Childhood sexual abuse and current suicidality in college women and men

Implications of Increased Trait Impulsivity on Psychopathology and Experienced Stress in the Victims of Early Trauma With Suicidality

There is a paucity of research characterizing suicide-related factors in victims of early trauma (ET). This cross-sectional study investigated an increase in trait impulsivity of ET victims with suicidal ideation or behavior and its role in severity of psychopathologies and experienced stress. Using data of 401 Korean suicidal ideators and attempters, trait impulsivity, severity of psychopathologies, and stress levels in addition to sociodemographic and clinical characteristics were compared between the ET group and the no ET group. Three first-order factors of trait impulsivity measured in Barratt Impulsive Scale-11 (cognitive instability, motor, and [lack of] perseverance) as well as depression, anxiety, overall stress level, and stress from social relationships were significantly elevated in the ET group. Owing to the long-lasting neurobiological influences of ET, it is recommended clinically that victims be carefully monitored for the development of mental distress, such as depression and anxiety, even in adulthood.

Medically unexplained symptoms in patients with PNES: Do they explain poor employment outcome in patients with good seizure outcomes?

BACKGROUND

Many patients with psychogenic nonepileptic seizures (PNES) have other medically unexplained symptoms (MUS). In order to assess their long-term contribution to ill-health and unemployment, we recorded MUS, employment, healthcare utilization, and seizure outcomes in a cohort of patients with PNES.

METHODS

We had complete computerized healthcare records and employment information in 120 patients with PNES, 5-10years postdiagnosis. We analyzed these data to assess the contribution of MUS to ill-health and to determine whether MUS could explain differences among seizure, employment, and healthcare utilization outcomes in PNES.

RESULTS

At 5-10years, 41/120 patients (34.2%) were attending primary or secondary care for seizures, 42/120 patients (35.0%) had MUS other than PNES, and 36/120 patients (30.0%) were employed. Unemployment was predicted by age at presentation (OR: 0.90 (0.86-0.94), p<0.001), presenting to primary or secondary care with seizures (OR: 0.16 (0.05-0.52), p=0.003), and contact with psychiatric services at 5-10years (OR: 0.16 (0.05-0.58), p=0.005). No outcome measures were predicted by additional MUS, though MUS themselves were predicted by psychiatric contact (OR: 2.27 (1.01-5.01), p=0.048).

CONCLUSIONS

Our data suggest that MUS do not contribute independently to unemployment in the population with PNES, whereas psychiatric morbidity appears to do so. Nonetheless, MUS and psychiatric morbidity persist in the long term in a substantial minority of patients with PNES. We found no evidence that seizures in patients whose PNES have resolved are replaced with other MUS.

Association between childhood adversities and long-term suicidality among South Africans from the results of the South African Stress and Health study: a cross-sectional study

OBJECTIVE

Suicide and suicidal behaviours are significant public health problems and a leading cause of death worldwide and in South Africa. We examined the association between childhood adversities and suicidal behaviour over the life course.

METHODS

A national probability sample of 4351 South African adult participants (aged 18 years and older) in the South African Stress and Health (SASH) study was interviewed as part of the World Mental Health Surveys initiative. Respondents provided sociodemographic and diagnostic information, as well as an account of suicide-related thoughts and behaviours. Suicidality or suicidal behaviour were defined as were defined as suicide attempts and suicidal ideation in the total sample, and suicide plans and attempts among ideators. Childhood adversities included physical abuse, sexual abuse, parental death, parental divorce, other parental loss, family violence, physical illness and financial adversity. The association between suicidality and childhood adversities was examined using discrete-time survival models.

RESULTS

More than a third of the respondents with suicidal behaviour experienced at least one childhood adversity, with physical abuse, parental death and parental divorce being the most prevalent adversities. Physical abuse, sexual abuse and parental divorce were identified as significant risk markers for lifetime suicide attempts, while physical abuse and parental divorce were significantly correlated with suicidal ideation. Two or more childhood adversities were associated with a twofold higher risk of lifetime suicide attempts. Sexual abuse (OR 9.3), parental divorce (OR 3.1) and childhood physical abuse (OR 2.2) had the strongest associations with lifetime suicide attempts. The effect of childhood adversities on suicidal tendencies varied over the life course. For example, sexual abuse was significantly associated with suicide attempts during childhood and teen years, but not during young and later adulthood.

