnicities.

METHODS

Participants reported CSA (

RESULTS

High-risk (i.e., genital penetration) CSA and recent ASA were associated with more avoidant coping (compared to no CSA or no ASA). No interaction between CSA and ASA was found, but history of both CSA and ASA had a stronger effect on avoidant coping than no victimization or CSA only.

CONCLUSIONS

Although sexual revictimization had a stronger impact on coping than CSA or ASA only, we did not find a synergistic effect (i.e., CSA and ASA may have had stacked independent effects). History of ASA was more strongly associated with coping than CSA. Recency of sexual victimization appears especially salient to coping among sexual minority women.

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Key Words

• Adult sexual assault
• Childhood sexual abuse
• Coping
• Revictimization
• Sexual minority women

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MESH Headings

• Adult
• Female
• Child
• Humans
• Adolescent
• Child Abuse, Sexual/psychology
• Sexual Behavior/psychology
• Crime Victims/psychology
• Coping Skills
• Ethnicity

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Grants

• F32 AA029957 NIAAA NIH HHS
• K01 AA028239 NIAAA NIH HHS
• L60 AA029575 NIAAA NIH HHS
• R01 AA013328 NIAAA NIH HHS

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Affiliation(s)

Mariah Xu Columbia University, School of Nursing, United States of America.
Thomas Corbeil Columbia University, Department of Psychiatry, United States of America
Lauren Bochicchio Columbia University, School of Nursing, United States of America
Jillian R Scheer Syracuse University, Department of Psychology, United States of America
Melanie Wall Columbia University, Department of Psychiatry, United States of America
Tonda L Hughes Columbia University, School of Nursing, United States of America

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"Finding My Worth as a Sexual Being": A Qualitative Gender Analysis of Sexual Self-Concept and Coping in Survivors of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is likely to have impacts on adult survivors' sexuality, particularly on their sexual self-concept. However, little is known about how survivors cope with CSA-related sexual impacts, including sexual self-concept impairments. Thus, this study aimed to examine the interplay between sexual self-concept and coping strategies in CSA survivors by (1) documenting the manifestations of their impaired sexual self-concepts; (2) identifying their strategies to cope with the sexual impacts of CSA; and (3) examining gender differences on sexual self-concept impairments and coping strategies. Content analysis was conducted on semi-structured interviews with 25 women and 26 men adult survivors of CSA recruited via social networks and victim support organizations. Analyses yielded three conceptual categories: (1) Developing an unconsolidated and unfavorable sexual self-concept following CSA; (2) Avoiding CSA-related sexual impacts and impaired sexual self-concept; (3) Approaching CSA-related sexual impacts with more authenticity. Men often managed their suffering and compensated for their impaired sexual self-concept by engaging in sexual dominance and over-investment, by accepting their sexual difficulties and relying on medication to overcome them. Women tended to restrict themselves and disconnect sexually to avoid suffering, complied with their partners' sexual demands out of a sense of duty, prioritized sexual intimacy over orgasm, and seek professional help. Interventions with survivors should promote the development of approach strategies to cope with sexual difficulties, including self-concept impairments, and foster sexual authenticity.

Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis

Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle-Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.PROSPERO registration: CRD42023394120.

The experience of childhood sexual abuse: An exploratory description of psychological and adaptive functioning in Canadian men

BACKGROUND

Childhood sexual abuse (CSA) affects a number of men yet knowledge gaps remain around comprehensively describing psychological and adaptive outcomes for this population.

OBJECTIVE

Examine how a Canadian sample of men with and without CSA histories compares on broader areas of psychological and adaptive functioning.

PARTICIPANTS AND SETTING

This exploratory study included 109 adult men aged 25-60 years who were grouped according to whether they experienced CSA (n = 69) or not (n = 40). Participants were recruited from Ottawa, Ontario, Canada.

METHOD

Using a multi-method approach, we conducted an exploratory and comprehensive examination of how CSA contributes to various areas of psychological (e.g., depression, anxiety, stress, dissociation, anger, PTSD) and adaptive functioning (e.g., friendship quality, employment) using self-report and clinician-administered measures.

RESULTS

CSA men were an average of 8.5 years old at abuse onset. Most (62.3 %) had disclosed their CSA experience, waiting an average of 13.6 years before disclosure. After controlling for covariates (i.e., other types of maltreatment, non-maltreatment adversities, education, income), results indicated a significant association between CSA and men's psychological functioning, but not their adaptive functioning.

CONCLUSIONS

Findings highlight the importance of broadening our understanding of how the experience of CSA, controlling for important covariates, can contribute to the well-being of men in order to better respond to their psychological needs.

Coping strategies among older adults living with HIV/AIDS with history of childhood sexual abuse

Background: Childhood sexual abuse (CSA) may be a risk factor for poor mental health in adulthood. Survivors may experience emotions detrimental to their social and mental wellbeing. Some of these emotions may include anger, fear, rage, helplessness, guilt, shame, which may impact their coping strategies. The aim of this study was to determine the association between CSA and coping among older adults living with HIV (OALH). Method: Data were obtained from 91 OALH via convenience sampling. The participants were recruited from an immunology clinic and were at least 50 years or older and living with HIV. CSA was operationalized using questions from the Adverse Childhood Experiences Questionnaire. Coping was assessed using the Brief COPE Inventory. Crude and adjusted linear regression models, controlling for age, sex, race, gender, and income were used to determine the association between CSA and each coping subscale. The analyses were conducted in SAS version 9.4. Results: Crude analyses showed statistically significant associations between CSA and specific coping strategies: humor (β = 1.244; p = 0.0018), religion (β = 1.122; p = 0.0291), Self-blame (β = 1.103; p = 0.0154), planning β = 1.197; p = 0.0196), venting (β = 1.218; p = 0.0063), substance use (β = 0.828; p = 0.0335) and instrumental support (β = 0.949; p = 0.0416) After adjusting for sociodemographic characteristics, there was a statistically significant association between CSA and humor (β = 1.321; p = 0.0048) and self-blame (β = 1.046; p = 0.0382). Conclusion: OALH with a history of CSA were more likely to use humor and self-blame as coping strategies. Trauma-informed interventions should be geared towards decreasing self-blame for OALH who are CSA survivors.

Meaning Making Mechanisms in Women Survivors of Childhood Sexual Abuse: A Scoping Review

Childhood sexual abuse (CSA) is a complex and prevalent problem with devastating long-term consequences for survivors. Despite these consequences, some survivors seem to find a source of meaning and fulfillment throughout their recovery process, which may facilitate resilience and posttraumatic growth (PTG). However, little is known from the literature about the specific meaning making mechanisms that CSA survivors experience. A scoping review was conducted by searching relevant journals and several online databases such as EbscoHost, Scopus, ProQuest, ScienceDirect, and Google Scholar. Studies published in English and that discussed meaning making as a topic of recovery from CSA in the context of women survivors' experiences were included, where a total of 57 articles were selected including qualitative (n = 32), quantitative (n = 9), mixed method (n = 9), and review (n = 7) articles. Using thematic analysis, the results of the scoping review found four mechanisms of meaning making and seven sources of meaning describing the meaning making processes of women survivors of CSA. The mechanisms were identified as being benevolent; restoring and empowering the inner self; mobilizing external and social resources; and lastly actively integrating the trauma narrative. This study contributes toward the global knowledge base on meaning making mechanisms of women survivors of CSA by providing the first known summary of studies to date. Future research is recommended to further confirm these findings to inform treatment interventions for women survivors of CSA.

Becoming Secondary Survivors: Exploring the Effects of Conflict-Related Sexual Violence on the Health and Well-Being of Families in Northern Uganda

The enduring consequences of conflict-related sexual violence (CRSV) and its catastrophic effects on the health and well-being of survivors has been well documented. However, there is a dearth of evidence on the impact of CRSV on families of survivors who care for them. The aim of this study was to explore the ripple effects of CRSV on families of survivors living in three post-conflict districts in northern Uganda: Gulu, Lira, and Pader. We present emerging themes from qualitative interviews with 22 family members including parents, siblings, and partners. Interviews were recorded, transcribed verbatim, translated to English, and imported into MAXQDA Analytics Pro 12. We used a modified approach to grounded theory to analyze the data. Our findings show that family members faced multiple challenges as a result of their indirect exposure to survivors that were abducted by the Lord's Resistance Army. These included negative impacts on their relationship with the survivor, secondary traumatic stress, stigma, and challenges with caring for children born in captivity. Participants also shared coping mechanisms they used to mitigate psychological distress, including focusing on their faith, seeking support from social connections, and memory repression. The interviews revealed that most female participants did not seek formal care because they feared stigma and did not think it would be available for individuals not directly affected by sexual violence. Our findings point to the importance of moving beyond a narrow focus on the impact of CRSV on survivors and health care workers to a broader view of understanding the effects on families, and designing interventions that address their needs. Integrating care for families and other informal caregivers might mitigate secondary trauma, and ensure individuals are emotionally protected and equipped to care for survivors.

Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.

False denials increase false memories for trauma-related discussions

False denials are sometimes used to cope with traumatic experiences. We examined whether false denials can affect true and false memory production for a traumatic event and conversations surrounding the trauma. One hundred and twenty-six participants watched a trauma analogue video of a car crash before being randomly asked in a discussion with the experimenter to (1) respond honestly or (2) falsely deny that certain details happened in the video. After one week, all participants received misinformation about the discussion with the experimenter and the car crash. Finally, all participants were instructed to respond truthfully in a source memory task. Participants who falsely denied information during the first session were statistically significantly more prone than honest participants to omit details they denied and to report misinformation about what was discussed in the first session. Our work suggests that false denials of a traumatic experience might lead to both forgetting and increased false memory levels for earlier conversations about the event.

Emotion Regulation and Mental Health among Men with Childhood Sexual Abuse Histories

Childhood sexual abuse (CSA) is a form of child maltreatment which has been increasingly recognized as a common experience among men. Research on male CSA remains under-developed but suggests many negative mental health impacts. The current study examined the link between mental health outcomes and different emotion regulation strategies among 69 adult men. Men completed measures on their current mental well-being, and participated in a clinical interview about emotion regulation strategies used to manage memories about their sexual victimization. Results indicated that the most frequently used emotion regulation strategies were expressive suppression, rumination, and cognitive avoidance. For perceived effectiveness, men identified cognitive avoidance, self-medication, and behavioral avoidance as being most helpful in managing their CSA-related distress. Finally, greater use of deliberate self-harm, rumination, and behavioral avoidance was associated with more internalizing difficulties, while greater use of deliberate self-harm and self-medication was linked with more externalizing difficulties. Greater perceived efficacy of positive reappraisal was associated with fewer externalizing behaviors. Although these findings require replication through larger mixed-methods studies, they suggest the importance of incorporating emotion regulation strategies into interventions aimed at improving mental well-being among men with CSA histories.

Appraisal and Coping Link Sexual Victimization History to Emotional Experience: A Multilevel Daily Diary Study

Sexual victimization (SV) history is common among college students and has many adverse effects on health, but little is known about whether these effects are explained by everyday stress and coping. Further, most studies conflate between- and within-person effects, limiting our understanding of distinct trait- versus state-level pathways. To address these gaps, we examined the multilevel association of SV history with contemporary positive and negative affect and somatic symptoms via daily control appraisals and coping (problem-focused, meaning-focused, and avoidance) with daily stressors. Online daily diary surveys assessed stress, appraisals, coping, affect, and somatization among 261 undergraduates with and without SV history over 11 consecutive days. Between- and within-person differences in appraisals, coping, affect, and somatic symptoms were examined using multilevel covariance modeling in a causal system, testing daily stressor type as a moderator of within-person effects. Across days, SV history was indirectly linked only to average positive affect via meaning-focused coping, with no other between-person indirect effects. At the within-person level, greater negative affect was experienced in the context of interpersonal stress, driven by greater problem-focused coping, greater positive affect was experienced in the context of academic stress, driven by greater control appraisals, and less positive and negative affect were experienced in the context of intrapersonal stress, driven by lower control appraisals and less problem-focused coping. SV may influence daily stress processes at multiple levels, depending on stressor type. Appraised control and active coping are potentially important but understudied ways in which SV history informs contemporary stress management.