CONCLUSIONS

Childhood adversities, especially sexual abuse, physical abuse and parental divorce, are important risk factors for the onset and persistence of suicidal behaviour, with this risk being greatest in childhood and adolescence.

Childhood sexual abuse and the development of recurrent major depression in Chinese women

BACKGROUND

Our prior study in Han Chinese women has shown that women with a history of childhood sexual abuse (CSA) are at increased risk for developing major depression (MD). Would this relationship be found in our whole data set?

METHOD

Three levels of CSA (non-genital, genital, and intercourse) were assessed by self-report in two groups of Han Chinese women: 6017 clinically ascertained with recurrent MD and 5983 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.

RESULTS

We confirmed earlier results by replicating prior analyses in 3,950 new recurrent MD cases. There were no significant differences between the two data sets. Any form of CSA was significantly associated with recurrent MD (OR 4.06, 95% confidence interval (CI) [3.19-5.24]). This association strengthened with increasing CSA severity: non-genital (OR 2.21, 95% CI 1.58-3.15), genital (OR 5.24, 95% CI 3.52-8.15) and intercourse (OR 10.65, 95% CI 5.56-23.71). Among the depressed women, those with CSA had an earlier age of onset, longer depressive episodes. Recurrent MD patients those with CSA had an increased risk for dysthymia (OR 1.60, 95%CI 1.11-2.27) and phobia (OR 1.41, 95%CI 1.09-1.80). Any form of CSA was significantly associated with suicidal ideation or attempt (OR 1.50, 95% CI 1.20-1.89) and feelings of worthlessness or guilt (OR 1.41, 95% CI 1.02-2.02). Intercourse (OR 3.47, 95%CI 1.66-8.22), use of force and threats (OR 1.95, 95%CI 1.05-3.82) and how strongly the victims were affected at the time (OR 1.39, 95%CI 1.20-1.64) were significantly associated with recurrent MD.

CONCLUSIONS

In Chinese women CSA is strongly associated with recurrent MD and this association increases with greater severity of CSA. Depressed women with CSA have some specific clinical traits. Some features of CSA were associated with greater likelihood of developing recurrent MD.

Factors from Durkheim's family integration related to suicidal ideation among men with histories of child sexual abuse

Men who were sexually abused during childhood represent a highly stigmatized, marginalized population at risk for a variety of long-term mental health problems. Using the family integration dimension of Durkheim's theory of suicide, factors associated with suicidal ideation among a purposive sample of 487 men with histories of child sexual abuse were examined. Four variables--length of cohabitation, maternal support after disclosure, parental divorce, and older age--were negatively related to suicidal ideation. The analysis provides partial support for Durkheim's model. Implications for education, clinical practice, and future research are presented.

Family environment, personality, and psychological symptoms in adults sexually abused as children

The current study examined the relationships between family environment characteristics, personality traits, and current psychological symptoms in adults with a history of child sexual abuse. Family environment characteristics, personality traits, and psychological symptoms in 18 abused and 18 nonabused college students were examined using ANOVAs and MANOVAs. Pearson product moment correlations were also performed. Results indicated significantly more dysfunctional family environment characteristics (inflexibility, poor cohesion, family dissatisfaction, and poor family communication) in the abused versus the nonabused group. There were significantly higher levels in the personality traits of neuroticism and openness to experience in the abused group; however, there were no significant differences in psychological symptoms when comparing the two groups. The implications of the results and areas of future research are discussed.

Risk for suicidal thoughts and behavior after childhood sexual abuse in women and men

Earlier studies have found an elevated risk for psychopathology and suicidal behavior associated with childhood sexual abuse (CSA); however, the degree to which risk is mediated by depression and posttraumatic stress disorder (PTSD) in women and men remains unclear. We examined these issues in data from a family study of childhood maltreatment (N = 2,559). We found significant CSA-associated risk for depression, PTSD, and suicidal behavior for women and men. In survival analyses controlling for these disorders, we observed persistent but somewhat reduced CSA-associated risk for suicidal ideation and suicide attempt. Our findings suggest that these disorders partially mediate CSA-associated risk.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Population-attributable risk of childhood sexual abuse for symptoms of depression and suicidal ideation in adulthood

Objective. The aim of the study was to assess the population-attributable risks (PAR) of childhood sexual abuse (CSA) for depressive symptoms and suicidal ideation in adulthood. Method. A total of 2501 adult participants were randomly recruited and interviewed using a computer-assisted telephone interviewing system. They responded to items designed to assess depressive symptoms (SF-12), suicidal ideation (GHQ-28), and other distressing events, including CSA, as part of a broader, mental health survey of the South Australian population. Results. Logistic regression analyses indicated that CSA was associated with both depressive symptoms and suicidal ideation. However, PAR estimates indicated that only 0.8% of depressive symptoms could be attributed to CSA. Similarly, only 2.2% of suicidal ideation in the population could be attributed to CSA. Conclusions. Notwithstanding the individual distress associated with CSA, a population perspective indicated that the impact of CSA in adulthood was not as great as one might interpret from media reports.

Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism

We examined the relation between child maltreatment and non-suicidal self-injury (NSSI). Participants were 86 adolescents who completed measures of child maltreatment, self-criticism, perceived criticism, depression, and NSSI. Analyses revealed significant, small-to-medium associations between specific forms of child maltreatment (physical neglect, emotional abuse, and sexual abuse) and the presence of a recent history of NSSI. Emotional and sexual abuse had the strongest relations with NSSI, and the data supported a theoretical model in which self-criticism mediates the relation between emotional abuse and engagement in NSSI. Specificity for the mediating role of self-criticism was demonstrated by ruling out alternative mediation models. Taken together, these results indicate that several different forms of childhood maltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associated with NSSI. Future research is needed to test the temporal relation between maltreatment and NSSI and should aim to identify additional pathways to engagement in NSSI.

Childhood sexual abuse: a gender perspective on context and consequences

Literature on gender and child sexual abuse (CSA) has highlighted patterns of similarity and difference among survivors and the need for further research. This study relied on gender analysis of 128 women and 69 men, obtained through an examination of childhood hospital records, to further examine gender differences in mental health outcomes among abuse survivors and correlates of mental health outcomes including professional help seeking, family environment, and other trauma exposure. Overall, men and women were similar in the context and consequences of CSA. The role of the characteristics of CSA and contextual variables in explaining variance in mental health for 106 male victims and nonvictims was also examined. Among male participants, number of incidents of sexual abuse, injury at the hands of a caregiver, and exposure to other traumas significantly explained higher levels of an array of mental health symptoms. Implications for future research are discussed.

Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?

OBJECTIVE

Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior.

METHOD

Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule.

RESULTS

The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated.

CONCLUSION

Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.

History of childhood abuse in Portuguese parents

OBJECTIVE

The study examines the self-reported prevalence of childhood physical and sexual abuse in a large sample of Portuguese parents.

METHOD

Nearly 1,000 parents (506 mothers and 426 fathers) were selected through public primary schools from the Northern area of Portugal. All completed the Portuguese version of the Childhood History Questionnaire (CHQ) [Journal of Family Violence 5 (1990) 15].

RESULTS

Results show that the prevalence of abuse was 73%, but more severe physical abuse involving sequelae/injury was reported by 9.5%. Most physical abuses began prior to age 13, with half continuing after age 13. No gender differences were found for rates of physical abuse. However, among the milder physical abuse without sequelae/injury, those women who experienced "whipping" or "slapping/kicking" were more likely to do so from their mothers than fathers. Among men who were "slapped/kicked" this was more likely to be from their fathers. Low rates of sexual abuse were found at 2.6% with no gender or age differences. Lack of a supportive adult in childhood related to the more severe abuses, but only in adolescence. Portuguese rates of abuse were consistently lower than those reported in USA and Spanish studies using the CHQ.

CONCLUSIONS

This is the first retrospective, self-report study of childhood abuse in a large sample of Portuguese parents and, even with a participation rate of 69%, shows lower rates than in US and Spanish samples.

Childhood maltreatment and college students' current suicidal ideation: a test of the hopelessness theory

Few studies have examined the relation between childhood maltreatment and adult suicidality within the context of a coherent theoretical model. The current study evaluates the ability of the hopelessness theory of depression's (Abramson, Metalsky, & Alloy, 1989) etiological chain to account for this relation in a sample of 297 undergraduates. Supporting the model, emotional, but not physical or sexual, maltreatment was uniquely related to average levels of suicidal ideation across a 2.5-year follow-up. Further, students' cognitive styles and average levels of hopelessness partially mediated this relation. Although these results cannot speak to causality, they support the developmental model evaluated.