Internalizing and Externalizing Symptoms in Adolescents With and Without Experiences of Physical Parental Violence, a Latent Profile Analysis on Violence Resilience

Questionnaire data from a cross-sectional study on social resilience in adolescence, with a sample of N = 1,974 Swiss seventh grade high school students ages 12-14 (M = 11.76; SD = 0.65) was used to identify and compare violence resilience profiles. Person-centered latent profile analysis (LPA) was applied and allowed for the grouping of adolescents into profiles of internalizing (depression/anxiety, dissociation) and externalizing symptoms (peer aggression, peer victimization, classroom disruption) and differentiation of adolescents with (n = 403) and without (n = 1,571) physical parental violence experiences. Subsequently, a multinomial logistic regression analysis was conducted to further investigate the sociodemographic predictors of violence resilience profiles. With LPA, we identified four distinct profiles for both adolescent groups (with and without parental physical violence experiences). The results showed three particularly burdened profiles of adolescents, one with higher externalizing and one with higher internalizing symptoms, which did not occur simultaneously to the same extent. Furthermore, the third profile contained adolescents with both elevated internalizing and externalizing symptoms, the comorbid profile. The fourth profile consisted of the majority of adolescents, who exhibited little or no internalizing and externalizing symptoms, the so-called no/low symptomatic profile. A differentiated view of the symptoms can create added value regarding the understanding of violence resilience. Moreover, in the multinomial logistic regression, significant associations were found between the profiles and adolescents' gender in the group of adolescents with parental physical violence experiences, but none were found in relation to sociocultural status and migration background.

Interrelationship of Posttraumatic Stress, Hassles, Uplifts, and Coping in Women With a History of Severe Sexual Abuse: A Cross-Sectional Study

Experiencing trauma, such as sexual abuse, increases the risk of a negative health outcome. The aim of the present study was to compare two groups of female survivors of sexual abuse, one group with a lower indication of posttraumatic stress disorder (L-PTSD) and one with a higher indication of posttraumatic stress disorder (H-PTSD). We hypothesized that, with a history of sexual abuse, higher levels of PTSD symptoms would be associated with more daily hassles, fewer daily uplifts, and more maladaptive coping strategies, and that there would be more reporting of severe types of sexual victimization, less resourceful socioeconomic conditions and a lower level of emotional stability. A questionnaire, including measures of socioeconomic conditions, trauma experience, emotional stability (the Single-Item Measures of Personality), Posttraumatic Stress Disorder Checklist (PCL), daily hassles and uplifts (the Stress Profile), and coping strategies (the Brief Coping Orientation to Problems Experienced [COPE] questionnaire), was completed by 57 female users at nine support centers for survivors of incest and sexual abuse in Norway. The results show that the H-PTSD group reported significantly more daily hassles, fewer daily uplifts, and more use of maladaptive coping strategies. The L-PTSD group reported more emotional stability, fewer daily hassles, and more uplifts, and used more adaptive coping strategies. However, few differences were found between the H-PTSD and the L-PTSD groups with regard to severity of sexual abuse and socioeconomic conditions. The results on the hassle, uplift, and coping scales are potentially interesting from an interventional point of view. Major life events such as sexual abuse may be out of control for the afflicted victim. Appraisal of and coping with everyday events, however, can be affected and offer interesting possibilities for interventions directed at the survivor, her significant others, and professional helpers.

Children's Coping and Perceptions of Coping Efficacy After Sexual Abuse: Links to Trauma Symptoms

Despite an emphasis on coping following childhood sexual abuse (CSA) to reduce trauma-related symptoms, very few studies have researched the associations between sexually abused children's coping and trauma-related difficulties, and perceived coping efficacy has been largely overlooked. The current study investigated whether children's use and perceived efficacy of avoidant, internalized, angry, and active/social coping strategies were associated with caregiver- and child-reported posttraumatic stress symptoms (PTSS), and caregiver-reported internalizing and externalizing symptoms among 202 sexually abused children (8-12 years; M = 10.47 years, SD = 1.70 years). Children reported using approximately eight types of coping strategies (M = 8.29, SD =2.50). Regression models indicated that internalized and angry coping were associated with child-reported PTSS. In contrast to expectations, none of the types of coping strategies were linked with caregiver's reports of PTSS or internalizing and externalizing symptoms. Interestingly, perceived efficacy of coping was largely unrelated to symptoms, with only perceived efficacy of avoidant coping inversely related to child-reported PTSS. Perceived efficacy was not tied to caregiver's reports of children's symptoms. Coping strategies may be associated with children's, but not caregiver's, reports of children's trauma-related difficulties. Furthermore, perceived efficacy of coping strategies may also be largely unrelated to children's symptoms, or children may have limited insight regarding the efficacy of their coping strategies. To further inform trauma-focused interventions that support effective long-term coping, future research should investigate which coping strategies children perceive to be efficacious, as well as potential reasons why.

#MeToo: Disclosure and Response to Sexual Victimization on Twitter

Communication on Twitter surrounding violence against women often occurs through the use of "hashtags" that allow users to engage in shared discourse. The present study examined utilization of the Twitter hashtag #MeToo, which emerged in 2017 as a method for disclosing personal experiences of sexual victimization. Specifically, the present study sought to clarify how Twitter users utilized the #MeToo tag to disclose and respond to sexual violence by conducting a qualitative analysis of a random sample of tweets using #MeToo (N = 1,660). Survivors frequently prioritized the "who," "what," "where," "when," "why," and "how" of personal trauma experiences when disclosing using #MeToo. Twitter users also reflected on the prevalence of violence in society, acted as advocates to highlight the problem of violence against women, called attention to the experiences of other survivors of violence, or utilized the forum in a manner that distracted from survivors' experiences. The present data highlight the utility of Twitter for raising awareness regarding the prevalence of sexual violence, and providing a space where users can share personal trauma, connect to others with similar experiences, and provide support to others.