The association between suicidal ideation and childhood and adult victimization

Despite the burgeoning literature on suicidal behavior, there are meager data available on the relationship between suicidal ideation and emotional abuse in childhood; adult physical or sexual victimization; and adult re-victimization in those with a history of childhood maltreatment. This study addressed these gaps in the literature. In a sample of 494 female undergraduates, current suicidal ideation was assessed dichotomously using an item from the SCL-90 and victimization was assessed retrospectively with validated multi-item measures. Analyses revealed an association between suicidal ideation and emotional and physical abuse in childhood and a history of partner violence. No relationship was found between childhood sexual abuse or forced sex in adulthood and suicidal ideation. Additionally, results of multiple logistic regression analyses did not support the hypothesis that the relationship between childhood victimization and SI is moderated by re-victimization in adulthood.

The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998)

B. Rind, P. Tromovitch, and R. Bauserman (1998) examined the long-term effects of childhood sexual abuse (CSA) by meta-analyzing studies of college students. The authors reported that effects "were neither pervasive nor typically intense" and that "men reacted much less negatively than women" (p. 22) and recommended value-neutral reconceptualization of the CSA construct. The current analysis revealed numerous problems in that study that minimized CSA-adjustment relations, including use of a healthy sample, an inclusive definition of CSA, failure to correct for statistical attenuation, and misreporting of original data. Rind et al.'s study's main conclusions were not supported by the original data. As such, attempts to use their study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings.

Suicide risk following child sexual abuse

OBJECTIVE

To determine the suicide rate and prevalence of suicide attempts and suicidal ideation in 183 young people who had experienced child sexual abuse and to examine variables related to the abuse, which may correlate with suicide attempts or suicidal ideation.

METHODS

Adolescents and young adults who had experienced child sexual abuse and individuals from a nonabused comparison group were asked about suicide attempts and suicidal ideation 5 and 9 years after intake to the study. Nine years after the abuse, a national death search was carried out to ascertain the number and causes of death in the 2 groups. Logistic regression was used to assess information on demographic and family functioning variables, the sexual abuse, notifications for other child abuse, criminal convictions, and out-of-home placements that were related to the outcome variables.

RESULTS

Young people who had experienced child sexual abuse had a suicide rate that was 10.7 to 13.0 times the national Australian rates. There were no suicides in the control group. Thirty-two percent of the abused children had attempted suicide, and 43% had thought about suicide since they were sexually abused.

CONCLUSIONS

Little information seems to be available to clinicians at the time of investigations for child sexual abuse in children that may identify those who are at increased risk of suicide. Abuse by an acquaintance, parental denial, or being angry with the child and not the abuser may predispose to suicide attempts but not necessarily to a completed suicide.

Outcomes of child sexual contacts: patterns of incarcerations from a national sample

OBJECTIVE

In a test of the relationships between sexual touching before puberty and later incarcerations during adolescence and adulthood, two theoretical models were examined. These models focus on examination of crime from the developmental origins of criminals and the adaptive and maladaptive outcomes of early experiences.

METHOD

Data were taken from the National Health and Social Life Survey to study the sexual touching and social origin variables in childhood and incarceration variable during teen years. The sample was a stratified, random sample of 3,362 adults (18 to 59 years of age) throughout the United States.

RESULTS

Data support inferences from the two interrelated models. Respondents reporting touching before puberty were significantly more likely to experience incarceration. They were also more likely to engage in behaviors as teenagers that were associated with an increased probability of jailing. Such behaviors include sexual promiscuity and early departure from the parental family.

CONCLUSIONS

These findings are consistent for first jailing as a teenager and as an adult, as well as for those with short (less than a week) or longer (a week or more) spells of incarceration. Prepubertal sexual touching has a significant and enduring effect on later adolescent and adult incarcerations.

Suicide in women

This article reviews research into suicide in women during the last 25 years. National rates vary between the extremes of 19/10(5) per year in Sri Lanka and < 1/10(5) per year in the Philippines and Egypt, but almost everywhere rates for women are much lower than male rates, with a median ratio of 2.8/1. The exceptions are in India and China, which report higher rates in young married women. The reproductive process has some influence. While menstruation, hormonal treatment, pregnancy and the puerperium have no major effect, unwanted pregnancy may still lead to suicide under certain circumstances, and severe labour can occasionally do so. Having children protects, but the relative risk is no more than 2.0 in nulliparous women. Social factors also have a limited effect. There are higher rates of suicide in divorced women, but the evidence on widowhood is equivocal. Prosperity and employment have no effect. Sexual abuse, rape and domestic violence undoubtedly lead to suicide attempts, but the evidence on completed suicide is lacking. There are many unanswered questions, especially why rates of completed suicide for women (with a greater prevalence of overt depression) are lower than for men, and why Chinese and Indian women have higher rates. More research is required, especially from developing nations.