The interplay between maternal childhood maltreatment, parental coping strategies as well as endangered parenting behavior during the current SARS-CoV-2 pandemic

The SARS-CoV-2-pandemic is associated different challenges, especially for families. The disruption and challenges require parents to develop strategies to cope with the current situation. One factor that may influence how parents deal with pandemic-associated stressors are experiences of parental childhood maltreatment (CM), which represent a high risk of engaging in endangered parenting. A decisive candidate for the connection between parental CM and the transgenerational transmission could be the parental ability to employ coping strategies. Mothers of a well-documented birth cohort for investigating the pathways leading to resilience or vulnerability in the transgenerational transmission of CM were imbedded in an online “SARS-CoV-2 pandemic survey” assessing maternal ability for coping strategies and the dimension of endangered maternal parenting behavior. 91 mothers completed the online survey. To describe the maternal CM, data from a longitudinal survey were used. Our mediation analysis shows a significant positive relationship between the sum of maternal CM experiences, lack of coping strategies and endangered parenting behavior. This suggests a partial mediation of the association between CM and endangered parenting behavior as the direct effect remained significant when the maternal lack of coping strategies was included as the mediator. Parental CM is a risk factor for coping with stressful situation as well as for endangered parenting behavior. The ability to deal with stress seems to have a significant influence on the context of a possible transgenerational transmission of CM. The results underline the need to consider the unique needs of families with children and to support them as to how to overcome the current crisis.

The Impact of Parental Bereavement on Young People: A Thematic Analysis of Using Online Web Forums as a Method of Coping

A qualitative approach was used to explore how online web forums might facilitate recovery and the process of coping. Ten online web forums written by young people who have personally experienced the death of a parent formed the data of this study. Previous research suggests forum users do not receive the supportive reactions from face-to-face interactions that they desire. Thematic analysis found that forums created an environment where young people can process the bereavement of a parent. Forums allowed young people to use their experience of bereavement to positively support others with similar experiences. The findings imply that the process of using forums can positively impact individuals who have experienced the loss of a parent. This supports recommendations by professionals, to consider online forums as a coping strategy. This study presents one of the few analyses of web forums written by young people who have experienced parental bereavement.

Externalizing and internalizing symptoms and coping strategies in young victims of abuse

This research analyses the internalizing and externalizing symptoms and the coping strategies of young victims of abuse. These young people are in residential care under protective measures due to abuse. The participants were 61 youths (32 male and 29 female) between 12 and 17 years of age. Different works of research stress the need for an early identification of the psychopathological symptomatology that these adolescents may present in order to provide an adequate psycho-educational intervention. The relationship between the adolescents’ psychopathological symptomatology and the coping strategies and styles they use to resolve problems is studied. It is also analyzed whether internalizing and externalizing problems predict the style and coping strategies of adolescents. Two tests were used: 1. Child and Adolescent Evaluation System (SENA); 2. Adolescent Coping Scales (ACS). The results indicate that young victims of abuse have internalizing and externalizing symptoms. These adolescents are characterized by an unproductive coping style, as well as by the use of coping strategies that are not very functional and ineffective for resolving conflicts. The psychopathological symptomatology is related to and predicts an unproductive coping style, badly adapted to solving daily problems (worrying, blaming oneself, not coping, ignoring the problem, or keeping it to oneself). This research has allowed us to identify the presence of several areas of vulnerability in these young persons which could be playing an important role in their psychosocial maladjustment. The research suggests the design of intervention strategies, for both groups and individuals, aimed at mitigating and modifying the sources of the problems in victims of child abuse.

The Impact of COVID-19 on Adolescent Mental Health: Preliminary Findings From a Longitudinal Sample of Healthy and At-Risk Adolescents

Background: The COVID-19 pandemic has brought on far-reaching consequences for adolescents. Adolescents with early life stress (ELS) may be at particular risk. We sought to examine how COVID-19 impacted psychological functioning in a sample of healthy and ELS-exposed adolescents during the pandemic. Methods: A total of 24 adolescents (15 healthy, nine ELS) completed self-report measures prior to and during the COVID-19 pandemic. The effect of COVID-19 on symptoms of depression and anxiety were explored using linear mixed-effect analyses. Results: With the onset of the pandemic, healthy but not ELS-exposed adolescents evidenced increased symptoms of depression and anxiety (ps < 0.05). Coping by talking with friends and prioritizing sleep had a protective effect against anxiety for healthy adolescents (t = -3.76, p = 0.002). Conclusions: On average, this study demonstrated large increases in depression and anxiety in adolescents who were healthy prior to the COVID-19 pandemic, while ELS-exposed adolescents evidenced high but stable symptoms over time.

Indirect Effects From Childhood Sexual Abuse Severity to PTSD: The Role of Avoidance Coping

Men who have sex with men (MSM) disproportionately experience childhood sexual abuse (CSA) compared with heterosexual men, often resulting in continued trauma-related sequelae, including symptoms of posttraumatic stress disorder (PTSD) such as avoidance. The variability in trauma-related sequelae may be associated with chronicity or duration of CSA. The relationship between duration of CSA and later PTSD symptom severity is not well understood, including the extent coping strategies account for these relationships. We used linear regression to examine these relationships and to assess the indirect effects of avoidance (behavioral disengagement and denial) and adaptive coping strategies on the relationship between CSA duration and adult PTSD symptom severity on a diverse sample included 290 MSM with a history of CSA. In adjusted models, CSA duration was significantly associated with adult PTSD symptom severity (standardized β = .23, p < .000) and with avoidance coping (standardized β = .19, p = .002). Separating this out, behavioral disengagement was significantly associated with CSA duration (standardized β = .20, p = .001) but denial was not. In adjusted analyses assessing indirect effects, avoidance coping partially accounted for the relationship between CSA duration and total trauma symptom severity (standardized β reduced from .23 to .17; Sobel = 2.90, p = .004). Similarly, behavioral disengagement partially accounted for the association between CSA duration and total symptoms (standardized β reduced from .23 to .18; Sobel = 2.68, p = .007). Avoidance coping, and behavioral disengagement specifically, may play a role in the severity of PTSD symptoms experienced by MSM with CSA histories. This work emphasizes the need for clinicians to consider behavioral disengagement in understanding PTSD symptom severity among MSM with histories of CSA.