History of physical and/or sexual abuse and current suicidality in college women

OBJECTIVE

The purpose of this study was to examine the relationship between a history of physical and/or sexual abuse and current suicidality in college-age women. It was hypothesized that abuse history would significantly predict level of suicidality. A secondary hypothesis was that abuse status would predict attitudes about life and death.

METHOD

Female college students (n = 707) were screened for histories of childhood (before age 15) and adulthood (after age 15) contact sexual abuse and physical abuse sequelae. Ninety-five women reported a history of childhood sexual abuse, 116 adult sexual abuse, 104 child physical abuse, and 55 adult physical abuse. Participants completed measures of attitudes about life and death and current suicidal ideation.

RESULTS

Child physical abuse and child sexual abuse accounted for variance in current suicidal ideation. Adult sexual abuse explained variance in positive attitudes about life. Adult physical abuse, adult sexual abuse, and child sexual abuse accounted for variance in negative attitudes about life. Finally, child sexual abuse and adult sexual abuse accounted for variance in fear of death.

CONCLUSIONS

Detailed assessment of female college students' abuse histories should facilitate understanding of their level of suicide risk. Patterns of attitudes about life and death may also be informative.

Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients

The aim of this study was to assess relative risk of histories of different types of abuse (sexual, physical, and emotional) and neglect (physical and emotional) for suicidal behavior (attempts, ideation, and self-mutilation) in psychiatrically hospitalized adolescents. Seventy-one adolescent inpatients (34 boys, 37 girls) completed self-report measures of abuse and neglect, current suicidal ideation, and lifetime suicide and self-mutilation attempts. The prevalence of sexual and physical abuse was 37.5% and 43.7%, respectively, with 31.3% and 61% of youngsters reporting emotional and physical neglect. Fifty-one percent of youngsters had made suicide attempts, and 39% had self-mutilated. Suicide attempters were significantly more likely to be female, Latino, to report sexual, physical, and emotional abuse, and to endorse emotional neglect. In multivariate analyses, female gender, sexual abuse, and emotional neglect remained significant predictors of self-mutilation and suicidal ideation. Female gender and sexual abuse remained significant predictors of suicide attempts. These findings suggest that emotional neglect is an important and deleterious component of maltreatment experiences and may be a more powerful predictor of suicidal behavior in hospitalized adolescents than physical abuse, emotional abuse, and physical neglect.

Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.

Type and severity of child abuse and college students' lifetime suicidality

OBJECTIVE

The present study compared reported histories and severity of child sexual abuse, child physical abuse, and both, in college men and women.

METHOD

Four hundred and eighty-six consenting undergraduates completed measures of suicidality, sexual abuse (SA), and physical abuse (PA). Based on their responses, they were categorized into 12 mutually exclusive groups: no PA/no SA (n = 234), moderate PA/no SA (n = 78), severe PA/no SA (n = 34), no PA/mild SA (n = 21), moderate PA/mild SA (n = 12), severe PA/mild SA (n = 5), no PA/moderate SA (n = 20), moderate PA/moderate SA (n = 15), and severe PA/moderate SA (n = 10).

RESULTS

Participants who reported both severe sexual and severe physical abuse reported more lifetime suicidality than participants who reported either mild sexual and/or physical abuse. Those who reported sexual abuse involving invasive sexual acts such as rape, and physical abuse involving behaviors that resulted in physical injury to the child, were more suicidal than those who reported less severe abuse. In addition, although combined sexual and physical abuse correlated with increased suicidality, unexpectedly, there was no interaction. Finally, women students endorsed more reasons for living than men and about the same level of suicidal ideas and global suicidality, despite a greater likelihood of having been abused.

CONCLUSIONS

The absence of an interaction between sexual and physical abuse suggests that this increased suicidality is additive rather than multiplicative. An implication is that college counseling personnel need to be aware of the suicidal risk of women and men students reporting either sexual or physical abuse.

Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse

OBJECTIVE

The aims of this study were to identify the factors which discriminated young people exposed to childhood sexual abuse (CSA) who developed psychiatric disorder or adjustment difficulties in young adulthood from those young people exposed to CSA who did not develop psychiatric disorder or adjustment difficulties by age 18.