Sexual violence victimization and suicide: Testing a coping-mental health framework

Sexual violence victimization is a prevalent public health concern. However, little research has investigated the factors linking sexual violence victimization to suicidal thoughts and behaviors (STBs). The current study tested the applicability of the psychological mediation framework, a coping-mental health model, for the prevention of STBs among victims of sexual youviolence. Furthermore, the current study explored whether sexual orientation moderated the progression from sexual violence victimization to STBs. Data were drawn from an online survey of victimization experiences and health (N = 2175). Bootstrap mediation tested whether the association of sexual violence victimization and STBs was mediated by emotion regulation strategies (cognitive reappraisal and expressive suppression) and psychopathology (anxiety, depression, and posttraumatic stress disorder). Multiple-groups analysis tested whether links within the mediation effects varied by sexual orientation. Bivariate findings showed that: (1) sexual minority persons were more likely to report sexual violence victimization and (2) cognitive reappraisal was more meaningfully associated with mental health among sexual minority persons. Sexual violence victimization was associated with STBs via a serial mediation through emotion regulation and psychopathology. The association between psychopathology and STBs was stronger among sexual minority compared with heterosexual respondents. Physical violence victimization was associated with STBs for heterosexual but not sexual minority persons in a follow-up model. Findings support an emotion regulation-mental health framework for the prevention of suicide among victims of sexual violence. Research and training implications are discussed.

Obstacles in the Process of Dealing With Child Sexual Abuse-Reports From Survivors Interviewed by the Independent Inquiry Into Child Sexual Abuse in Germany

Obstacles in dealing with child sexual abuse (CSA) can hinder survivors in the process of coming to terms with their experiences. The present study aims to identify and analyze factors that may pose obstacles in the long-term process of dealing with CSA. It is part of a larger research consortium "Auf-Wirkung," funded by the German Federal Ministry of Education and Research, and was conducted in cooperation with the Independent Inquiry into Child Sexual Abuse in Germany (IICSAG). The IICSAG was appointed by the Independent Commissioner for Child Sexual Abuse Issues and the German Federal Ministry for Family Affairs, Senior Citizens, Women, and Youth in 2016. To determine responsibilities, recognize injustice, and further acknowledge the survivors of CSA in the Federal Republic of Germany (FRG) and the German Democratic Republic (GDR), the Independent Inquiry has held 1,303 private sessions with survivors of CSA by Oct. 17th, 2020. The present study focuses on exploring reoccurring problematic experiences reported by survivors in private sessions regarding the long-term process of dealing with experiences of CSA. A total of 30 transcripts of private sessions, conducted by members and appointees of the IICSAG between September 2016 and June 2019, were analyzed using qualitative content analysis. Attendants of private sessions described a variety of obstacles, including negative social reactions to disclosure, institutions' unwillingness to elucidate occurrences of CSA within their midst, as well as general financial difficulties, and those linked to redress claims. Manipulative grooming by perpetrators and limited access to adequate psychotherapy were perceived as obstructive by survivors dealing with CSA. In the context of criminal proceedings, survivors reported long durations of court proceedings and negative experiences in connection to credibility assessment. Results will be discussed to better support survivors of CSA in the process of dealing with their experiences in the future.

Childhood Sexual Abuse: Sibling Perspectives

Despite a recent focus highlighting the systemic impact of childhood sexual abuse (CSA), the needs of nonabused siblings have been largely overlooked. This interpretative phenomenological analysis study explored the lived experience of nonabused adult siblings of survivors of CSA. Semistructured interviews were undertaken with five adult siblings who were, or had been attending a support service. Emergent themes demonstrated the personal and relational impact of CSA on siblings which were captured across five domains: trying to make sense of it all, struggling to provide support, managing the impact on the wider family, feeling silenced and finding a voice, and rescripting the future. Participants struggled to make sense of their sibling's experience, questioning their own memories of happy childhoods, often in the face of limited information about what happened. The impact of the sexual abuse not only affected the sibling relationship but was compounded by the distress of other family members, particularly parents. Participants reported feeling a lack of reciprocity in terms of their own support needs and described ongoing issues arising from the sexual abuse that they believed would likely continue for the rest of their lives. How siblings can be supported through psychoeducation and family therapy is discussed, both for their own needs and those of the entire family.

Personality Pathology among Adults with History of Childhood Sexual Abuse: Study of the Relevance of DSM-5 Proposed Traits and Psychobiological Features of Temperament and Character

BACKGROUND

The main aim of this study was to determine whether childhood sexual abuse (CSA) is reflected in the pathological traits of the alternative model of personality disorders (AMPD) in section-III of DSM-5 and Cloninger's temperament and character profiles.

METHODS

The Persian versions of Personality Inventory for DSM-5 (PID-5), Temperament and Character Inventory (TCI-125), and Structured Clinical Inventory for DSM-IV-TR-Axis II-Screening Questionnaire (SCID-II-SQ) were administered to 43 Iranian college students who reported a history of CSA and 390 participants who did not. Bivariate Pearson correlations and general linear model repeated measures (GLMRM) were used to compare results.

RESULTS

Bivariate correlations indicated that both the PID-5 and TCI-125 were significantly associated with their relevant personality disorders. Profile analysis showed that the pathological trait domains of the PID-5, except for negative affectivity, were significantly greater in those with an experience of CSA. Of the seven dimensions of TCI-125, novelty seeking and persistence were higher in those with an experience of CSA, but reward dependence, self-directedness, and cooperativeness were lower.

CONCLUSIONS

These results confirmed a correlation between CSA and personality dysfunction. The pattern of dysfunction was complex and somewhat different from the two facet measures used.

Roles of Emotional Reactions and Potency in Coping with Abusive Experiences of Indian Adolescent

Victimized children's perceptions of the severity of abusive incidents have been found to be associated with their willingness to disclose. However, the relationship between perceptions, disclosure, and coping processes of abused Indian adolescents, has rarely been studied. To explore the roles of emotional reactions associated with disclosure, and potency on individuals' perception of the severity of abusive incidents, reluctance to disclose, and posttraumatic stress symptoms. A randomly selected sample, consisting of 324 adolescents (aged 12 to 16) in Kolkata, India was included. Of these, 170 adolescents disclosed incidents of abuse last year. Data were analyzed by conditional process modeling. A moderated mediation analysis (n = 170) revealed that the overall perception of the severity of abusive incidents predicted greater reluctance to disclose (B = .63, p < .0001) through heightened emotional reactions, especially with a higher potency level (B = .07, p < .05; B = .1, p < .05). Potency moderated (B = -.02, p = .01) the effect of reluctance on posttraumatic stress symptoms. When tested on the entire sample (324) the results replicated the sub-sample (170). Adolescents revealed similar results irrespective of their exposure. The reluctance to disclose abuse is discussed from an Indian cultural and societal perspective.

"The whole wall fell apart, and I felt free for the first time": Men's perceptions of helpful responses during discussion of child sexual abuse

BACKGROUND

There is a growing awareness of the prevalence and consequences of childhood sexual abuse (CSA) for boys. Disclosure experiences often impact long-term functioning following CSA. Current understanding around disclosure has evolved from a singular act of telling to a broader, reciprocal process that can include discussion. However, there is limited empirical evidence about what constitutes a helpful response from others during the discussion of CSA for men.

OBJECTIVE

This study examines the characteristics of a helpful response during the discussion of CSA among a large sample of men with histories of CSA.

PARTICIPANTS AND SETTING

Participants included 487 men ranging in age from 19 to 84 years (mean = 50.1) who completed an anonymous, one-time online survey as part of a larger project on men's health and well-being. Participants were recruited through research announcements on web sites and discussion boards of national organizations that support adult survivors of CSA.

METHODS

Narrative data from an open-ended prompt were analyzed using qualitative content and inductive thematic analyses over eleven months.

RESULTS

The analysis yielded five superordinate themes on men's perceptions of helpful responses from others during discussions of CSA: (1) experience; (2) personal characteristics; (3) specific actions; (4) therapeutic interventions; and (5) insights.

CONCLUSIONS

Clinicians and health care professionals should convey an awareness of CSA for boys, reach out to men dealing with difficulties tied to early trauma, and implement helpful response strategies in discussions of CSA. Family members, friends, and colleagues within men's social networks can also support recovery with helpful response strategies.

Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed.

At risk and in love: A mixed methodexamination of the link between childhood maltreatment and youth relationships

INTRODUCTION

Research indicates that sexual and romantic relationships play an important role in youth well-being and development. This strengths-based perspective sits in tension with the documented risks that youth with histories of maltreatment face in sexual/romantic relationships. We conducted a U.S.-based mixed-method study to examine the connection between childhood maltreatment and youth relationships.

METHOD

We collected retrospective ratings of relationship quality and open-ended comments about those relationships using an online sexual life history calendar. Quantitative analyses drew on data from 98 participants (51 cisgender women, 47 cisgender men) between the ages of 18-25 (M_age = 22.51). Qualitative analyses compared demographically matched subsamples of 19 participants who reported multiple forms of child maltreatment and 20 who reported none.

RESULTS

Quantitative analyses indicated that ratings of relationship stability, intimacy, and pleasure were unrelated to prior abuse or neglect. Qualitative analyses showed the relationships of those with multiple maltreatment histories, compared to those without any maltreatment, to be more often intertwined with and complicated by other hardships (e.g., homelessness).

CONCLUSIONS

Quantitatively, childhood maltreatment appeared unrelated to youth sexual/romantic relationship quality, though we regard those findings with due caution. Complementing this was qualitative evidence of differences between participants based on trauma histories, with those who had experienced childhood maltreatment referring more often to surrounding circumstances and hardships in descriptions of their youth sexual/romantic relationships. These mixed method findings reinforce the importance of youth sexuality research, policy, and practice that takes the broader conditions of young people's lives into consideration.

The Relevance of Cognitive Behavioral Models of Post-Traumatic Stress Following Child Maltreatment: A Systematic Review

While it is known that young people exposed to maltreatment or abuse are at elevated risk of developing post-traumatic stress disorder (PTSD), much of our current knowledge of mechanisms that link trauma to childhood PTSD is based on single-incident, often noninterpersonal, trauma. Theoretical models highlight psychological processes of appraisals, memory, and coping as important for the development of PTSD. The aim of this review was to synthesize the literature on the role of these key psychological processes in relation to PTSD in maltreated children and teens. Studies were included if they (1) identified a sample of maltreated individuals, ≤18 years old; (2) measured (a) trauma memory, (b) appraisals, or (c) post-trauma cognitive or behavioral responses; and (3) measured PTSD symptoms. The systematic search of three electronic databases (American Psychological Association PsychNet, PubMed, and Published International Literature on Traumatic Stress) resulted in the inclusion of 36 papers, which described 31 studies and 33 unique samples. The review found cognitive behavioral models of PTSD appeared appropriate for understanding outcomes following maltreatment, but further research is needed on all processes, particularly trauma memory. Overall, there remain significant gaps in our knowledge of how psychological processes link maltreatment to PTSD. There is limited evidence concerning how maltreatment-related characteristics (e.g., chronicity, duration, and type of abuse) influence psychological processes and in turn affect outcomes. This review recommends further research in this area and suggests that, at the very least, comprehensive assessment should be conducted with all young people reporting maltreatment to identify appraisals and coping strategies that will potentially impact on their ongoing adjustment.

Facing Interpersonal Violence: Identifying the Coping Profile of Poly-Victimized Resilient Adolescents

Coping strategies are factors that mediate the relationship between interpersonal victimizations and psychological maladjustment. The objectives are as follows: (a) to establish the coping profile of adolescents according to the number of reported interpersonal victimizations; (b) to identify the most victimized adolescents (poly-victims), detecting those with psychological symptoms (nonresilient poly-victims) and those without psychological symptoms (resilient poly-victims), and then to examine any differences in coping strategies between the two groups; (c) to determine the accumulative effect of victimizations on mental health; and (d) to test the mediating role of both approach and avoidance coping between lifetime interpersonal victimizations and symptoms. Participants were 918 community Spanish adolescents (62.7% girls) aged between 14 and 18 years. Measures used were Youth Self-Report, Juvenile Victimization Questionnaire, and Adolescent Coping Orientation for Problem Experiences. The following results were reported: (a) The most victimized adolescents used to a greater degree avoidance coping strategies than nonvictimized adolescents. (b) Resilient poly-victimized adolescents were more likely to seek family support and tended to use more positive reappraisal than nonresilient poly-victimized adolescents. (c) A clear cumulative effect of victimizations on mental health was observed: 45% of the most victimized adolescents (poly-victims) reached clinical range on Youth Self-Report in front of 2% of nonvictimized adolescents. (d) Avoidance coping and more specifically Escaping and Venting feelings strategies played a mediating role between interpersonal victimizations and psychological symptoms. Approach coping had no mediating role, except for Positive reappraisal in girls. In conclusion, the possibility of identifying the coping profile of victimized adolescents may have clinical implications in terms of both prevention and intervention.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