METHOD

Data were gathered on a birth cohort of 1,025 New Zealand children studied from birth to the age of 18 on (a) exposure to CSA; (b) patterns of psychiatric disorder and adjustment difficulties at age 18 years; (c) factors that may have influenced responses to CSA including characteristics of the abuse, parental bonding, parental characteristics, and adolescent peer affiliations.

RESULTS

Just over 10% of the cohort reported CSA. Those reporting CSA were at increased risks of a range of difficulties at age 18 (depression, anxiety, conduct disorder, alcohol abuse/dependence, other substance abuse/dependence, post sexual abuse trauma, attempted suicide). However, not all of those exposed to CSA developed difficulties and approximately a quarter of those exposed to CSA did not meet criteria for any adjustment difficulty. Further analysis suggested that the extent of adjustment difficulties in those exposed to CSA was influenced by two additional factors: (a) the extent of affiliations with delinquent or substance using peers in adolescence; and (b) the extent of paternal care or support in childhood.

CONCLUSIONS

The findings of this study suggest that while young people exposed to CSA are at increased risks of psychiatric disorder and adjustment difficulties in young adulthood, not all individuals exposed to CSA will develop adjustment difficulties. Important factors protecting against the development of adjustment difficulties in young people experiencing CSA appear to be the nature and quality of peer and family relationships.

Child sexual abuse and emotional and behavioral problems in adolescence: gender differences

OBJECTIVE

To compare sexually abused boys with sexually abused girls and with their non-sexually abused counterparts with regard to (1) the type of mental health problems they experience; and (2) the number and patterns of such problems.

METHOD

The sample comprised 745 secondary school students, aged 12 to 19 years, with a self-reported history of sexual abuse (151 boys and 594 girls) and 745 matched students without such a history. Sexually abused and non-sexually abused boys and girls were compared with regard to four problem categories: emotional problems, aggressive/criminal behaviors, addiction-risk behaviors, and suicidality.

RESULTS

A larger proportion of sexually abused adolescents than nonabused adolescents reported problems in the separate categories and in a combination of problem categories. Sexually abused boys had considerably more emotional and behavioral problems, including suicidality, than their female counterparts. There were differences between the specific combinations of problem categories reported by sexually abused girls and boys. These differences could not be attributed to the finding that sexually abused boys were more often the victim of concurrent physical abuse than sexually abused girls.

CONCLUSIONS

The results suggest that although there was a strong association between being sexually abused and the existence of a multiple problem pattern in both sexes, the aftermath for boys might be even worse or more complex than for girls.

Suicidality, hopelessness, and attitudes toward life and death in clinical and nonclinical adolescents

To see if hopelessness and four attitudes (attraction to life and death and repulsion by life and death) account for the development of suicidality in children, 15 adolescent psychiatric inpatients and 84 middle and high school students, average age 15.2 years, took a four-item version of the Suicidal Behaviors Questionnaire, the Hopelessness Scale for Children (HSC), and the Multi-Attitude Suicide Tendency Scale for Adolescents (MAST-A). Profiles on the four attitudes differentiated adolescents at risk for suicide from those not at risk. Suicidality was negatively related to Attraction to Death and positively related to Repulsion by Life, Attraction to Death, Repulsion by Death, and hopelessness. Hopelessness was negatively related to Attraction to Life, and positively related to Repulsion by Life and Repulsion by Death. The best predictors of suicidality were hopelessness and Repulsion by Life. Results imply that reducing feelings of rejection by their families might lessen suicidality in adolescents.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Psychometric properties of the Suicidal Behaviors Questionnaire

In order to assess the reliability and validity of Cole's (1988) four-item version of the Suicidal Behaviors Questionnaire (SBQ), 57 clinical outpatients completed it and the Reasons for Living Inventory (RFL), and 86 undergraduates completed it and the Scale for Suicide Ideation (SSI). Two weeks later, 30 undergraduates completed the SBQ again. Cronbach alphas were moderate (clinical sample = .75; nonclinical sample = .80). Test--retest correlations were also significant (r = .95). The SBQ and SSI were significantly correlated (r = .69). The SBQ and RFL were also significantly correlated (r = -.34), although modestly. In view of its moderate to strong reliability, its construct and fact validity, its ease of administration and scoring, and its brevity, the SBQ is recommended as a brief screening instrument for suicidality for researchers and clinicians.