Emotion Dysregulation in Sexually Abused Preschoolers: Insights from a Story Completion Task

Child sexual abuse (CSA) during the preschool period can seriously undermine children's ability to develop emotional competency. Narrative tasks, such as the MacArthur Story Stem Battery (MSSB), are particularly adapted to gain a better understanding of young children's self-regulation processes. To explore the emotion regulation competencies of sexually abused preschoolers, we developed a coding grid and undertook a detailed analysis of abused and non-abused children's narratives using the MSSB. A sample of 62 sexually abused and 65 non-abused preschoolers 3½ to 6½ years old was recruited and children were presented with nine stories and an expressive vocabulary test. Analyses were performed to compare abused and non-abused children's narratives and to assess the contribution of CSA to children's narratives. CSA was associated with fewer demonstrations of empathy, help, and comfort, and less coherent and resolved stories. The narratives of CSA victims also included less emotions and emotional variations. The influence of CSA appeared the strongest in the stories involving fear. These findings suggest the presence of emotion dysregulation among sexually abused preschoolers, but also insecure attachment, and a sense of betrayal, isolation, and powerlessness.

Core Interpersonal Patterns in Complex Trauma and the Process of Change in Psychodynamic Therapy: A Case Comparison Study

We performed a case comparison study to investigate the nature of interpersonal patterns in childhood trauma and the process of change therein. We analyzed three matching cases of childhood trauma that followed a psychodynamic treatment via a mixed-methods design. We found that (1) the core tendency to avoid negative reactions from others through passive behaviors emerged in all three cases, both in childhood and adulthood, (2) core interpersonal patterns transpired in the interaction between patient and therapist and thereby affected the therapeutic relationship, and (3) change ensued when a repetition of core interpersonal patterns was avoided and a new relational experience occurred. The accumulated findings across cases further resulted in several clinical implications and recommendations, such as the importance of the assessment of patients' (covert) conditions, responsiveness, supervision and facilitating patients' agency, and provided several avenues for further research.

Psychopathology among adult survivors of child pornography

BACKGROUND

The majority of studies investigating child pornography have focused on conceptualizing the problem and the harm of the crime, evaluating the risk for child pornography offending, or discuss preventive measures. Little is known about survivors of this type of crime.

OBJECTIVE

This research explores the relationship between child pornography victimization and psychopathology in adulthood. Specifically, we examined the contribution of emotional reactions at the time of the crime and shortly after (guilt, embarrassment and avoidance) on psychopathology among adult survivors of child pornography.

PARTICIPANTS AND SETTING

The study was conducted among 107 child pornography adult survivors, aged 18-63 (M = 39.48, SD = 12.31). All participants were sexually molested during the crime.

METHODS

An online survey was completed by a convenience sample of adult survivors of child pornography.

RESULTS

Findings indicate survivor's current age predicted current psychopathology symptoms. Survivor's emotional reactions of guilt and embarrassment at the time of the crime and shortly after were significantly associated with elevated psychopathology, above and beyond demographic characteristics and features of the crime.

CONCLUSIONS

The present results suggest the way survivors of child pornography react to the crime might shape their mental health in the long term.

A scoping review of adult survivors' experiences of shame following sexual abuse in childhood

Shame following childhood sexual abuse (CSA) can be intensely painful and destructive to one's sense of self and place in the world. Organised around an internalised core belief of worthlessness, extreme shame presents as a major therapeutic challenge in therapy with many CSA survivors. A range of clinical and empirical literature, alongside recounts of survivors lived experience, shows that shame is an effect of CSA for many survivors. Yet research has rarely focused specifically on survivors' qualitative or lived experiences of shame. This article reports the results of a scoping review of the empirical research investigating adult survivors' experiences of shame following sexual abuse in their childhood. Conducted in March 2018, the search strategy involved on-line searches of English language, peer review and select grey literature repositories for articles published up to the end of 2017. Of the 28 peer reviewed studies included in the review, only three studies specifically investigate adult survivors lived experiences of shame. The synthesised findings from the studies identify five themes demonstrating the pervasive and detrimental influence of shame following CSA: (1) Psychological effects and trauma symptoms; (2) Relationships and social connections and disconnections; (3) Disclosure; (4) Self concept; and, (5) The process of recovery. These findings resonate with conceptual literature and broader research on the influence of shame following violence and highlight areas for future research and clinical practice. This scoping review identifies three key gaps: a need for further research across specific populations and groups; research evaluating therapeutic interventions responding to shame; and research that specifically investigates adult survivors' lived experiences of shame following CSA.

Quality not quantity: loneliness subtypes, psychological trauma, and mental health in the US adult population

PURPOSE

Loneliness is a recognised public-health concern that is traditionally regarded as a unidimensional construct. Theories of loneliness predict the existence of subtypes of loneliness. In this study, latent class analysis (LCA) was used to test for the presence of loneliness subtypes and to examine their association with multiple mental health variables.

METHODS

A nationally representative sample of US adults (N = 1839) completed the De Jong Gierveld Loneliness Scale, along with self-report measures of childhood and adulthood trauma, psychological wellbeing, major depression, and generalized anxiety.

RESULTS

When treated as a unidimensional construct, 17.1% of US adults aged 18-70 were classified as lonely. However, the LCA results identified four loneliness classes which varied quantitatively and qualitatively: 'low' (52.8%), 'social' (8.2%), 'emotional' (26.6%), and 'social and emotional' (12.4%) loneliness. The 'social and emotional' class were characterised by the highest levels of psychological distress, followed by the 'emotional' class. The 'social' loneliness class had similar mental health scores as the 'low' loneliness class. Childhood and adulthood trauma were independently related to the most distressed loneliness classes.

CONCLUSIONS

Current findings provide support for the presence of subtypes of loneliness and show that they have unique associations with mental health status. Recognition of these subtypes of loneliness revealed that the number of US adults aged 18-70 experiencing loneliness was twice as high as what was estimated when loneliness was conceptualized as a unidimensional construct. The perceived quality, not the quantity, of interpersonal connections was associated with poor mental health.

Impact of maltreatment on depressive symptoms in young male adults: The mediating and moderating role of cortisol stress response and coping strategies

BACKGROUND

Converging evidence suggests that maltreated children suffer from depression at an early age and experience recurrent episodes of depression that persist over longer periods of time. However, the stress-related mechanisms hypothesized to be implicated in these associations remain to be specified. The present study tested the mediating and moderating roles of acute cortisol response to stress and coping strategies in the association between child maltreatment and depressive symptoms in early adulthood.

METHODS

Data from 156 men aged 18 to 35 years (n = 56 maltreated) were collected using self-reported questionnaires assessing child maltreatment, depressive symptomatology and coping strategies. Cortisol was measured in response to the "Trier Social Stress Test" (TSST).

RESULTS

Although acute cortisol response to stress did not mediate the maltreatment-depressive symptoms association, a moderation effect was found. Child maltreatment was associated with higher risk of depressive symptoms among participants with a higher cortisol response to stress, but not for those with moderate-to-lower cortisol responses. Additionally, maltreated participants reported more depressive symptoms, an association that was partly explained by their higher use of emotion-oriented coping (mediation). Finally, maltreated individuals who reported using less task-oriented coping had greater depressive symptomatology than those who adopted this coping strategy more frequently (moderation).

CONCLUSION

These findings extend prior work examining the role of the hypothalamic-pituitary-adrenal (HPA) axis in the etiology of depression. The results draw attention to coping strategies, in addition to acute cortisol response to stress, as potential targets for mitigating the onset of depressive symptoms in adults maltreated as children.

The Role of Maternal Relationship in the Persisting Effect of Combat Exposure

Background and Objectives

The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans.

Research Design and Methods

Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association.

Results

We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS—relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship.

Discussion and Implications

Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.

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.

Profiles of childhood trauma and psychopathology: US National Epidemiologic Survey

PURPOSE

Childhood trauma may increase vulnerability to numerous specific psychiatric disorders, or a generalised liability to experience dimensions of internalising or externalising psychopathology. We use a nationally representative sample (N = 34,653) to examine the long-term consequences of childhood trauma and their combined effect as predictors of subsequent psychopathology.

METHODS

Data from the US National Epidemiologic Survey on Alcohol and Related Conditions were used. Latent class analysis was used to identify childhood trauma profiles and multinomial logistic regression to validate and explore these profiles with a range of associated demographic and household characteristics. We used Structural Equation Modelling to substantiate initial latent class analysis findings by investigating a range of mental health diagnoses. Internalising and externalising domains of psychopathology were regressed on trauma profiles and associated demographic and household characteristics. We used Differential Item Functioning to examine associations between the trauma groups and a number of psychiatric disorders within internalising and externalising dimensions of mental health.

RESULTS

We found a 3-class model of childhood trauma in which 85% of participants were allocated to a low trauma class; 6% to a multi-type victimization class (reporting exposures for all the child maltreatment criteria); and 9% to a situational trauma class (exposed to a range of traumas). Confirmatory Factor Analysis revealed an internalising-externalising spectrum was used to represent lifetime reporting patterns of mental health disorders. Both trauma groups showed specific gender and race/ethnicity differences, related family discord and increased psychopathology. Additionally, we found significant associations between the trauma groups and specific diagnoses within the internalising-externalising spectrum of mental health.

CONCLUSIONS

The underlying patterns in the exposure to types of interpersonal and non-interpersonal traumas and associated mental health highlight the need to screen for particular types of childhood traumas when individuals present with symptoms of psychiatric disorders.

Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel

BACKGROUND

The current study sought to advance the existing literature by providing the first assessment of the factorial and discriminant validity of the ICD-11 proposals for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in a nationwide level.

METHODS

A nationally representative sample from Israel (n = 1,003) using a disorder-specific measure (ITQ; International Trauma Questionnaire) in order to assess PTSD and CPTSD along with the Life Events Checklist and the World Health Organization Well-Being Index.

RESULTS

Estimated prevalence rates of PTSD and CPTSD were 9.0 and 2.6%, respectively. The structural analyses indicated that PTSD and disturbances in self-organization symptom clusters were multidimensional, but not necessarily hierarchical, in nature and there were distinct classes that were consistent with PTSD and CPTSD.

CONCLUSIONS

These results partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in a nationally representative sample using a disorder-specific measure; findings also supported the international applicability of these diagnoses. Further research is required to determine the prevalence rates of PTSD and CPTSD in national representative samples across different countries and explore the predictive utility of different types of traumatic life events on PTSD and CPTSD.

Understanding sexual assault risk perception in college: Associations among sexual assault history, drinking to cope, and alcohol use

INTRODUCTION

Sexual assault history and alcohol use are associated with higher likelihood of subsequent sexual assault. Alcohol use and drinking to cope are associated with re-assault, but it is unclear whether these factors are associated with malleable constructs like sexual assault risk perception. This study examined typical weekly drinking and drinking to cope motive as factors underlying the association between sexual assault history and risk perception.

METHODS

Both perceived likelihood of experiencing incapacitated sexual assault and when to leaving a hypothetical sexual assault scenario were assessed as indicators of sexual assault risk perception. 660 female college students recruited from psychology courses completed questionnaires online.

RESULTS

Results revealed that sexual assault history severity was positively associated with perceived incapacitated sexual assault likelihood and when to leave a risky scenario. Drinking to cope with anxiety was positively associated with perceived incapacitated sexual assault likelihood. Among women who reported regular drinking, typical weekly drinking was positively associated with when to leave a risky scenario, such that women who reported more weekly drinks stayed in a potentially risky scenario longer than women who reported fewer weekly drinks.

CONCLUSIONS

These findings suggest that alcohol use and drinking to cope with anxiety are associated with risk perception. Sexual assault history was associated with both perceived incapacitated sexual assault likelihood and when to leave a hypothetical scenario. Alcohol use and drinking to cope are two potential points of intervention for sexual assault risk reduction programs, but further examination is needed.

The impacts of institutional child sexual abuse: A rapid review of the evidence

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse.